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All orthopaedic surgeons are leaders in the operating room and clinic, and many orthopaedic surgeons choose to pursue other formal leadership roles. Effective leaders are proficient communicators, have high emotional intelligence, have a growth mindset, create structure, and facilitate teamwork. Participating in formal leadership training offered through the American Orthopaedic Association, the American Academy of Orthopaedic Surgeons, or advanced degree programs can facilitate the development of leadership skills. By setting goals, being aware of available leadership positions, and promoting diversity, senior leaders may help orthopaedic faculty to achieve senior leadership roles. Maxwell's leadership hierarchy, which consists of 5 levels of leadership (position, permission, production, people development, and pinnacle), provides a framework for the promotion and mentorship of junior partners by senior leaders. Seeking out and promoting leadership will encourage an environment of leaders and improve the field of orthopaedic surgery. [ABSTRACT FROM AUTHOR]

The outbreak of the novel coronavirus (COVID-19) has resulted in upward of 14 million confirmed cases and >597,000 deaths worldwide as of July 19, 2020. The current disruption in sports activities caused by COVID-19 presents a challenge to physicians, coaches, and trainers in discerning best practices for a safe return to sport. There is a distinct need to develop and adopt consistent measures for resumption of sports activities, including training and competition, in a way that places the health and well-being of athletes at the forefront while also protecting coaches, allied staff, and spectators. This article provides an overview of the effects of COVID-19 in the athletic population and presents considerations for training during the pandemic, as well as guidelines for return to sports as restrictions are lifted. [ABSTRACT FROM AUTHOR]

Orthopaedic specialization has increased substantially over the past several decades, partly due to the desire of residents to improve their clinical expertise and to increase the likelihood that they will obtain a position with better compensation and a more balanced lifestyle. The American Academy of Orthopaedic Surgeons (AAOS) census data support this trend, demonstrating a substantial rise in the percentage of practicing orthopaedic surgeons who identify themselves as specialists rather than as general orthopaedic surgeons. There is a perception that a more narrowed scope of practice may prevent the current orthopaedic workforce from being able to adequately care for populations in rural areas of the United States. Additional consideration should be given to clearly defining the necessary knowledge and skills of a general orthopaedist in the twenty-first century, to understanding their role in musculoskeletal care, and to reevaluating residency educational experiences relative to their ability to prepare graduates to practice general orthopaedics independently. [ABSTRACT FROM AUTHOR]

Background: The Internet is a popular and powerful resource used by both clinicians and patients. However, medical information on the Internet is often unregulated, biased, and of poor quality. Given the frequency of ACL injuries in young women, this topic was used as a case study to examine the information available to patients on the Internet. Methods: An Internet search was performed using the top three general search engines for four different search phrases related to ACL injuries in females. The top ten sites from each search were analyzed on the basis of both website interface and a specific content scoring guide. Results: A total of 35 unique websites were analyzed. The majority of websites were authored by a layperson or had an unidentified author. Readability data indicated that many sites were written at literacy levels that were too difficult for the average reader. Finally, the average content analysis score for all sites was 41.6 out of a possible 100 points (range 10-87.5); only one-third of the websites cited references for the information provided. Conclusions: We found the Internet information on ACL injuries in women to be largely unsupported, outdated and too difficult for the average reader to comprehend. The average site covered less than half of the topics that we considered relevant to ACL injuries in females indicating that information available on the Internet is largely incomplete. Clinical relevance: Clinicians should be aware of the deficiencies in Internet information in order to appropriately address these issues with patients. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to compare tibiofemoral (TF) kinematics and TF compressive stresses between single bundle- (SB-) and double bundle-ACL reconstruction (DB-ACLR) during simulated squatting. Twelve matched pairs of fresh frozen cadaver knees were utilized. A simulated squat through 100° of knee flexion was performed in the ACL-intact joint. The ACL was transected and SB- and DB-ACLR procedures were performed in one knee of each pair. The squat was repeated. Knee kinematics were measured using a motion tracking system and the TF compressive forces were measured using thin film pressure sensors. The posterior shifts of the tibia for SB- and DB-ACLR knees were significantly greater than the ACL-intact condition for knee flexion angles 0° to 40° (p <.05). However, there was no difference between the SB- and DB-ACLR knees at any flexion angle (0° to 100°; p =.37). SB- and DB-ACLR knees had greater IE rotation than intact knees from 90° through 50° of flexion (p <.05), but not between 40° and full extension. There was no difference between SB- and DB-ACLR knees (p =.68). The TF compressive stresses of the DB-ACLR were significantly lower than intact for all angles except 10° (p =.06), whereas SB-ACLR knees did not differ from intact at flexion angles between 30° and 50° (p >.32). There were no significant differences between the two reconstruction conditions (p =.74). This study showed that there was no difference in the TF kinematics or compressive stresses between SB- and DB-ACLR, and only minor differences when compared to the intact state. [Copyright &y& Elsevier]

Background: New techniques are being developed to decrease the failure rate of anterior cruciate ligament (ACL) grafts and prevent revision surgery. One such technique involves high-strength suture tape (ST), also referred to as internal bracing. Recent literature has highlighted the use of ST for ACL reconstruction, but no study has compared ST augmentation between graft types. Purpose: To compare the use of ST augmentation for ACL reconstruction based on the type of graft used (ie, bone–patellar tendon–bone [BPTB], quadriceps, hamstring). Study Design: Systematic review; Level of evidence, 5. Methods: An online search of multiple databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was completed April 2022 to identify studies related to ST augmentation of ACL grafts. Results: Of 926 studies identified, 10 met inclusion criteria. Five studies (50%) used hamstring tendon (HT), 3 (30%) used quadriceps tendon (QT), 1 (10%) used BPTB, and 1 (10%) used both HT and QT grafts. HT autografts augmented with ST had decreased dynamic and peak elongation (15%-56%), increased load to failure, and increased initial and final dynamic stiffness compared with controls. There was no significant difference in postoperative physical examination findings (range of motion, Lachman, pivot shift), except that ST-augmented grafts had significantly less laxity after surgery compared with HT alone (0.8 vs 1.9 mm; P <.05). QT allografts with ST augmentation showed increased graft strength. Human QT autograft studies showed higher Knee injury and Osteoarthritis Outcome Score scores compared with controls. BPTB allografts with ST augmentation had decreased cyclic displacement by 31% (P =.015) and increased load (758 ± 128 N; P <.001) and stiffness (156 ± 23 N/mm; P =.003) compared with nonaugmented groups. The complication rate was low or showed no increase in the ST augmentation groups compared with control groups. Conclusion: HT, QT, and BPTB grafts augmented with ST demonstrate an effective method for ACL reconstruction. All graft types with ST augmentation showed no evidence of clinical disadvantage, with some studies indicating significant biomechanical or clinical advantages compared with conventional ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: An athlete's preexisting psychological factors may influence the incidence and/or severity of sports-related concussions (SRCs). Purpose: To determine if emotional states, personality traits, temperament, life stressors, and explanatory styles (optimism vs pessimism) influence the incidence and severity of SRCs in athletes. Study Design: Systematic review. Methods: A systematic literature search of multiple major medical reference databases was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included that evaluated the effect of preexisting psychological factors on the incidence and severity of SRCs in male and female athletes participating in all sports. Results: The initial search identified 1195 articles. Ten studies met our inclusion criteria and were included in our analysis. Factors such as meanness, aggression, and psychoticism were associated with an increased incidence of SRCs. Baseline traits of irritability, sadness, nervousness, and depressive symptoms were associated with worse symptomatology after SRCs. In young athletes, preexisting psychiatric illnesses, family history of psychiatric illness, and significant life stressors were associated with an increased risk of developing postconcussion syndrome after SRCs. Conclusion: This systematic review demonstrated a potential relationship between an athlete's preexisting psychological factors and the incidence and severity of SRCs. These associations are not entirely clear owing to the heterogeneity across included studies and the low-to-moderate certainty of evidence. Future studies should attempt to evaluate men and women independently, use well-validated psychological questionnaires, and limit the usage of self-reported SRCs, when possible. Furthermore, the potential efficacy of baseline psychological factor and/or symptom reports on the prevention and management of SRCs should be explored. [ABSTRACT FROM AUTHOR]

Objective: Softball players commonly suffer overuse injuries due to the demands of repetitive throwing. The biceps tendon plays an important role in stabilizing the shoulder during the windmill pitch. The purpose of this study was to evaluate the measures used to identify and study biceps tendon pathology in softball players. Design: This was a systematic review. Setting: PubMed MEDLINE, Ovid MEDLINE, and EMBASE were searched. Participants: Studies that investigated biceps tendon injuries in softball players. Interventions: None. Main Outcome Measures: Range of motion (ROM), strength, and visual analog scale data were collected. Results: Of 152 search results, 18 were included. A total of 536 of 705 athletes (76%) were softball players (average age 14-25 years). Five of 18 articles (27.7%) studied changes in external rotation with the shoulder at 90 degrees of abduction, and 4 of 18 (22.2%) studied internal rotation. Two of 18 studies (11.1%) examined ROM or strength changes in forward flexion. Conclusions: While researchers agree that the windmill pitch places significant stress on the biceps tendon, our study finds that the metrics used to evaluate shoulder pathology in these players primarily evaluate the rotator cuff without isolating the biceps tendon. Future studies should include clinical tests and biomechanical metrics more specific to identifying biceps and labral pathology (eg, strength, fatigue, and ROM in glenohumeral forward flexion, elbow flexion, and forearm supination) and attempt to clarify differences in pathology between pitchers and position players to better characterize the frequency and severity of biceps tendon pathology in softball players. [ABSTRACT FROM AUTHOR]

Background: The quadriceps tendon (QT) autograft is a commonly used and effective graft option for anterior cruciate ligament reconstruction (ACLR). Surgical techniques vary, and there is no current standard of care for management of the QT autograft harvest site. Purpose: To examine the literature on patient-reported outcomes and complications after ACLR with a QT autograft and to further clarify the frequency with which the harvest site is closed and potential biomechanical implications. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using multiple medical databases. Level 1 to 4 studies on patients undergoing ACLR with a QT autograft were included. There were 2 independent reviewers who analyzed all studies. Study quality was analyzed using the methodological index for non-randomized studies checklist. Results: Overall, 13 studies with a total of 650 patients were included. The mean patient age for all studies was 31 years (range, 14-59 years) with a mean follow-up of 21.2 months (range, 6-84 months). Of the 13 studies, 12 studies (92%) documented patient sex, comprising 331 female patients (55%) and 274 male patients (45%). There were 8 studies (62%) that reported the use of a bony QT autograft in 273 patients, and 5 studies (38%) reported the use of a soft tissue QT autograft in 377 patients. The graft length harvested was most commonly 7 to 8 cm, while the tendon width harvested was 10 mm. Moreover, 5 studies (38%) did not discuss closure of the harvest site, while 2 studies (15%) only closed the harvest site if a capsular rent was present. The surgical technique for harvest-site closure varied when reported in 7 studies (54%). Good to excellent clinical outcomes were reported in 80% of patients when the harvest site was closed. Conclusion: Based on the results of this study, there is no consensus on whether the QT defect should be closed after harvesting the graft for ACLR. It has been reported that closure of the harvest site is performed if there is a capsular rent present. Several techniques are utilized to close the QT autograft harvest site; however, it is unclear if there is a difference in outcomes based on the technique used. Future studies should further clarify whether there are any biomechanical and clinical advantages to closing the QT autograft harvest site. [ABSTRACT FROM AUTHOR]

Softball is the third most popular women's collegiate sport in the United States, with 19,680 total athletes as of the 2015–2016 season. Despite its popularity and growth in recent years, research focusing on the biomechanics of the windmill pitch and its associated shoulder injuries is relatively scarce. The incidence of shoulder injury is highest during the preseason and the beginning of the regular season. The windmill pitch can be divided into distinct phases, with the shoulder experiencing the greatest force during the delivery phase. Significant demands placed on the shoulder during the windmill pitch put pitchers at a higher risk of developing shoulder injuries than position players. Maximum shoulder compression/distraction forces during the windmill pitch have been shown to be comparable to those experienced during the baseball overhand throw, dispelling the myth that the windmill pitch is not taxing on the shoulder. Injuries associated with the high compression/distraction forces include lesions to the rotator cuff, glenoid labrum, and biceps brachii. Pitcher-specific training, cross-training, and whole-body conditioning should be incorporated into current training regimens to decrease the risk of shoulder injuries. [ABSTRACT FROM AUTHOR]

Injuries caused by road traffic have become the leading cause of death in people aged 5 to 29 years, with pedestrians and cyclists being disproportionately affected. Research has demonstrated age and sex differences in road accidents in European populations. The purpose of this study was to determine age and sex-specific differences in pedestrian and cyclist accidents involving passenger cars at a single Level 1 Trauma Center in a major US metropolitan area. We performed a retrospective chart review of 1,845 patients that presented to a single level 1 trauma center from January 1, 2016 - October 1st, 2021, and were involved in a motor vehicle vs. pedestrian or motor vehicle vs. cyclist accidents. Demographics, injury pattern, abbreviated injury scores (AIS), and hospital stay were analyzed, and the data was stratified by pedestrian vs. cyclist, biological sex, and race. Chi square analysis, t tests, and binomial logistic regression was used to examine sex and age-based differences. Pedestrian vs. motor vehicle collisions (N = 1359, 74%) occurred more frequently than cyclists (N = 475, 26%) with an overall mortality rate of 6%. The mean age of pedestrians and cyclists was 39 and 42 years of age, respectively. Overall, more female than male patients had hand (mean=0.05 vs. 0.02) (p = 0.03) and pelvis fractures (mean 0.28 vs. 0.19) (p = 0.007). Females had a 1.2 times higher likelihood of getting a pelvis fracture than males (95% CI, 1.06 to 1.43). Linear regression analysis found a statistically significant relationship between older age and increased AIS severity (p <.001). Half of our sample consisted of Black patients (49.6% Black vs. 42.1% white). Female pedestrians and cyclists are at increased risk of obtaining pelvis fractures when in a traumatic road accident than males, regardless of age stratification, and age is a predictor of injury severity. Our study also found that race-based differences exist, with Black patients being injured more frequently. Further research is needed to better understand demographics at risk for traumatic road accidents, as well as evaluation of city infrastructure for biking and walking. [ABSTRACT FROM AUTHOR]

An abstract of the article "Evaluation of the Content and Accessibility of Web Sites for Accredited Orthopaedic Sports Medicine Fellowships," by Mary K. Mulcahey, Michelle M. Gosselin, and Paul D. Fadale is presented.

Background: Women residents are underrepresented in orthopaedic surgery. The causes of the deficit of women in orthopaedic surgery are multifactorial, but by identifying the perceptions of women in orthopaedic residency training and comparing them with the perceptions of men, we can improve our understanding of ways to enhance the recruitment of qualified and diverse candidates. Questions/purposes: (1) What differences exist in the perceived experiences of residents identifying as women and men regarding professional, social, and personal interactions during residency training? (2) Are there differences in the percentage of women and men residents who have experienced harassment or discrimination in preresidency interviews, and are there differences in the type of harassment or discrimination experienced? Methods: A survey was generated using Academy of Critical Care: Development, Evaluation, and Methodology guidelines. Two focus groups with seven attending orthopaedic surgeons who participate in the Collaborative Orthopaedic Education Research Group and who are experts on gender diversity in orthopaedics were held to improve survey validity. The survey included binary-response, Likert, and free-text questions on the perception of professional, social, and personal interactions held by the resident being surveyed. The questions focused on a respondent's perception of interactions with staff members, patients, resident colleagues, and attending surgeons, as well as sexual harassment. Program directors at 10 selected Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic residency programs that participate in the Collaborative Orthopaedic Education Research Group shared the survey with residents at their institutions. There were 95 programs in the Collaborative Orthopaedic Education Research Group at the time this survey was distributed. In this program, directors or other interested teaching faculty in orthopaedic residency programs voluntarily participate to discuss and develop quality research on resident and fellow education. These 95 programs account for 46% of the ACGME-accredited programs in the United States at the time the survey was created and distributed. The 10 residency programs had a total of 232 enrolled residents; 15% (34) identified as women. This gender distribution models the national sample of orthopaedic residents. Survey reliability was assessed by calculating the Cronbach alpha after determining the variance in each relevant (nondemographic) survey item. The final survey was found to have excellent internal reliability (alpha = 0.95). Responses from residents identifying as women and those identifying as men were compared using Fisher exact tests for all categorical data, and two-tailed independent t-tests were used for all continuous data. Differences in each survey category (professional interactions, social interactions, personal interactions, and sexual harassment in preresidency interview experiences) were calculated. Results: Women reported experiencing microaggressions (left undefined to the survey respondent, but generally considered to be subtle, stunning, often automatic, and nonverbal exchanges that are "put downs") at work more frequently than men did (40% [six of 15] versus 5% [four of 74]; p < 0.001). Specifically, women perceived being interrupted (53% [eight of 15] versus 5% [four of 75]); p < 0.001) by men colleagues, called by their first name (67% [10 of 15] versus 4% [3 of 72]; p < 0.001), and given administrative tasks (27% [four of 15] versus 1% [one of 75]; p = 0.004) more often than men. More women than men perceived that patients (33% [five of 15] versus 0 of 74 [0%]; p < 0.001) and hospital staff (27% [four of 15] versus 7% [five of 74]; p = 0.01) respected their opinion less than that of men. More women than men perceived that group humor negatively targeted their gender (47% [seven of 15] versus 1% [one of 75]; p < 0.001) and that criticism of their surgical skill was based on their gender rather than their ability (33% [five of 15] versus 5% [four of 78]; p = 0.005). In residency or subinternship interviews, 20% of women reported experiencing sexual harassment as defined by a listing of known types of harassment in the question stem, compared with 0% of men (p = 0.004). Women reported harassment in the form of verbal remarks of a sexual nature and obscene images in the workplace, whereas men did not report any form of harassment during interviews. Conclusion: These findings suggest that the greatest discrepancies in the perceived experiences of women and men residents lie in professional interactions, and women residents are more likely to experience sexual harassment and disparaging humor than men residents. Clinical Relevance: Addressing these discrepancies, particularly in the professional setting, will help to create a more inclusive work environment and attract more women to orthopaedic surgery. Annual distribution of the survey used in this study by program directors to residents in their programs can help to identify discrepant perceptions that, coupled with the collection of objective data, can be targeted for improvement. [ABSTRACT FROM AUTHOR]

Introduction Stress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population. Methods A literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. Results Modifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening. Conclusion This review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally. [ABSTRACT FROM AUTHOR]

Introduction Stress fractures (SFx) represent a significant proportion of musculoskeletal injuries in military recruits internationally. Incidence rates as high as 40% have been reported, varying by country and branch of military cohorts. Tibial SFx are the most common, followed by other lower extremity sites, and are related to the emphasis on running during training. SFx disproportionately affect female recruits, similarly to a disparity demonstrated in female athletes. Methods A literature review of articles relevant to our review was conducted using PubMed, utilizing keywords stress fracture, military, recruits, diagnosis, management, treatment, prevention, epidemiology, background, and/or female. Articles older than 10 years old (prior to 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. Results SFx can cause medical morbidity and financial burden and can require discharge from military service. SFx management in the military has cost the United States approximately $100 million annually, which may be underestimated due to lost duty hours or medical discharge with resulting compensation. However, SFx incidence rates have been demonstrated to be reducible with concerted efforts in military cohorts. Conclusion This review, Part I of a two-part series , provides updated information for multidisciplinary management of SFx in female military recruits. There are many similarities to management in athletes, but unique nuances of the military recruit require specific knowledge to reduce the high incidence rates of injury. [ABSTRACT FROM AUTHOR]

Background: The negative effects of bullying, discrimination, harassment, and sexual harassment (BDHS) on well-being and productivity of surgical residents in training have been well documented. Despite this, little has changed over the past decade and these behaviors continue. The purpose of this study was to determine the prevalence of each abusive behavior experienced by residents, identify the perpetrators, and examine the reporting tendency. Methods: A systematic review of articles published between 2010 and 2020 in the MEDLINE, EMBASE, and Cochrane databases was performed following PRISMA guidelines. The following search terms were used: bullying, harassment, sexual harassment, discrimination, abuse, residency, surgery, orthopedic surgery, general surgery, otolaryngology, obstetrics, gynecology, urology, plastic surgery, and training. Results: Twenty-five studies with 29,980 surgical residents were included. Sixty-three percent, 43, 29, and 27% of surgical residents experienced BDHS, respectively. Female residents reported experiencing all BDHS behaviors more often. Thirty-seven percent of resident respondents reported burnout, and 33% reported anxiety/depression. Attending surgeons, followed by senior co-residents, were the most common perpetrators. Seventy-one percent did not report the behavior to their institution. Fifty-one percent stated this was due to fear of retaliation. Of those who reported their experiences, 56% stated they had a negative experience reporting. Conclusion: Our review demonstrates high prevalence rates of BDHS experienced by residents during surgical training, which have been associated with burnout, anxiety, and depression. The majority of residents did not report BDHS due to fear of retaliation. Residency programs need to devise methods to have a platform for residents to safely voice their complaints. [ABSTRACT FROM AUTHOR]

In preparation for surgery, it is important for surgeons to have a detailed discussion with patients about the risks, benefits, and alternatives to surgery. Patient optimization, ensuring the patient is in the best medical condition before surgery, is also an important aspect of patient care that the surgeon must consider. Although complications cannot be eliminated, there are often opportunities to optimize patients, so these risks can be minimized based on current evidence-based medicine. To minimize the risk of complications, the surgeon should take an active role in each step of the patient's care beginning with the history and physical examination, obtaining the correct preoperative labs, and continuing through positioning, draping, and prepping before making an incision. [ABSTRACT FROM AUTHOR]

Kusumoto, H, Ta, C, Brown, SM, and Mulcahey, MK. Factors contributing to diurnal variation in athletic performance and methods to reduce within-day performance variation: A systematic review. J Strength Cond Res 35(12S): S119–S135, 2021—For many individuals, athletic performance (e.g., cycle ergometer output) differs based on the time of day (TOD). This study identified factors contributing to diurnal variation in athletic performance and methods to reduce TOD performance variation. Comprehensive searches of PubMed, Ovid, EMBASE, Web of Science, and Cochrane Libraries were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed publications reporting quantitative, significant diurnal variation (p ≤ 0.05) of athletic performance with explanations for the differences were included. Studies providing effective methods to reduce diurnal variation were also included. Literature reviews, studies involving nonhuman or nonadult subjects, studies that intentionally manipulated sleep duration or quality, and studies deemed to be of poor methodological quality using NIH Quality Assessment Tools were excluded. Forty-nine studies met the inclusion criteria. Body temperature differences (n = 13), electromyographic parameters (n = 10), serum biomarker fluctuations (n = 5), athlete chronotypes (n = 4), and differential oxygen kinetics (n = 3) were investigated as significant determinants of diurnal variation in sports performance. Successful techniques for reducing diurnal athletic performance variability included active or passive warm-up (n = 9), caffeine ingestion (n = 2), and training-testing TOD synchrony (n = 3). Body temperature was the most important contributor to diurnal variation in athletic performance. In addition, extended morning warm-up was the most effective way to reduce performance variation. Recognizing contributors to diurnal variation in athletic performance may facilitate the development of more effective training regimens that allow athletes to achieve consistent performances regardless of TOD. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic osteoarthritis (PTOA) after injury to the anterior cruciate ligament (ACL) is common. Purpose: To perform a systematic review of basic science and animal studies to determine the effect of doxycycline treatment on the prevention of PTOA after ACL rupture/transection. Study Design: Systematic review. Methods: A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify basic science and animal studies evaluating the effect of doxycycline treatment on the prevention of PTOA of the knee joint after ACL/cranial cruciate ligament (CCL) injury. The search phrase used was "doxycycline cruciate ligament." Inclusion criteria were basic science and animal studies evaluating the effect of oral administration of doxycycline in ACL/CCL-deficient animals with or without a control group. Results: Seven studies met inclusion criteria and were included in this systematic review. Five studies were performed in dogs, 1 in rabbits, and 1 in mice. Overall, the effects of doxycycline treatment on the prevention of PTOA after ACL/CCL rupture/transection were mixed. In dogs, no significant effects of doxycycline treatment were found in terms of matrix metalloproteinase (MMP) activity, while a mouse study found significantly lower MMP-13 expression on the tibia in doxycycline-treated animals, suggesting that doxycycline may protect against proteoglycan loss and decrease osteoarthritis progression. Cartilage nitric oxide concentrations were lower in doxycycline-treated dogs compared with untreated dogs, suggesting decreased cartilage degradation among doxycycline-treated dogs, although there were no significant effects on cartilage stromelysin levels with no significant effects in terms of physiological remodeling or catabolism of cartilage. Bone formation or resorption was not found to be affected by doxycycline treatment. One study demonstrated a substantial beneficial effect of doxycycline on gross morphology of the medial femoral condyle. Doxycycline was found to conserve bone strain energy density and appeared to limit subchondral bone loss in 1 study. Conclusion: Based on the limited available animal studies, doxycycline appears to demonstrate some benefits in the prevention of PTOA after ACL/CCL rupture/transection. Additional studies are needed to further characterize the potential benefits, side effects, dosage, and duration of this treatment after ACL injury in human patients. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction (BFR) is a novel technique involving the use of a cuff/tourniquet system positioned around the proximal end of an extremity to maintain arterial flow while restricting venous return. Purpose: To analyze the available literature regarding the use of BFR to supplement traditional resistance training in healthy athletes. Study Design: Systematic review. Methods: A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. From November to December 2018, studies that examined the effects of BFR training in athletes were identified using PubMed and OVID Medline. Reference lists from selected articles were analyzed for additional studies. The inclusion criteria for full article review were randomized studies with control groups that implemented BFR training into athletes' resistance training workouts. Case reports and review studies were excluded. The following data were extracted: patient demographics, study design, training protocol, occlusive cuff location/pressure, maximum strength improvements, muscle size measurements, markers of sports performance (eg, sprint time, agility tests, and jump measurements), and other study-specific markers (eg, electromyography, muscular torque, and muscular endurance). Results: The initial search identified 237 articles. After removal of duplicates and screening of titles, abstracts, and full articles, 10 studies were identified that met the inclusion criteria. Seven of 9 (78%) studies found a significant increase in strength associated with use of BFR training as compared with control; 4 of 8 (50%) noted significant increases in muscle size associated with BFR training; and 3 of 4 (75%) reported significant improvements in sport-specific measurements in the groups that used BFR training. Occlusive cuff pressure varied across studies, from 110 to 240 mm HG. Conclusion: The literature appears to support that BFR can lead to improvements in strength, muscle size, and markers of sports performance in healthy athletes. Combining traditional resistance training with BFR may allow athletes to maximize athletic performance and remain in good health. Additional studies should be conducted to find an optimal occlusive pressure to maximize training improvements. Registration: CRD42019118025 (PROSPERO). [ABSTRACT FROM AUTHOR]

Objective Instagram and Twitter are two of the most popular social media platforms today. Beyond social communication, these platforms also have the potential to enhance medical education by providing early exposure and mentorship to students and residents in training. The purpose of this study was 1) to investigate orthopaedic surgery related content posted on Instagram and Twitter 2) to analyze who posts orthopaedic surgery related content and 3) to better understand how social media may be used to supplement medical education and exposure for students interested in orthopaedics. Design Three hashtags, #Orthopedics, #OrthopedicSurgery, and #OrthopedicSurgeon were searched on Instagram and Twitter from March 8 to March 18, 2020. Posts on both platforms were analyzed for the hashtag used, number of likes, source type (e.g. physician, company promoting a product), and type of post (e.g. advertisement, educational). Descriptive statistics were used to analyze the results. Setting This study was performed at the Tulane University School of Medicine, New Orleans, LA, by medical students, with guidance and supervision from faculty in the Tulane University Department of Orthopaedics. Results Data was collected from 212 (47.2%) Instagram and 237 (52.8%) Twitter posts over a 10-day period. Significantly more Instagram posts used the hashtags #Orthopedicsurgeon and #Orthopedicsurgery (P<.001), while more Twitter posts used the hashtag #Orthopedics (72.0% P<.001). Companies using these hashtags posted more frequently on Twitter than Instagram (P<.001), while a higher number of physicians, orthopaedic practices, and personal accounts utilized Instagram (P<.001). There was significantly more advertising content on Twitter (P<.001), while Instagram included more personal anecdotes, medical imaging and procedures (P<.001). Conclusion This study demonstrated that content related to orthopaedic surgery is regularly posted on both Instagram and Twitter. Instagram is a visually driven platform that more frequently posted educational and personal content from medical professionals and individuals, while Twitter predominantly published advertisements from companies and orthopaedic practices. The current use of Instagram may make it better suited for providing information and early exposure to medical students interested in the field. [ABSTRACT FROM AUTHOR]

Medial collateral ligament (MCL) reconstruction (MCLR) is performed after failed nonoperative treatment or high-grade MCL injury with associated valgus instability.To evaluate clinical outcomes after MCLR with autograft versus allograft.Systematic review, Level of evidence, 4.A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors conducted a search of the PubMed, CINAHL, EMBASE, and Cochrane databases to identify studies comparing outcomes of MCLR with autograft versus allograft. Studies were included if they evaluated clinical outcomes after MCLR using autograft and/or allograft. Any study that included concomitant knee ligament injury other than the anterior cruciate ligament injury was excluded. A quality assessment was performed using the modified Coleman Methodology Score.The initial search identified 746 studies, 17 of which met the inclusion criteria and were included in this review. The studies included 307 patients: 151 (49.2%) patients received autografts, and 156 (50.8%) received allografts. The most used autograft was the semitendinosus tendon (136 grafts; 90.1% of specified allografts), and the only allograft used was the Achilles tendon (110 grafts; 100% of specified autografts). The mean follow-up of the studies was 25.6 months. Postoperative pain (Lysholm scores) ranged from 82.9 to 94.8 in patients receiving autografts and 87.5 to 93 in patients receiving allografts. Postoperative range of motion was full in 8 of 15 (53.3%) patients receiving autografts compared with 82 of 93 (88.2%) patients receiving allografts. Five of the 151 (3.3%) patients who had MCLR with autografts had complications such as infection, instability, and prominent screws. Two of the 156 (1.3%) MCLRs with allografts developed complications of prominent screws and nonhealing incisions.MCLR with either autografts or allografts leads to improved patient-reported, radiographic, and clinical outcomes. Patient-reported postoperative pain was similar in patients receiving either graft type. Other outcomes were difficult to compare between graft types because of nonstandardized reporting and a lack of pre- and postoperative measurements. Therefore, there is no evidence of significantly improved outcomes in the use of either autograft or allograft with MCLR. [ABSTRACT FROM AUTHOR]

Regarding management, we appreciate Dr Tenforde for highlighting preliminary evidence to support further investigation for the benefit of extracorporeal shockwave therapy, parathyroid hormone-related peptide therapy, photobiomodulation therapy, and orthobiologics for the treatment of bone stress injuries. Dr Tenforde also highlighted a study from 2000, which supports the promotion of impact sports with multidirectional loading in the general population to improve bone health and reduce injury risk. We appreciated receiving the letter to the editor, which was submitted by Dr Tenforde and his team regarding our initial review, a two-part series on stress fractures in military recruits. [Extracted from the article]

Background The field of orthopaedic surgery is not free from sexual harassment, with one recent study revealing that 47% of surveyed American Academy of Orthopaedic Surgeons (AAOS) members reported experiencing sexual harassment during their careers. Further characterization of the reported sexual harassment experienced by orthopaedic surgeons is warranted, especially as it relates to women trainees. Questions/purposes (1) What is the overall proportion of women orthopaedic surgeons who reported having experienced sexual harassment during their orthopaedic residency? (2) Is the proportion of current orthopaedic trainees who report having experienced sexual harassment at work lower than the proportion of women attending orthopaedic surgeons who recall having been sexually harassed during their residency years? (3) Does this finding differ based on location of residency training? Methods An anonymous 12-question online survey was distributed between October 2019 and December 2019 to the 682 active and resident members of the Ruth Jackson Orthopaedic Society, a professional society for women orthopaedic surgeons. The survey was created by Speak Up, an organization that is dedicated to identifying and correcting sources of workplace sexual harassment. Though not validated, the authors felt that this survey was the most easily adaptable to reflect orthopaedic training, and the authors felt it had good face validity for the purpose in a study of this kind. A total of 37% (250 of 682) of those contacted returned completed surveys. Twenty percent (51 of 250) were current residents, and 80% (199 of 250) were currently in fellowship or in practice. All survey respondents self-identified as women. Survey data were analyzed using descriptive and comparative statistics to determine the differences in proportions of sexual harassment among current residents and attendings, as well as differences in geographic locations. Results Sixty-eight percent (171 of 250) of women reported having experienced sexual harassment during their orthopaedic training. We found no differences between current and past trainees in terms of the proportion who reported having experienced sexual harassment during residency training (59% [30 of 51] versus 71% [141 of 199], odds ratio 0.59 [95% CI 0.31 to 1.11]; p = 0.10). Compared with the northeast region of the United States, we found no differences in the proportion of women who reported having experienced sexual harassment during residency training in the South region (65% [55 of 84] versus 67% [36 of 54], OR 1.06 [95% CI 0.51 to 1.17]; p = 0.89), the Midwest region (75% [53 of 71], OR 1.55 [95% CI 0.77 to 3.12); p = 0.22), or the West region 66% [27 of 41], OR 1.02 [95% CI 0.46 to 2.23); p = 0.97). Conclusions We found that a high proportion of women orthopaedic trainees report having experienced sexual harassment during orthopaedic residency. Residency programs should take steps to further identify and combat the sources of sexual harassment by increasing the number of women in leadership roles within the department and by ensuring that women trainees have adequate mentorship from both women and men attendings. After such measures are implemented, future studies should aim to evaluate their efficacy. [ABSTRACT FROM AUTHOR]

Background: The field of orthopaedic surgery is not free from sexual harassment, with one recent study revealing that 47% of surveyed American Academy of Orthopaedic Surgeons (AAOS) members reported experiencing sexual harassment during their careers. Further characterization of the reported sexual harassment experienced by orthopaedic surgeons is warranted, especially as it relates to women trainees.Questions/purposes: (1) What is the overall proportion of women orthopaedic surgeons who reported having experienced sexual harassment during their orthopaedic residency? (2) Is the proportion of current orthopaedic trainees who report having experienced sexual harassment at work lower than the proportion of women attending orthopaedic surgeons who recall having been sexually harassed during their residency years? (3) Does this finding differ based on location of residency training?Methods: An anonymous 12-question online survey was distributed between October 2019 and December 2019 to the 682 active and resident members of the Ruth Jackson Orthopaedic Society, a professional society for women orthopaedic surgeons. The survey was created by Speak Up, an organization that is dedicated to identifying and correcting sources of workplace sexual harassment. Though not validated, the authors felt that this survey was the most easily adaptable to reflect orthopaedic training, and the authors felt it had good face validity for the purpose in a study of this kind. A total of 37% (250 of 682) of those contacted returned completed surveys. Twenty percent (51 of 250) were current residents, and 80% (199 of 250) were currently in fellowship or in practice. All survey respondents self-identified as women. Survey data were analyzed using descriptive and comparative statistics to determine the differences in proportions of sexual harassment among current residents and attendings, as well as differences in geographic locations.Results: Sixty-eight percent (171 of 250) of women reported having experienced sexual harassment during their orthopaedic training. We found no differences between current and past trainees in terms of the proportion who reported having experienced sexual harassment during residency training (59% [30 of 51] versus 71% [141 of 199], odds ratio 0.59 [95% CI 0.31 to 1.11]; p = 0.10). Compared with the northeast region of the United States, we found no differences in the proportion of women who reported having experienced sexual harassment during residency training in the South region (65% [55 of 84] versus 67% [36 of 54], OR 1.06 [95% CI 0.51 to 1.17]; p = 0.89), the Midwest region (75% [53 of 71], OR 1.55 [95% CI 0.77 to 3.12); p = 0.22), or the West region 66% [27 of 41], OR 1.02 [95% CI 0.46 to 2.23); p = 0.97).Conclusions: We found that a high proportion of women orthopaedic trainees report having experienced sexual harassment during orthopaedic residency. Residency programs should take steps to further identify and combat the sources of sexual harassment by increasing the number of women in leadership roles within the department and by ensuring that women trainees have adequate mentorship from both women and men attendings. After such measures are implemented, future studies should aim to evaluate their efficacy.Level Of Evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

Background: The prevalence of youth athletes specializing in 1 sport has been increasing over the past decade. Subsequently, the rate of youth athlete injury has also been increasing. It is possible that an association exists between youth specialization and sports injury rate. Purpose: To determine if sport sampling is associated with a lower sports injury rate in youths compared with youths who specialize in 1 sport. Study Design: Systematic review and meta-analysis. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Embase, and the Cochrane library. Inclusion criteria included studies written in the English language, studies with athletes between 7 and 18 years of age, studies that report injury rates, and studies that specify if athletes were sport samplers or specialized in a sport. Data relevant to this study, including injuries and patient characteristics, were extracted and statistically analyzed. Results: The initial search identified 324 studies, 6 of which met inclusion criteria. From these 6 studies, the total participant number was 5736. Of those, 2451 (42.7%) were "sport samplers," 1628 (28.4%) were "sport specializers," and 1657 (28.9%) were considered "others" (ie, could not be classified as true samplers or true specializers). The average age of all the athletes was 14.6 years (range, 7-18 years). Sport specializers had a significantly higher injury risk than the sport samplers (RR, 1.37; 95% CI, 1.19-1.57; P <.0001). There was a higher risk of injury in the "others" group when compared with the "sport sampler" group (RR, 1.21; 95% CI, 1.14-1.29; P <.0001). There was a higher risk of injury in the "sport specializer" group over the "others" group (RR, 1.09; 95% CI, 1.04-1.14; P <.005). Conclusion: Sport sampling is associated with a decreased risk of sports injury in youth athletes when compared with those who specialize in 1 sport. Injury rates increase as a youth athlete becomes increasingly specialized. Youth athletes would benefit substantially from participating in sport sampling. [ABSTRACT FROM AUTHOR]

Background: Orthopaedic studies have reported the prevalence of injuries and outcomes after treatment in men and women patients, and although these differences have been recognized, few studies have evaluated for gender-specific injury patterns, disease progression, and treatment outcomes. A thorough understanding of gender-related differences is important to better individualize treatment and improve outcomes.Questions/purposes: In this study, we sought (1) to determine the proportion of studies published in six orthopaedic journals that provided sex- or gender-specific analyses in 2016 and whether a difference was found in outcomes between men and women and (2) to evaluate whether this proportion varied across several orthopaedic subspecialty journals or between general orthopaedic journals and subspecialty journals.Methods: Six leading orthopaedic surgery journals were selected for review, including two general orthopaedic journals (Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research®) and four subspecialty journals (American Journal of Sports Medicine, Journal of Arthroplasty, Journal of Shoulder and Elbow Surgery, and Spine). Journal issues published in the even-numbered months of 2016 were reviewed for clinical randomized controlled, cohort, and case-control studies in which women were a part of the study population. A total of 712 studies evaluating 24,607,597 patients met the criteria and were included in our review of publications from 2016. The selected studies were stratified based on whether gender was a variable in a multifactorial statistical model. Outcomes of interest included the proportion of patients who were women and the presence or absence of a gender-specific analysis. These endpoints were compared between journals.Results: Overall, 55% (13,565,773 of 24,607,597) of patients analyzed in these studies were women. Only 34% (241 of 712) of the studies published in 2016 included gender as variable in a multifactorial statistical model. Of these, 39% (93 of 241) demonstrated a difference in the outcomes between patients who were men and women. The Journal of Arthroplasty had the greatest percentage of patients who were women (60%, 9,251,068 of 15,557,187) and the American Journal of Sports Medicine had the lowest (44%, 1,027,857 of 2,357,139; p < 0.001). Orthopaedic subspecialty journals tended to include a greater percentage of women (54%) than did general orthopaedic journals (50%; p = 0.04).Conclusion: Currently, it is unclear what percentage of published orthopaedic studies should include a gender-specific analysis. In the current study, more than one-third of publications that performed a gender-specific analysis demonstrated a difference in outcomes between men and women, thereby emphasizing the need to determine when such an analysis is warranted.Clinical Relevance: Future studies should aim to determine when a gender-specific analysis is necessary to improve the management of orthopaedic injuries in men and women. It is important for investigators at the individual-study level to look for every opportunity to ensure that both men's and women's health needs are met by performing appropriate by-sex and by-gender analyses, but not to perform them when they are unnecessary or inappropriate. [ABSTRACT FROM AUTHOR]

Background: Mentorship has been identified as an important element of educational and professional development for surgeons. An assessment that was conducted and reported through the American Association of Orthopaedic Surgeons (AAOS) in 2008 showed variability among U.S. residencies regarding the structure and requirements for mentorship during orthopaedic training; the assessment also demonstrated variability in residents' satisfaction with mentorship opportunities during their surgical training.Methods: An updated survey was developed and distributed via e-mail to residents attending the Resident Leadership Forum at the 2015 American Orthopaedic Association Annual Meeting to determine their views regarding the importance of mentorship, as well as their assessments of formal mentorship programs within their residencies. The updated data were compared with the prior survey results from 2008.Results: A total of 149 (87.6%) of 170 residents responded to the survey. Of these, 34.9% (51 of 146) reported the existence of a formal mentorship program within their residency, as compared with 26.0% of residencies as stated in the 2008 report. One hundred percent of residents indicated that having a mentor during orthopaedic residency was either critical (63.7%, 93 of 146) or advantageous (36.3%, 53 of 146) to professional development as a surgeon; 74.7% (109 of 146) of residents reported currently having mentors, which appears to represent an increase from the prior report (51%, 258 of 506). However, the percentage of residents who reported being "very" satisfied (17.9%, 25 of 140) or "somewhat" satisfied (43.6%, 61 of 140) with their mentorship opportunities was almost identical to the prior report (61.9% [86 of 139] versus 61.0%, respectively). Overall, residents from programs with formal mentorship programs in place reported significantly higher satisfaction with their mentoring program/environment compared with those from programs without formal mentorship programs in place (3.98 versus 3.54, p = 0.026).Conclusions: Orthopaedic residents continue to overwhelmingly indicate that mentorship is an important component of residency education: 34.9% of residencies have a formal mentorship program, compared with 26.0% in the prior survey. Additionally, 74.7% of current residents reported having a mentor compared with 51% of residents in the prior study. Despite this difference, a very similar percentage of residents indicated that they were either "very" or "somewhat" satisfied with their mentorship experience. Residents from programs with formal mentorship programs reported significantly higher satisfaction with their mentorship programs compared with those without formal programs. These results support continued efforts toward improving mentorship opportunities within U.S. orthopaedic residency programs. [ABSTRACT FROM AUTHOR]

Background: Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes. Purpose: To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint. Study Design: Systematic review. Methods: The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded. Results: Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases. Conclusion: No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization. [ABSTRACT FROM AUTHOR]

Background: Orthopaedic surgery has become an increasingly competitive specialty for medical students applying to residency. Aside from residency interviews, away rotations are one of the only opportunities for residency programs to qualitatively evaluate an applicant. The purpose of this study was to determine if residency program directors (PDs) use a minimum United States Medical Licensing Examination (USMLE) Step-1 score as a screening tool for students applying for away rotations at their institution.Methods: An anonymous 12-question survey about residency selection criteria and which criteria are used to select applicants for away rotations was distributed to PDs at U.S. allopathic orthopaedic surgery residency programs who are members of the Council of Orthopaedic Residency Directors (CORD). Questions included information on minimum USMLE Step-1 scores, the number of students who complete away rotations at the program each year, and how applicants are selected for rotations.Results: Survey responses were received from 87 (58%) of 149 PDs. Seventy-one (82%) of these PDs reported that their program uses a minimum Step-1 score for residency applications, with the most common cutoff score being between 231 and 240 (as answered by 33 [46%] of 72 PDs). Twenty-seven (31%) of 87 PDs reported that if a student does not meet their residency minimum Step-1 score, he or she is not offered the opportunity to rotate at the program. Eleven (25%) of 44 PDs reported that they do not inform students when their score is below the program's minimum.Conclusions: A substantial proportion of orthopaedic surgery residency PDs use the USMLE Step-1 score as a screening tool for students interested in doing away rotations at their programs. If a student's Step-1 score does not meet the program's minimum, the majority of programs still will allow the student to rotate at their institution. Students should take this information into account when selecting away rotations in order to maximize their chances of matching into an orthopaedic surgery program. [ABSTRACT FROM AUTHOR]

Leadership skills are important to all orthopedic surgeons, regardless of practice or location, as interactions with patients, staff, and other physicians necessitate professionalism and leadership. Leadership skills are best developed through formal training and experiential opportunities. Several programs emphasizing leadership skills for orthopedic surgeons exist; however, the number of programs is not adequate to meet the demand. It is difficult for orthopedic surgeons to take advantage of these opportunities, given clinical and professional responsibilities. To appropriately adapt to the changing healthcare environment and ensure advancement of the orthopedic field, formal leadership skills development should be widely integrated into orthopedic training. [ABSTRACT FROM AUTHOR]

➤ The most predictive factor for hamstring injury is a previous hamstring injury. ➤ Magnetic resonance imaging is the most useful study for determining the extent of the hamstring injury and whether surgical intervention is warranted. ➤ Conservative treatment is indicated for acute hamstring strains, partial tears, and single-tendon avulsions. ➤ Surgical repair of complete proximal hamstring ruptures, both acute and chronic, results in improved outcomes compared with nonoperative management. ➤ Repair of acute proximal hamstring tendon tears results in better functional outcomes than repair of chronic tears. ➤ Stretching and strengthening the hamstring tendons with eccentric exercise is useful for physical therapy after injury and may reduce the risk of reinjury. [ABSTRACT FROM AUTHOR]

Biomimetic proteoglycans (BPGs) have the potential to treat osteoarthritis (OA) given that these molecules mimic the structure and properties of natural proteoglycans, which are significantly reduced in OA. We examined the effects of BPGs injected into the intra‐articular space in an in vivo OA rabbit knee model and evaluated the effect on histological response, joint friction, and BPG distribution and retention. Rabbits underwent ACL transection to create an arthritic state after 5 weeks. OA rabbits were treated with BPGs or Euflexxa® (hyaluronic acid) intra‐articular injections. Non‐OA rabbits were injected similarly with BPGs; contralateral joints served as controls. The progression of OA and response to injections were evaluated using Mankin and gross grading systems indicating that mild OA was achieved in operated joints. The coefficient of friction (COF) of the intact knee joints were measured using a custom pendulum friction apparatus, showing that OA joints and OA + Euflexxa® joints demonstrated increased COF than non‐operated controls, while BPG‐injected non‐OA and OA + BPGs were not significantly different from non‐OA controls. Injected fluorescently labeled BPGs demonstrated that BPGs diffused into cartilage with localization in the pericellular region. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:403–411, 2019. [ABSTRACT FROM AUTHOR]

Fluoroscopy poses an occupational hazard to orthopedic surgeons. The purpose of this study was to examine resident and faculty understanding of radiation safety and to determine whether or not a radiation safety intervention would improve radiation safety knowledge. An anonymous survey was developed to assess attitudes and knowledge regarding radiation safety and exposure. It was distributed to faculty and residents at an academic orthopedic program before and after a radiation safety lecture. Pre- and post-lecture survey results were compared. 19 residents and 22 faculty members completed the pre-lecture survey while 11 residents and 17 faculty members completed the post-lecture survey. Pre-lecture survey scores were 48.3% for residents and 49.5% for faculty; post-lecture survey scores were 52.7% and 46.1% respectively. Differences between pre and post-survey scores were not significant. This study revealed low baseline radiation safety knowledge scores for both orthopedic residents and faculty. As evidence by our results, a single radiation safety information lecture did not significantly impact radiation knowledge. Radiation safety training should have a formal role in orthopedic surgery academic curricula. [ABSTRACT FROM AUTHOR]

BACKGROUND: Orthopaedic interest groups (OIGs) are student-run organizations that can provide medical students with early exposure to orthopaedic surgery. OIGs can serve as venues for musculoskeletal education, clinical experiences, and mentorship to students with otherwise limited access to orthopaedics. The purpose of this study was to evaluate the prevalence and opportunities offered by OIGs. METHODS: The websites of all allopathic medical schools in the United States were evaluated. Each website was examined for an established OIG and any pertinent information regarding shadowing, research opportunities, lectures, workshops, or opportunities to interact with residents. OIGs were categorized based on the number and type of offerings provided to their members. RESULTS: Of the 141 allopathic medical school websites evaluated, 108 (108/141, 76%) had evidence of an orthopaedic interest group. Sixty-nine (69/108, 64%) of these schools described the opportunities provided. The most common opportunities were clinical skills workshops (41/69, 59%), lectures (32/69, 46%), and opportunities to interact with current residents (30/69, 43%). The majority of OIGs (39/69, 57%) offered fewer than half of the possible opportunities and only 6 groups (9%) offered all five opportunities. CONCLUSION: The majority of allopathic medical schools in the United States have an OIG; however, the opportunities provided to orthopaedic interest group members vary widely from institution to institution. [ABSTRACT FROM AUTHOR]

Background Residency program location may be an important factor for orthopedic surgery residency applicants. More than half of residents locate their practice near the site of their training, and surgical specialties (eg, otolaryngology, plastic surgery, and general surgery) have shown geographic patterns in their residency matches. Objective We analyzed geographic trends in the orthopedic surgery Match. Methods Hometown, undergraduate institution, and medical school “preresidency locations” of all allopathic, nonmilitary, orthopedic surgery residents were recorded from program websites for the 2015–2016 academic year. Program and preresidency locations were coded according to state and US census division. Statistical analysis was used to investigate associations between residency program locations and preresidency locations. Results Of 2662 residents in the study, 1220 of 2614 (47%), 536 of 1329 (40%), and 308 of 744 (41%) matched into the same division as their medical school, undergraduate institution, and hometown, respectively. There were significant differences among divisions (P <.001). Also, 817 of 2662 (31%), 319 of 1329 (24%), and 200 of 770 (26%) residents matched in the same state as their medical school, undergraduate institution, and hometown, respectively, with significant differences between states for medical school (P <.0001) and undergraduate institution (P <.0001), but not hometown (P =.22). Overall, 21% of residents (538 of 2612) matched at the program affiliated with their medical school. Conclusions There is an association among hometown, undergraduate institution, and medical school for the training program location in which orthopedic surgery residents match, with variability in locations matched at state and census division levels. [ABSTRACT FROM AUTHOR]

Background Residency program location may be an important factor for orthopedic surgery residency applicants. More than half of residents locate their practice near the site of their training, and surgical specialties (eg, otolaryngology, plastic surgery, and general surgery) have shown geographic patterns in their residency matches. Objective We analyzed geographic trends in the orthopedic surgery Match. Methods Hometown, undergraduate institution, and medical school "preresidency locations" of all allopathic, nonmilitary, orthopedic surgery residents were recorded from program websites for the 2015-2016 academic year. Program and preresidency locations were coded according to state and US census division. Statistical analysis was used to investigate associations between residency program locations and preresidency locations. Results Of 2662 residents in the study, 1220 of 2614 (47%), 536 of 1329 (40%), and 308 of 744 (41%) matched into the same division as their medical school, undergraduate institution, and hometown, respectively. There were significant differences among divisions (P < .001). Also, 817 of 2662 (31%), 319 of 1329 (24%), and 200 of 770 (26%) residents matched in the same state as their medical school, undergraduate institution, and hometown, respectively, with significant differences between states for medical school (P < .0001) and undergraduate institution (P < .0001), but not hometown (P=.22). Overall, 21% of residents (538 of 2612) matched at the program affiliated with their medical school. Conclusions There is an association among hometown, undergraduate institution, and medical school for the training program location in which orthopedic surgery residents match, with variability in locations matched at state and census division levels. [ABSTRACT FROM AUTHOR]

Background: Ice hockey is a physically demanding sport where athletes are susceptible to a variety of injuries. Several studies reported the overall injury rates in ice hockey; however, there is a paucity of information on upper extremity (UE) injuries among collegiate ice hockey players. Purpose: To describe the epidemiology of UE injuries among collegiate male and female ice hockey players with NCAA (National Collegiate Athletic Association) injury surveillance data from 2004-2005 to 2013-2014. Study Design: Descriptive epidemiology study. Methods: Data were obtained from the NCAA Injury Surveillance Program for all UE injuries sustained during the academic years 2004-2005 to 2013-2014. Injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs. Results: During the 10 years studied, the overall rate of UE injuries for men was higher than that for women (236 vs 125 injuries per 100,000 athlete-exposures [AEs]; RR, 1.89; 95% CI, 1.67-2.15). UE injuries sustained during either pre- or postseason were approximately 3 times higher for men than for women (preseason: 149 vs 53 per 100,000 AEs; RR, 2.83; 95% CI, 1.69-4.74; postseason: 143 vs 49 per 100,000 AEs; RR, 2.91; 95% CI, 1.33-6.38). The overall injury rate was highest during the regular season (men: 257 per 100,000 AEs; 95% CI, 242-272; women: 143 per 100,000 AEs; 95% CI, 126-160). Additionally, the injury rate for men and women was higher during competition than practice (men: 733 vs 83 per 100,000 AEs; 95% CI, 687-780 and 75-92; women: 303 vs 64 per 100,000 AEs; 95% CI, 259-348 and 52-76). The most common injury observed was acromioclavicular joint sprain (men, 29.1%; women, 13.8%). For both groups, acromioclavicular joint injuries accounted for most non–time loss, moderate time loss (2-13 days), and severe time loss (≥14 days) injuries. Conclusion: Men and women sustained a significant number of UE injuries playing collegiate ice hockey during the period studied, with acromioclavicular joint sprain being the most common UE injury and the one that most frequently led to significant time loss. These data may provide insight for future injury prevention and guide improvements in training. [ABSTRACT FROM AUTHOR]

Background: Women are underrepresented as applicants to and trainees of orthopaedic surgery residencies. Factors that attract women to or deter them from orthopaedic surgery have been previously published; however, there has been no analysis of the programs that train high percentages of female residents and the factors that differentiate them from programs that have low percentages of women. The purpose of this study was to identify and compare these factors between programs with high and low percentages of female residents.Methods: Information on each orthopaedic surgery residency program listed in the American Medical Association (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was collected utilizing residency program web sites, an online survey distributed to residency program coordinators, and a follow-up telephone survey. These included data on resident and faculty demographic characteristics and residency program curriculum structure. The prevalence of factors in programs with the highest percentages of female residents was compared with those with lower percentages.Results: Data were obtained from 143 (97.3%) of 147 programs, with 3,406 residents identified. Only 485 residents (14.2%) were female. Programs with more female residents had more female faculty members per program (p = 0.001), a higher percentage of faculty who were female (p < 0.001), more female associate professors (p < 0.001), more women in leadership positions (p < 0.001), and a higher prevalence of women's sports medicine programs (p = 0.03); were more commonly listed in the Top 40 for National Institutes of Health (NIH) funding (p = 0.03) and U.S. News & World Report rankings (p = 0.02); and were more likely to offer a research year (p = 0.045).Conclusions: There are greater percentages of female residents at orthopaedic residency programs with more female faculty members, more women in leadership positions, a women's sports medicine program, and the option to do a research year. Departmental and national leaders may consider these factors when efforts are undertaken to enhance the recruitment of female applicants and improve female interest in orthopaedic surgery as a specialty. [ABSTRACT FROM AUTHOR]

13 Rahman R,, Zhang B,, Humbyrd CJ,, LaPorte D. How do medical students perceive diversity in orthopaedic surgery, and how do their perceptions change after an orthopaedic clinical rotation? Orthopaedic faculty and resident sex diversity are associated with the orthopaedic residency application rate of female medical students. Letter to the Editor: How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States?. [Extracted from the article]

First administered in November 1963, the orthopedic in-training examination (OITE) is now distributed to more than 4000 residents in over 20 countries and has become important for evaluation of resident fund of knowledge. Several studies have assessed the effect of didactic programs on resident performance, but only recently has it become possible to assess detailed testtaking metrics such as time spent per question. Here, we report the first assessment of resident OITE performance utilizing this full electronic dataset from two large academic institutions. Full 2015 OITE score reports for all orthopedic surgery residents at two institutions were anonymized and compiled. For every question answered by each resident, the resident year, question content or domain, question result (correct or incorrect), and answer speed were recorded. Data were then analyzed to determine whether resident year, result, or domain affected answer speed and whether performance in each subspecialty domain varied based on resident year in training. Data was available for 46 residents and 12,650 questions. Mean answer speed for questions answered correctly, 54.0±48.1 s, was significantly faster than for questions answered incorrectly, 72.2±61.2 s (P<0.00001). When considering both correct and incorrect answers, PGY-1s were slower than all other years (P<0.02). Residents spent a mean of nearly 80 seconds on foot and ankle and shoulder and elbow questions, compared to only 40 seconds on basic science questions (P<0.05). In education, faster answer speed for questions is often considered a sign of mastery of the material and more confidence in the answer. Though faster answer speed was strongly associated with correct answers, this study demonstrates that answer speed is not reliably associated with resident year. While answer speed varies between domains, it is likely that the majority of this variation is due to question type as opposed to confidence. Nevertheless, it is possible that in domains with more tiered experience such as shoulder, answer speed correlates strongly with resident year and percentage correct. [ABSTRACT FROM AUTHOR]