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Background: The COVID-19 pandemic presented unique and unprecedented challenges for international students, those studying at institutions of higher education outside of their home countries, due to their distinct circumstances and vulnerabilities. This literature review examines the multifaceted mental health burdens they experienced and highlights the need for targeted support and interventions., Methods: A rigorous search across three databases (i.e., PubMed, PsycINFO, and ERIC) yielded 50 empirical studies for inclusion in this literature review. A six-phase thematic analysis framework was employed to identify and synthesize key themes., Results: Seven prominent themes emerged: (1) academic and professional disruptions; (2) challenges navigating international student status; (3) social isolation and loneliness; (4) difficulties with living arrangements; (5) financial and food insecurity; (6) health concerns for self and loved ones; and (7) experiences of discrimination and xenophobia., Conclusions: This review highlights a range of tolls that mental health consequences took on international students, and it suggests the need for targeted interventions and support services to address these challenges. It also identifies critical research gaps, such as the need for longitudinal studies and comparative analyses with domestic students. The implications for inclusive policies and supportive environments to promote international students' well-being are discussed.

Purpose: To define the topographic anatomy of the footprint of the adductor longus origin on the pubis and its underlying bony morphology to better inform surgical repair of adductor longus tendon injuries., Methods: Five cadaveric pelvis specimens were dissected, making 10 adductor footprints available for analysis. The adductor longus tendon origin was isolated and the surrounding tissue debrided. The circumference of the tendinous attachment to the pubic crest was marked before excising the tendon and fibrocartilage enthesis from the pubis. Radiopaque paint was prepared by mixing 30 mL of all-purpose acrylic paint (Anita's no. 11150 Island Blue; Rust-Oleum Corp, Vernon Hills, IL) with 15g of E-Z-HD 98% w/w barium sulfate (Bracco Diagnostics Inc., Anjou Quebec, Canada) and applied to the marked footprint. The specimens underwent a 1.0-mm slice computed tomographic scan with 3-dimensional reconstructions. Synapse PACS (FujiFilm, Valhalla, NY) software for measurements of the tendon footprint and underlying bone., Results: Average age and weight of the specimens at the time of death was 37 years and 204.6 ± 48.7 lbs, respectively. The width and length of the tendon origin was 12.0 ± 1.1 mm and 10.9 ± 1.1 mm, respectively. The distance of the center of the footprint from the center of the pubic tubercle was 8.5 ± 1.4 mm lateral and 12.2 ± 0.4 mm caudal. The osseous thickness underlying the footprint was 18.7 ± 3.7 mm at an angle of 34.5 ± 1.5° in relation to the sagittal plane. The correlation between specimen body weight and the thickness of the bone underlying the footprint was strongly positive (r = 0.92)., Conclusions: We found that there is a consistent angle from the center of the adductor longus tendon footprint to the point of maximal underlying bony thickness, as well as a positive correlation between body mass index and osseous thickness, which may inform anatomic reattachment of this tendon., Clinical Relevance: Our findings will assist surgeons in identifying the footprint of the adductor longus tendon and safely perform anatomic repair of adductor longus tendon avulsions., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Background: In response to the COVID-19 pandemic, many US health systems suspended elective surgery at the recommendation of the US Surgeon General. This dramatically decreased case volumes for orthopaedic sports medicine fellows at academic institutions., Purpose: To describe how the COVID-19 pandemic has affected the education of the sports medicine fellowship class of 2020 as well as the subsequent effects on their career plans and psychological well-being., Study Design: Cross-sectional study., Methods: A 33-item survey was distributed via email to all American Orthopaedic Society for Sports Medicine (AOSSM) 2020 fellow members on April 22, 2020. Frequencies are presented as raw totals and percentages of respondents. The Fisher exact test was used to determine statistical significance between nominal variables, with significance set at P < .05., Results: Of 210 registered fellows, 101 (48.1%) responded. Before the COVID-19 outbreak, the typical case volume per week for most fellows (47.5%) was 11 to 15 cases. From the enactment of COVID-19 mitigation policies to the date of survey completion, 90.1% of fellows had performed fewer than 20 cases. A total of 32 fellows were presented with redeployment options by their fellowship program, with 10 redeployed mandatorily to other hospital departments. Fellows reported that web-based didactics (n = 100) and web-based journal clubs (n = 72) were utilized as alternative supplements in the absence of clinical education. There were 8 respondents who had either their prior contract or job offer rescinded, while 1 had a signed contract voided. As a result, 6 fellows now plan to matriculate into a previously unplanned fellowship. Also, 10 respondents' intended practice start date was being delayed by their employer. Respondents whose postfellowship plans were affected were statistically more likely to experience doubts about readiness for practice (58.8% vs 20.3%, respectively; P = .005), anxiety about future career plans (94.4% vs 63.8%, respectively; P = .01), anxiety about their financial situation (86.7% vs 50.8%, respectively; P = .018), stress in personal relationships (58.8% vs 29.9%, respectively; P = .045), and signs or symptoms of depression (41.2% vs 11.1%, respectively; P = .007) compared with those whose plans were not affected., Conclusion: This survey illustrates that during the early stages of the COVID-19 pandemic and the subsequent suspension of elective surgery, there have been downstream effects to this group's education, careers, board certification timeline, and potentially their social and/or emotional well-being., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was sponsored by the American Orthopaedic Society for Sports Medicine (AOSSM). The AOSSM was responsible for distributing the survey to its members. O.L. has received consulting fees from Arthrex and Linvatec, nonconsulting fees from Arthrex, and royalties from Linvatec. M.B. has received educational support from Arthrex, consulting fees from Stryker, nonconsulting fees from Arthrex and Vericel, and honoraria from Vericel. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

We use a straightforward technique for insertion of proximal interlocking screw fixation during retrograde intramedullary nailing of the femur utilizing a common 3 cc syringe as a radiolucent soft tissue protector. Following insertion of the implant and distal interlock insertion, the distal Luer-Lok tip of a 3 cc syringe is cut off to create a hollow tube. Once the correct location of the proximal locking holes is confirmed fluoroscopically, the syringe is inserted through the incision into the soft tissue over the long drill sleeve and trochar. The inner drill guide and trochar is then removed, leaving only the syringe. Through this syringe, the proximal interlocking hole is drilled and measured, and the screw is inserted. The syringe establishes a safe pathway for passage of instrumentation, mitigating damage to the surrounding soft tissues, and allowing for unobstructed fluoroscopic visualization throughout insertion of the locking screws. This technique is safe, inexpensive and reproducible; utilizing common equipment available in most operative settings., Competing Interests: Declare that they have no conflict of interest., (© 2020 Delhi Orthopedic Association. All rights reserved.)

Background: We sought to examine the association between having a psychiatric condition and undergoing hip arthroscopy for femoroacetabular impingement (FAI)., Methods: A matched case-control study was performed to control for age and gender. All patients over 16 years of age with FAI treated with hip arthroscopy by a single surgeon were randomly matched to a patient of the same age and gender undergoing knee arthroscopy for any diagnosis other than infection by the same surgeon during the same period. Conditional logistic regression was used to compare the odds of having a psychiatric condition between groups., Results: Fifty-one matched pairs of patients undergoing hip and knee arthroscopy were identified. Each group contained 35 females (69%) and had a mean age of 33.6 years. Of the 51 hip arthroscopy cases, 23 (45.1%) had a psychiatric condition. Of the 51 knee arthroscopy controls, 11 (21.6%) had a psychiatric condition. Patients undergoing hip arthroscopy were statistically significantly more likely to have a psychiatric condition compared to patients undergoing knee arthroscopy with an odds ratio of 3.4 (95% confidence interval 1.3-9.2, P < .01)., Conclusion: There was a strong association between having a psychiatric condition and undergoing hip arthroscopy for FAI. More research should be done investigating psychiatric conditions among patients with FAI and whether this association can identify strategies to optimize patient outcomes., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We conducted a study of outcomes of modern hip resurfacing arthroplasty (HRA) in severely obese patients. Patients who had undergone HRA and been followed for a minimum of 2 years were divided into 2 groups, those with body mass index under 35 (control, 366 hips) and those with body mass index of 35 or above (study, 63 hips). At mean follow-up of 41 months, there was no significant difference between the groups with respect to postoperative Harris Hip Scores, complication rates, and need for revision. Six revision surgeries were required in the control group (98.4% survival), and 2 were required in the study group (96.8% survival). These results suggest that severely obese patients should be considered candidates for HRA.