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Purpose: To determine whether activity on Twitter was correlated with increasing impact factor (IF) among 6 orthopaedic sports medicine journals., Methods: Twitonomy software was used to collect account activity for the American Journal of Sports Medicine ; Arthroscopy: The Journal of Arthroscopic and Related Surgery; Knee Surgery, Sports Traumatology, Arthroscopy ; Journal of Shoulder and Elbow Surgery ; Orthopaedic Journal of Sports Medicine ; and Sports Health . Data from 2000 to 2020 were collected. Each journal's annual IF score was collected via scijournal.org. A multivariate regression model was used to predict the influence of different Twitter metrics on IF from 2012 to 2019. The journal name, number of tweets, and interaction of the two were used to predict IF. Additionally, Pearson correlation was used to assess correlations between Twitter account metrics and IF., Results: Over the study period, all IFs increased, with the exception of that for American Journal of Sports Medicine . The effect size between number of tweets and IF was not the same for each journal. For every additional tweet, American Journal of Sports Medicine increased its IF by 0.001 ( P  = .18). Sports Health and Orthopaedic Journal of Sports Medicine increased their IF by 0.01 ( P  = .002) and 0.022 ( P < .001), respectively. Knee Surgery, Sports Traumatology, Arthroscopy would expect a decrease in its IF by 0.004 ( P  = .55) and Journal of Shoulder and Elbow Surgery and Arthroscopy would increase its IF by 0.002 ( P  = .71) and 0.001 ( P  = .99), but this was not significant. There was a statistically significant positive correlation between annual tweets and IF across all journals., Conclusions: Markers of Twitter account activity, specifically the number of annual tweets, were predictive of an increase in IF among the orthopedic sports medicine journals included in this study., Clinical relevance: The findings of this study may allow orthopaedic sports medicine journals to make more effective, targeted, and productive use of their social media accounts to reach a broader audience, increase their influence, and increase the IF of their journal., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.K.M. reports a consulting or advisory role with Arthrex. M.K.M. is also a board or committee member of the American Academy of Orthopaedic Surgeons; American Orthopaedic Association; American Orthopaedic Society for Sports Medicine; Arthroscopy Association of North America; Association of Bone and Joint Surgeons; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and Ruth Jackson Orthopaedic Society. M.K.M. is also a member of the editorial or governing board of American Journal of Sports Medicine Electronic Media, Arthroscopy, Journal of Bone and Joint Surgery (American), and OrthoInfo. C.J.T. is a board member of the Society of Military Orthopaedic Surgeons. C.J.T. also reports travel reimbursement from the Arthroscopy Association of North America. C.J.T. is also a podcast editor for Arthroscopy. All other authors (K.K., T.R.L., S.M.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Purpose: To compare postoperative knee stability, functional outcomes, and complications after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) versus quadriceps tendon autograft., Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, the PubMed, Embase, and Cochrane Library databases were searched for studies published in 2002 or later. Studies were included if they met the following criteria: randomized controlled trials that included patients who underwent ACL reconstruction with BPTB or quadriceps tendon autograft including all soft tissue and bone-quadriceps tendon and in which measures of postoperative stability and functional outcomes were reported. Studies that were not written in English and those that analyzed animals or cadavers, were not randomized controlled trials, or used other grafts (e.g., hamstring) were excluded., Results: The initial search identified 348 studies, 6 of which were included in this systematic review. Two of the six studies found no significant difference in performance outcomes or complications between quadriceps and BPTB autografts. One study found that patients receiving quadriceps autograft self-reported improved knee functional status compared with those receiving BPTB autograft. Another study found that quadriceps autograft resulted in a significantly reduced Quadriceps Index postoperatively compared with BPTB autograft (69.5 vs 82.8, P  = .01) but found no difference in postoperative quadriceps strength. An additional study found that the outcomes of quadriceps tendon and BPTB autografts were equivalent per the International Knee Documentation Committee scale, but anterior knee pain was less severe in patients with quadriceps tendon autograft. Furthermore, one study revealed the overall International Knee Documentation Committee score was reported as normal significantly more often in patients who underwent ACL reconstruction with BPTB autograft (85% vs 50%, P < .001) and that donor-site morbidity was greater in patients with quadriceps autograft. No significant difference was found in complications requiring reoperation across studies., Conclusions: Patients undergoing ACL reconstruction with either BPTB or quadriceps tendon autograft reported improved postoperative knee stability and functional outcomes. There is no significant difference in complications between quadriceps autograft use and BPTB autograft use., Level of Evidence: Level III, systematic review of Level III retrospective studies., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.K.M. reports board membership with American Academy of Orthopaedic Surgeons, American Journal of Sports Medicine Electronic Media, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy, Arthroscopy Association of North America, Association of Bone and Joint Surgeons, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Ortho Info, and Ruth Jackson Orthopaedic Society; has a consulting or advisory relationship with Arthrex; and receives speaking and lecture fees from 10.13039/100007307Arthrex. All other authors (U.D. S.A.O. V.K.I. A.P-C.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Purpose: To (1) perform a systematic review of level I randomized controlled trials (RCTs) detailing the incidence of anterior knee pain and kneeling pain following anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft and (2) investigate the effect of bone grafting the patellar harvest site on anterior knee and kneeling pain., Methods: A systematic review of level I studies from 1980 to 2023 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome evaluated was the presence of donor site morbidity in the form of anterior knee pain or kneeling pain. A secondary subanalysis was performed to assess for differences in the incidence of postoperative pain between patient groups undergoing ACLR with BPTB receiving harvest site bone grafting and those in whom the defect was left untreated., Results: Following full-text review, 15 studies reporting on a total of 696 patients met final inclusion criteria. Patients were followed for an average of 4.78 years (range, 2.0-15.3), and the mean age ranged from 21.7 to 38 years old. The incidence of anterior knee pain, calculated from 354 patients across 10 studies, ranged from 5.4% to 48.4%. The incidence of postoperative pain with kneeling was determined to range from 4.0% to 75.6% in 490 patients from 9 studies. Patients treated with bone grafting of the BPTB harvest site had no significant difference in incidence of any knee pain compared with those who were not grafted, with incidences of 43.3% and 40.2%, respectively., Conclusions: Based on the current level I RCT data, the incidences of anterior knee pain and kneeling pain following ACLR with BPTB autograft range from 5.4% to 48.4% and 4.0% to 75.6%, respectively., Level of Evidence: Level I, systematic review of RCTs., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: A.J.S. declares he is a paid consultant for Mitek and owns stock or stock options in 10.13039/100012630Zimmer Biomet, ConMed Linvatec, 10.13039/100004331Johnson & Johnson, 10.13039/100004319Pfizer, Smith & Nephew, and 10.13039/100008894Stryker. M.K.M. declares she is a board or committee member of the 10.13039/100009885American Academy of Orthopaedic Surgeons, 10.13039/100005382American Orthopaedic Association, 10.13039/100011549American Orthopaedic Society for Sports Medicine, 10.13039/100008542Arthroscopy Association of North America, 10.13039/100013880Ruth Jackson Orthopaedic Society, and The Forum; is on the editorial or governing board of Journal of Bone & Joint Surgery, American Journal of Sports Medicine Electronic Media, Arthroscopy, and OrthoInfo; and is a paid presenter or speaker for Arthrex., (© 2024 The Authors.)

Purpose: To systematically review the literature and provide a detailed summary of the current treatments and outcomes for arthrofibrosis following knee arthroscopy and anterior cruciate ligament reconstruction (ACLR) and to compare the treatment strategies in pediatric and adult populations., Methods: A systematic review was performed in March 2022 using PubMed, EMBASE, and Cochrane Library Databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Search terms consisted of variations of the following: ("arthrofibrosis" OR "stiffness" OR "stiff" OR "complications") AND ("arthroscopy" OR "arthroscop" OR "ACL" OR "anterior cruciate") AND ("treat" OR "care" OR "management" AND "knee"). The inclusion criteria were studies that were written in English, were published since 2000, and that reported outcomes of knee arthroscopy or ACLR for treatment of arthrofibrosis of the knee. The study quality was assessed, and data about the patients and treatments were recorded. Treatments were compared between pediatric and adult patients., Results: A total of 1,208 articles were identified in the initial search, 42 (3.48%) of which met eligibility criteria, involving treatment regimens for arthrofibrosis following knee arthroscopy or ACLR. Of the 42 studies included, 29 (69.0%) were reported data for adults and 13 (31.0%) reported data for pediatric patients. Thirty-nine studies (92.8%) discussed manipulation under anesthesia and/or lysis of adhesions (LOA) as treatment for arthrofibrosis of the knee, whereas 2 (4.8%) described the use of medications., Conclusions: Within orthopaedic sports medicine literature, there is variability in the reported treatment options for arthrofibrosis of the knee. Most studies identified manipulation under anesthesia and/or LOA as the treatment among both adult and pediatric patients. Other variants include notchplasty, open posterior arthrolysis, total graft resection, removal of hardware with LOA, dynamic splinting, casting in extension, bracing, and medications., Level of Evidence: Level IV, systematic review of Level I-IV studies., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.K.M. reports personal fees from 10.13039/100007307Arthrex, outside the submitted work; 10.13039/100009885American Academy of Orthopaedic Surgeons, 10.13039/100005382American Orthopaedic Association, 10.13039/100011549American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North American, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, 10.13039/100013880Ruth Jackson Orthopaedic Society, and The Forum: board or committee member; and American Journal of Sports Medicine-Electronic Media, Arthroscopy, and Ortho Info: editorial or governing board. B.G.V. reports personal fees from Artelon, Spinal Simplicity stock options, Altior stock options, Carbon 22 stock options, American Orthopedic Foot and Ankle Society Board or Committee member. All other authors (R.R., C.B., A.T., T.M., M.L.V.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

Purpose: To determine the content posted by sports medicine orthopaedic surgeons on Instagram and Twitter and to evaluate the associated engagement., Methods: Data were collected from sports medicine orthopaedic surgeons' Instagram profiles and Twitter profiles between December 2020 and June 2022. The median number of total number of likes, comments, and retweets was calculated. The content of posts from both platforms was divided into the following categories: personal life, research, patient testimony, day in the life, pathway to becoming a physician, clinical cases, medical facts, and team coverage., Results: Data from 71 Instagram profiles and 39 Twitter profiles were used in this study. A total of 1,193 posts were identified on Instagram and 1,284 posts were identified on Twitter. The personal life category had the greatest number of posts on Instagram (303, 25.4%), whereas the medical facts category had the greatest number of posts on Twitter (251, 19.5%). Pathway to becoming a physician had the greatest median number of likes on both Instagram (97.5, range 48-2,467) and Twitter (19, range 0-50) and the greatest median number of comments on Instagram at 16 (range 1-203). The team coverage category on Instagram had the greatest percentage of likes per follower at 9.9%. A significantly greater percentage of orthopaedic surgeons posted about day in the life content, medical facts, and research on Twitter in comparison with Instagram. Instagram resulted in significantly more social media engagement than Twitter in all 8 categories ( P < .05)., Conclusions: Instagram resulted in significantly more social media engagement across all categories in comparison with Twitter with team coverage, personal life, and pathway to becoming a physician being the most popular categories., Clinical Relevance: The information learned in this study may help sports surgeons understand how they may best utilize social media to engage with others and enhance their clinical practice., Competing Interests: All authors (A.B.E., S.C.C., V.K.I., M.K.M.) declare the following financial interests/personal relationships which may be considered as potential competing interests. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.)

Purpose: To understand the opinions of both orthopaedic sports medicine fellowship program directors (PDs) and applicants regarding the utility of virtual interviews in comparison to in-person interviews following the 2022-2023 application cycle., Methods: An anonymous online survey was distributed through the American Orthopaedic Society for Sports Medicine to applicants and PDs of orthopaedic sports medicine fellowship programs. Questions in the survey included how the virtual format affected the applicants' personal connection to the program, the interview day structure, and costs associated with the interview process., Results: Responses were received from 69 of 93 PDs (74%) and 97 of 266 applicants (36%). Ninety-five percent of PDs (59 of 62) preferred in-person interviews, compared to 79% of applicants (70 of 89). Ninety-eight percent of PDs (60 of 61) and 82% of applicants (72 of 88) thought it was important/very important to interview in-person. Sixty-one percent of PDs (35 of 57) and 49% of applicants agreed/strongly agreed that conducting virtual interviews negatively affected their personal connection with the fellowship interviewee/program. The presence of virtual interviews allowed 50% (43 of 86) of applicants to go on more interviews. Thirty-two percent (18 of 57) of fellowship programs saved up to $5,000 conducting virtual interviews, and 85% (69 of 81) of applicants saved up to $5,000 on travel expenses by attending virtual interviews., Conclusions: Virtual interviews allow fellowship applicants to complete more interviews and presented financial savings for both programs and applicants. However, both PDs and applicants stated that interviewing in-person is essential for applicants to meet faculty and tour the facilities., Clinical Relevance: This study may be valuable to fellowship programs considering continued use of virtual interviews., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: M.J.K. is on the editorial or governing board for Arthroscopy. M.K.M. is a paid presenter, speaker, or consultant for Arthrex; is a board or committee member for AAOS, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Association of Bone and Joint Surgeons, Ruth Jackson Orthopaedic Society, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and is on the editorial or governing board for American Journal of Sports Medicine Electronic Media, Arthroscopy, Journal of Bone and Joint Surgery–American, and OrthoInfo. G.T. declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 The Authors.)

Objective: To develop and clinically evaluate a customizable active upper extremity (UE) assistive system with integrated functional electrical stimulation (FES) that improves function and independence of individuals during activities of daily living (ADLs)., Design: Single-arm, prospective, open-label cohort feasibility trial., Setting: An academic research institution., Participants: Subjects were 5 adults with a medical history of stroke resulting in distal UE impairment (N=5). The subjects volunteered from recruitment materials that detailed information about the study., Interventions: A novel, wearable, lightweight, low-profile, and patient-tailored UE assistive system. It comprises a splint component and FES unit that may each be controlled by electromyography (EMG) signals, inertial measurement units (IMUs), manual control source (joystick), and/or voice control., Main Outcome Measures: Several occupational therapy outcome measures were used, including the Canadian Occupational Performance Measure (COPM), Action Research Arm Test (ARAT), The Box and Blocks Test (BBT), the ABILHAND-Manual Ability Measure, and Patient Reported Outcomes Measurement Information System (PROMIS) UE Short Form., Results: All participants learned to use our UE assistive system to perform ADLs and were able to use it independently at home. Most participants experienced a clinically meaningful improvement in both performance and satisfaction for the majority of their COPM goals while using the system. All participants experienced improvement in hand grip and release as shown by their baseline and post assessment scores for hand function (BBT, ARAT) and patient-reported outcomes (ABILHAND, PROMIS)., Conclusions: The clinical outcomes suggest that our UE assistive system improves functional performance in patients with UE impairment, allowing them to engage more actively in ADLs. Further innovation including elbow and shoulder components will allow users to have more degrees of freedom during tasks., (© 2023 The Authors.)

Purpose: To report rates of preoperative and postoperative opioid use between male and female patients and to identify risk factors for extended opioid use following anterior cruciate ligament reconstruction (ACLR)., Methods: Patients undergoing ACLR between 2011 and 2018 were identified from the PearlDiver database. The opioid refill rates for males vs females were compared at monthly intervals for 1 year after ACLR. Patients who filled an opioid prescription <3 months before surgery were classified as opioid users, while those who had never filled one were classified as nonopioid users., Results: Of 106,995 ACLR patients, 37,890 (35.4%) were opioid users <3 months before surgery, and 37,554 (35.1%) had never filled an opioid prescription. Of the preoperative opioid users, 20,413 (53.9%) were female and 17,477 (46.1%) were male ( P < .001). Postoperatively, females were at higher risk of filling an opioid prescription at each monthly interval, except for the first month after surgery. The refill rate for opioid users was also higher than that for nonopioid users at each monthly interval after ACLR. In addition to patient sex, a preoperative diagnosis of anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use increased a patient's risk of filling an opioid prescription postoperatively., Conclusions: This study demonstrated that females are significantly more likely to be opioid users than males prior to ACLR and are more likely to continue to refill an opioid prescription in the year following surgery. Multiple risk factors were associated with prolonged postoperative opioid utilization, including female sex, anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use., Level of Evidence: Level III, retrospective cohort study., (© 2023 The Authors.)

Purpose: To compare the time to publication of accepted manuscripts and content in orthopaedic sports medicine journals during the first 2 years of the COVID-19 pandemic., Methods: A convenience sample of articles published in January, May, and September during the years 2019-2021 was taken from Arthroscopy , American Journal of Sports Medicine (AJSM) , and Knee Surgery, Sports Traumatology, Arthroscopy ( KSSTA ). The duration between the aspects of the article publication process was compared between journals and years., Results: Overall, 826 journal articles were included. Arthroscopy demonstrated no significant differences in the time from manuscript submission to journal publication from 2019 to 2021, a significant decrease in time from acceptance to e-Pub (140 vs 74 vs 16 days; P < .001), but an increase from e-Pub to journal publication (23 vs 74 vs 130 days; P < .001). In AJSM , there was an overall increase in time from submission to journal publication significant between 2019 and 2021 ( P  = .05) and 2020 and 2021 ( P  = .001). KSSTA demonstrated the longest timelines in 2020. There was a trend toward a greater number of systematic reviews and meta-analyses., Conclusion: Changes in various aspects of the time to publication and journal content occurred in orthopaedic sports medicine journals in the years surrounding the peak of the COVID-19 pandemic in 2020. Although it is not possible to know whether these delays are caused by journal or author-related factors, orthopaedic surgeons should be aware of the possible delay in time to publication and consider online and e-publication resources for the most current evidence-based medicine, while journals may take this information into account to consider ways of improving the publication process and when determining journal content., Clinical Relevance: It is important to understand the impact the COVID-19 pandemic had on the publications which orthopaedic sports medicine surgeons rely on for clinical knowledge and the practice of evidence-based medicine., (© 2023 The Authors.)

Purpose: The purpose of this study was to report demographic trends in terms of ethnicity/race and gender among the membership and leadership positions of the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society of Sports Medicine (AOSSM). Over the years both AANA and AOSSM will increase in diversity through their committee membership and leadership positions., Methods: AANA and AOSSM membership and leadership were reviewed for the years 2010, 2015, and 2020. Race/ethnicity was divided into Caucasian, Asian, African American (AA), Hispanic/Latin/South American (HLSA), and Middle Eastern (ME). Gender was limited to male or female, based on name and photographic depiction., Results: Diversity in AANA and AOSSM committee and leadership positions is summarized in Table 1 and Table 2, respectively. In 2010, 166/191 (87%) AANA committee members were Caucasian, as compared with 125/186 (67%) in 2020. Asian committee members were similar in 2010 (13/191, 7%) and 2015 (13/216, 6%) but increased to 17/186 (10%) in 2020. HLSA committee members increased from 5/191 (3%) 2010 to 11/186 (6%) in 2020. AA committee membership increased from 2/191 (1%) in 2010 to 5/186 (3%) in 2020. The diversity of AANA Board of Director leadership positions increased, with Caucasian representation decreasing from 14/14 (100%) 2010 to 11/12 (92%) in 2020 and Asian representation increasing from 0% in 2010 to 1/12 (8%) in 2020, with HLSA, AA and ME remaining the same with 0/12 (0%). In AANA, men comprised 181/191 (95%) committee members in 2010 and 166/186 (89%) in 2020. The percentage of female committee members increased from 10/191 (5%) in 2010 to 20/186 (11%) in 2020. In 2010, 73/79 (92%) AOSSM committee members were Caucasian compared to 62/81 (77%) in 2020 with AA having the largest increase in committee members from 0% in 2010 to 6/81 (7%) in 2020 (Table 2). Within AOSSM, men comprised 73/79 (92%) committee members in 2010 and 70/81 (86%) in 2020. The percentage of female committee members in AOSSM increased from 6/79 (8%) in 2010 to 11/81 (14%) in 2020., Conclusion: There has been a progressive trend toward increasing diversity in both committee membership and leadership positions in AANA and AOSSM from 2010 to 2020. Within AANA, there has been a decrease in the Caucasian representation from 87% in 2010 to 67% in 2020 and an increase in the female representation from 5% in 2010 to 11% in 2020. AOSSM demonstrated a similar trend, with Caucasian representation decreasing from 92% in 2010 to 77% in 2020, in addition to female percentage increasing from 8% in 2010 to 14% in 2020. Although there has been an increase in representation of minority and female orthopaedic surgeons within both societies, there is still room for more diversity and inclusion within committee membership and leadership. It is important to progress toward the understanding of the changes that need to be made and work to implement opening the field of orthopaedic sports medicine., (© 2023 The Authors.)

As one-year orthopaedic sports medicine fellowships rely heavily on elective cases and sports coverage, the COVID-19 pandemic necessitated fellowship programs to temporarily transition to virtual mediums for fellow education. Early in the pandemic, there was uncertainty as to how programs would address concerns of trainee readiness, adequate education, and accompanying psychological impact. However, with a return to prepandemic elective procedure volumes and sideline sports coverage responsibilities, sports medicine fellowships have regained some of their traditional education opportunities. Moreover, the implementation of novel training resources, including virtual didactics, augmented reality surgical skills labs, and telehealth medicine training are poised to outlast the current public health crisis and further supplement fellowship education. This article seeks to report on current evidence-based strategies and developments across several critical aspects of sports medicine training during the COVID-19 pandemic., (© 2023 The Authors.)

Purpose: To evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete description of gender diversity within this subspecialty., Methods: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last 5 years., Results: Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021 to 2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women ( P < .001). Within the past 5 years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women ( P < .001). There was no significant difference in the gender composition of current fellows compared with the composition of fellows within the last 5 years ( P  = .74). When we examined gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women ( P < .001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared with 83 men in such positions (85.6%) ( P < .001)., Conclusions: Orthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared with those who graduated in the last 5 years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine., Level of Evidence: IV, descriptive study., (© 2023 The Authors.)

Purpose: To determine the proportion of faculty members at the top orthopaedic sports medicine fellowship programs who completed a fellowship at one of these programs themselves, how many remained at their fellowship training programs as an attending (institutional loyalty), where they most commonly completed residency and medical school, and to characterize their research productivity., Methods: The fellowship programs of current orthopaedic sports medicine fellowship faculty members at each of the top 10 orthopaedic sports medicine fellowship programs (based on a recent study) were determined by searching program websites or contacting program coordinators. For each program, we determined the proportion of faculty members who completed fellowship at one of these top 10 programs and the proportion who remained at their fellowship program as an attending. Residency and medical school information was found for faculty members on their professional websites. To determine research output, each faculty member's name was searched within the Scopus database and the number of publications was recorded., Results: Data were obtained from each of the top 10 sports medicine fellowship programs. Fifty-eight of 82 (70.7%) fellowship faculty members completed fellowship at a top 10 program. Regarding institutional loyalty, 36 of 82 (43.9%) fellowship faculty members remained at the program where they trained, with one program led entirely by alumni. The average number of publications per faculty member was 130.6, with a range among the 10 programs of 23-355.8., Conclusions: Most orthopaedic sports medicine fellowship faculty at the top perceived training programs completed a fellowship at one of these same programs and maintain high research productivity., Clinical Relevance: Orthopaedic surgery trainees who wish to become faculty members at one of the top orthopaedic sports medicine training programs should aim to match into one of these top programs when applying for fellowship., (© 2023 The Authors.)

Purpose: To provide updated information on which sports medicine patients are most influenced by provider presence on social media, as well as their preferences in social media platforms and content., Methods: Between November 2021 and January 2022, an anonymous online, voluntary, self-administered questionnaire containing 13 questions was distributed to patients who had a clinic visit with 1 of 2 orthopaedic sports medicine surgeons at the same institution. Descriptive statistics were used to analyze the data., Results: A total of 159 responses were received for a response rate of 29.5%. The most common platforms used by patients were Facebook (110; 84%), YouTube (69; 53%), and Instagram (61; 47%). Most participants indicated that it did not make a difference if their sports medicine surgeon was on social media (N = 99, 62%), and they indicated they would not travel further to see a physician who was active on social media (N = 85, 54%). Compared with other age groups, significantly more respondents over the age of 50 years used Facebook to follow their physicians (47 of 60, 78%, P  = .012). Seventy-eight (50%) patients noted that they were interested in seeing medical facts, whereas 72 (46%) were interested in seeing educational videos on their physician's social media page., Conclusions: In this study, we found that sports medicine patients prefer to see educational videos and medical facts from their surgeons on social media, most predominantly on Facebook., Clinical Relevance: Social media is a popular way to connect in our modern world. As the influence of sports medicine surgeons on social media grows, it is important to understand how this is perceived by patients., (© 2023 The Authors.)

Purpose: To determine which residency programs the fellows of the top 10 orthopaedic sports medicine fellowship programs attended and whether residents are selected from the same residency programs multiple years., Methods: The residency programs of current and former fellows at each of the top 10 orthopaedic sports medicine fellowship programs (based on a recent study) over the last 5 to 10 years was determined by searching program websites and/or contacting program coordinators/directors. For each program, we determined the number of occurrences of at least 3 to 5 fellows from the same residency program. We also calculated a "pipelining ratio," defined as the ratio of the total number of fellows at the program over the duration of the study to the number of different residency programs represented within the fellowship program during that same time period., Results: Data were obtained from 7 of the top 10 fellowship programs. Of the remaining 3 programs, 1 declined to provide the information and 2 did not respond. Pipelining was found to be highly prevalent at one program, with a pipelining ratio of 1.9. Two different residency programs had at least 5 residents match at this fellowship program over the past 10 years. Four additional programs demonstrated evidence of pipelining with ratios of 1.4-1.5. Two programs exhibited minimal pipelining (ratio of 1.1). One program was found to take 2 residents from the same program in the same year on 3 different occasions., Conclusions: Most of the top orthopaedic sports medicine fellowship programs have matched fellows from the same orthopaedic surgery residency programs in multiple years., Clinical Relevance: It is important to understand how fellows are selected for sports medicine fellowship programs and to recognize the potential for inequitable bias in the selection process., (© 2023 The Authors.)

Purpose: To determine the top orthopaedic surgery sports medicine fellowship programs in the United States and the most important aspects of fellowship programs as perceived by applicants., Methods: An anonymous survey was distributed via e-mail and text message to all current/former orthopaedic surgery residents who applied to one particular orthopaedic sports medicine fellowship program during the 2017-2018 through 2021-2022 application cycles. The survey asked applicants to rank what they considered to be the top-10 orthopaedic sports medicine fellowship programs in the United States before and after completion of their application cycle, based on operative and nonoperative experience, faculty, game coverage, research, and work-life balance. Final rank was calculated by awarding 10 points for a first-place vote, 9 points for a second-place vote, etc., with total number of points used to determine final ranking for each program. Secondary outcomes included rates of applying to perceived top-10 programs, relative importance of different fellowship program aspects, and preferred type of practice., Results: Seven-hundred sixty-one surveys were distributed with 107 applicants responding (14% response rate). Applicants voted the top orthopaedic sports medicine fellowships programs to be: (1) Steadman Philippon Research Institute, (2) Rush University Medical Center, and (3) Hospital for Special Surgery, both before and following the application cycle. When ranking fellowship program aspects, faculty members and fellowship reputation were most likely to be ranked highest in importance., Conclusions: This study demonstrates that most orthopaedic sports medicine fellowship applicants highly valued program reputation and faculty members when choosing a fellowship program and that the application/interview process did not have a substantial effect on how individuals perceived the top programs., Clinical Relevance: The findings of this study are important for residents applying to orthopaedic sports medicine fellowships and may have implications on fellowship programs and future application cycles., (© 2022 The Authors.)

Purpose: To identify and characterize the most cited publications in orthopaedic research related to posterolateral corner (PLC) injuries of the knee., Methods: The Science Citation Index Expanded was queried for PLC injury articles. The 50 most-cited studies from 1976 to 2021 were selected. Article characteristics, including number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence, were analyzed., Results: The number of citations for individual articles ranged from 47 to 205. The 50 most cited articles were published in 16 journals. Eleven of the 50 articles (22%) were published in Arthroscopy-The Journal of Arthroscopic and Related Surgery . The largest proportion of the articles (n = 22, 44%) were classified as clinical, with the rest classified as reviews (n = 15, 30%), and basic science research (n = 13, 26%). The most common level of evidence for clinical articles was IV (14/22, 63.6%). Nine countries contributed to the top 50 articles, with the majority published in the United States (n = 35, 70%)., Conclusions: In the last 20 years, papers published on the diagnosis and surgical management of PLC injuries have a high citation frequency. Future high-quality research is needed to establish best-practice guidelines for the management of PLC injuries due to the low overall level of evidence of existing clinical studies., Clinical Relevance: This research provides a comprehensive list for practitioners and may help educators identify articles to include in the curriculum for residents and fellows., (© 2022 The Authors.)

Purpose: To evaluate the quality and correlation of readability on actionability and understandability of shoulder arthroscopy-related patient education materials (PEMs) found via a routine Google search., Methods: Two independent authors performed an online Google search with the term "shoulder arthroscopy." The first 5 pages of search results were then screened for PEMs. Journal articles, news articles, nontext materials, and unrelated websites were excluded. The readability of included resources was calculated using objective metrics: Flesch-Kincaid Grade Score, Simple Measure of Gobbledygook index, Coleman-Liau Index, and the Gunning Fog Index. Patient Education Material Assessment Tool for Printed Materials assessed for understandability and actionability. Associations between readability and actionability and understandability were determined using Spearman correlation and linear regression., Results: The searches returned 53 websites related to shoulder arthroscopy. A total of 34 (64%) met inclusion criteria. A high school reading level or greater was required to read the average PEM according to all scales used. The average PEM received a Patient Education Material Assessment Tool for Printed Materials score of 61.33 in understandability (range 18.75-89.47) and 55.59 points in actionability (range 16.67-83.33). An easily understood or actionable article would score at least 70 points. A moderate correlation was observed between readability and actionability on three of the scales used (r = 0.5, r = 0.59, r = 0.61)., Conclusions: Most shoulder arthroscopy PEMs identified on Google are not written at a level that the average patient can read, understand, or act on (actionability)., Clinical Relevance: Orthopaedic surgeons should be aware of the resources that patients use to obtain medical information. More accessible PEMs should be developed for patients undergoing shoulder arthroscopy to enhance comprehension of their condition and improve shared decision-making., (© 2022 The Authors.)

Purpose: To summarize the quantitative and qualitative anatomy of the acromioclavicular (AC) and coracoclavicular (CC) ligaments of the AC joint., Methods: A systematic review of the literature evaluating the quantitative and qualitative anatomy of the CC and AC ligaments of the AC joint was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines., Results: The conoid ligament (CL) arises from the posterior coracoid precipice and courses with a tapered inferior apex to insert on the conoid tubercle of the posteroinferior clavicle. The trapezoid ligament originates from the anterior-superior coracoid with medially extending fibers anterior to the conoid's C-shaped footprint and runs with the CL to insert along the trapezoid line on the inferior aspect of the anterior clavicle, anterolateral to the conoid tubercle. The AC capsule's superoposterior bundle and the CL are robust stabilizing ligaments characterized by prominent attachment sites to the posteroinferior clavicle., Conclusions: Clear and consistent quantitative and qualitative descriptions of the CC ligaments (CL and trapezoid ligament) have been well defined; however, quantitative data on the capsuloligamentous anatomy of AC ligaments (superoposterior and anteroinferior) ligaments) remain limited., Clinical Relevance: There are high complication and failure rates after AC joint stabilization. To improve patient outcomes, the anatomy of the CC and AC joints needs to be better understood., (© 2022 The Authors.)

Purpose: To obtain a quantifiable measure of the frequency with which a shoulder instability article is discussed online and the association with its corresponding bibliometric impact, based on the Scopus Cite Score (SCS) or Web of Science Impact Factor (WSIF)., Methods: The top 100 most-mentioned articles on shoulder instability based on Altmetric Attention Score (AAS) were extracted from the Altmetric Database. Mentions within blogs, news articles and outlets, public policy, and social media platforms, such as Twitter and Facebook, were included. Study impact was assessed using SCS or WSIF. The degree of association between AAS and impact was determined using Spearman correlation, logarithmic regression, and multivariate regression., Results: The most common study designs were "Clinical Trial," with 52 articles (49.5%), "Systematic Review" with 16 articles (15.2%), and "Review" with 10 articles (9.5%). Twitter provided more online mentions than other platforms, with the average article being discussed 27.7 times (range 0-220 times). A significant positive effect (estimate = 2.616, P  = .0075) was observed between the AAS and WSIF, based on the logarithmic regression. Multivariate regression revealed that blogs help raise both WSIF and SCS (estimate = 7.272, P < .05)., Conclusions: Social media and other online platforms are a strong way to disseminate information to patients. A positive association was observed between overall online attention and the bibliometric impact of an article related to shoulder instability. Clinical trials related to shoulder instability that receive online mentions, especially discussion in blogs, are more likely to be cited in the future than their counterparts., Clinical Relevance: The results of our study can guide authors as they aim to disseminate their articles. Twitter may be used as a tool to reach patients who may not venture into academic journals with current peer-reviewed articles. Further, blogs may be used to reach academic audiences and raise bibliometric impact broadly., (© 2022 The Authors.)

Purpose: The purpose of this cross-sectional study was to analyze publicly available posts on Instagram and Twitter to gain an understanding of patients' perspectives regarding Bankart injuries and repair., Methods: Public posts on Instagram and Twitter were queried from June 1, 2019, to June 1, 2020, with the following hashtags: #Bankart #Bankartrepair #Bankartlesion #labrumrepair #labralrepair #shoulderdislocation. Posts that did not contain those hashtags were excluded. In addition, posts that included that hashtag but displayed content unrelated to Bankart repair were excluded. A binary categorical system was used for media format (picture or video), perspective (patient, family or friend, physician, hospital or physical therapy group, professional organization, news media, or industry), timing (preoperative, postoperative, nonoperative), tone (positive, negative, or neutral), content (surgical site, hospital or surgeon, imaging, rehabilitation, activities of daily living [ADLs], return to work, surgical instruments, or education), post popularity (number of likes), and geographic location., Results: 1,154 Instagram posts were identified. 722/1,154 posts (62.6%) were made by patients. 600 (52.0%) of the post tones were positive, 407 (35.3%) were neutral, and 667 (57.8%) were postoperative. The most common content included in Instagram posts were ADLs (577; 50.0%), education (233; 20.2%), and rehabilitation (226; 19.6%). Overall, posts had an average of 117 likes and had geotags from 49 different countries. 155 tweets were identified, 92 of which (59.4%) were made by physicians, 113 (72.9%) were neutral, 127 (81.9%) were nonoperative, and the most common type of content posted was education (130; 83.9%). Overall, posts on Twitter had an average of 3.2 likes and had geotags from 4 different countries., Conclusions: Instagram posts were made mostly by patients postoperatively and focused on ADLs. The tone of the Instagram posts indicates that a majority of patients have a positive experience with Bankart repair. The majority of tweets were made by physicians and provided educational information with a neutral tone., Clinical Relevance: Exploring patient's experiences with Bankart repair on social media provides insight into their overall experience with the surgery. The majority of patients reported a positive experience., (© 2022 The Authors.)

Purpose: To investigate the efficacy of YouTube videos as a patient education resource related to rehabilitation and return to play following medial patellofemoral ligament (MPFL) reconstruction., Methods: YouTube was queried using 6 predetermined search terms. Videos were included if they met the following criteria: (1) written in the English language; and (2) within the first 100 videos for each search term. Videos were excluded if they met any of the following criteria: (1) not written in the English language; (2) did not include medial patellofemoral ligament/MPFL in the title; (3) duplicate videos; (4) part of a multivideo series such a vlogs; (5) advertisements; and (6) videos <1 minute. The remaining videos were evaluated by 2 independent viewers and scored using 4 distinct scoring systems: Global Quality Scale, The Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT), MPFL Rehabilitation and Return to Play Score, and the Journal of the American Medical Association benchmark criteria. The data was analyzed with IBM SPSS Statistics, version 27). The Kruskal-Wallis test was used to compare quality scores and video analytics to their assigned categories. Results where P < .05 were considered statistically significant and pairwise comparison analysis was completed to determine the video categories with statistically significant differences. Correlation of categorical variables with video analytics (views, video power index, duration, and days since publication) and quality scores was determined using the Pearson Correlation coefficient., Results: Of the initial 600 videos, 58 met inclusion criteria, which were subsequently reviewed and scored. Most videos scored on the low-end of the possible scoring ranges with a mean Global Quality Scale score of 1.61 (standard deviation [SD] 0.81), PEMAT Understandability score of 59.40 (SD 17.54), PEMAT Actionability score of 18.20 (SD 29.92), MPFL Rehabilitation and Return to Play Score of 1.64 (SD 2.13), and Journal of the American Medical Association benchmark score of 2.08 (SD 0.75)., Conclusions: The videos in YouTube's library received low scores in quality, reliability, understandability and actionability. Therefore, YouTube is currently a poor source of information for patients regarding postoperative rehabilitation and return to play following MPFL reconstruction., Clinical Relevance: Patients increasingly view medical information online. YouTube is second only to Google as the most used search engine. It is important to understand the quality of information patients receive on YouTube following MPFL reconstruction so orthopaedic surgeons know to guide patients to higher-quality alternatives., (© 2022 The Authors.)

Purpose: To describe the growth and characteristics of active orthopaedic sports medicine podcasts., Methods: Three common podcasting platforms (Apple, Google, and Spotify) were queried July 24, 2021 using the search term "sports medicine." For each unique active podcast hosted by an orthopaedic surgeon, data were collected on year of the first episode, number of episodes, frequency of episodes, types of guests, topics discussed, episode length, and social media presence. Descriptive characteristics were then calculated., Results: 15 podcasts met inclusion criteria. Seven (46.7%) of these podcasts were started within 12 months of July 24, 2021. The most common episode release schedule was weekly, and podcast lengths averaged 21 minutes, 47 seconds (SD 17:17, range: 11:02-1:49:13). All podcasts featured guests, most often from a variety of sports medicine backgrounds. Social media platforms were commonly used by podcast hosts, with social media account follower numbers as high as over 100,000, and consistent engagement across three major social media platforms for most podcasts., Conclusions: This study found that episodes are typically released weekly and average 21 minutes, 47 seconds long, with most covering a wide array of topics in sports medicine. The Facebook accounts of these podcasts displayed higher numbers of followers compared to other social media platforms; however, Instagram was superior for engagement., Clinical Relevance: Orthopaedic sports medicine podcasts have an increasing presence and can be used to increase trainee engagement and public exposure via tailoring of podcast episode lengths and selection of social media platforms with high audience interaction., (© 2022 The Authors.)

Purpose: To determine the readability of online patient information for common sports injuries., Methods: A systematic search of the literature using PubMed/MEDLINE, Embase, and the CINAHL databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were included if they (1) were published between 2000 and September 2020, (2) were English-language publications and complete studies from peer-reviewed journals, (3) evaluated online information directed toward patients with common sports injuries., Results: Eleven studies met inclusion criteria and were included. The mean Flesch-Kincaid Grade Level for online education information was 10.5, whereas the mean Flesch Reading Ease was 51.2, indicating existing health resources are written above the recommended readability grade level (no greater than a sixth-grade reading level). The mean DISCERN score was 41.5, indicating that the quality of information accessible to patients was fair. The accuracy of health content determined by the ACL-Specific Score was reported as moderate level (mean 8.85)., Conclusions: This study demonstrates that online patient information regarding common sports injuries the does not match the readability recommendations of the American Medical Association and National Institutes of health., Clinical Relevance: Future health-related information should be written by qualified experts at a level that can be easily understood by patients of all health literacy levels. Surgeons should be more attentive to where patients get their information from and how they interpret it. Accurate, easy to understand educational tools can improve efforts to help patients identify misconceptions about treatment options, and to guide patients to choices that are consistent with their values., (© 2022 The Authors.)

The increase in female participation in athletics over the past decade has been accompanied by an increase in injury rates as a result of higher demands placed on athletes. Although previous studies have shown that anatomic, biomechanical, hormonal, and psychological factors may play a role in differences between men and women that can influence injury risk in athletes, there is still a lack of understanding of sex-related mechanisms of injury, guidelines, and prevention strategies. This article provides an overview of common injuries affecting female athletes. We present guidelines for upper- and lower-extremity injury rehabilitation, focusing on considerations specific to the female athlete with the goal to facilitate a safe return to sports., Level of Evidence: Level V, expert opinion., (© 2021 The Authors.)

Purpose: To evaluate the venous thromboembolism (VTE) prophylaxis practices of surgeons performing anterior cruciate ligament reconstruction (ACLR) in female patients using hormonal contraceptives., Methods: Our research team designed an investigational survey using branching logic that was made available to the AANA membership. The survey was designed to identify clinical decision making regarding VTE prophylaxis after ACLR in patients without risk factors for VTE, the counseling of patients about VTE risk associated with hormonal contraceptives, and the use of VTE prophylaxis after ACLR in patients taking hormonal contraceptives., Results: Ninety-four respondents completed the survey. Eighty-nine respondents identified their gender (63% male and 37% female respondents). Respondents reported performing the following number of ACLRs annually: more than 50 (40%), 30 to 50 (29%), 15 to 30 (29%), and fewer than 15 (2%). Of the respondents, 62 (67%) reported that VTE developed after ACLR in their patients (male patients only, 32%; female patients only, 24%; and both male and female patients, 34%). Sixty-seven percent used chemoprophylaxis after ACLR. Surgeons who asked about hormonal contraceptive use were more likely to be women ( P  = .01; odds ratio [OR], 4.2). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to be women ( P  = .02; OR, 2.8). Surgeons who asked about hormonal contraceptive use were more likely to have female patients with VTE after ACLR ( P  = .03; OR, 2.9). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to have female patients with VTE after ACLR ( P  = .001; OR, 4.6)., Conclusions: There is no standard of care for VTE prophylaxis after ACLR. A surgeon's own gender and prior clinical experience with VTE after ACLR may influence his or her likelihood to consider a patient's hormonal contraceptive use regarding VTE risk after ACLR., Clinical Relevance: The use of hormonal contraception is a risk factor for VTE in female patients undergoing ACLR. It is important to identify current practice patterns and the need for a standard of care., (© 2022 The Authors.)

Purpose: To understand the perceptions of program directors (PDs) and fellowship applicants regarding the virtual interview process for orthopaedic surgery sports medicine fellowship programs., Methods: An anonymous online survey was distributed through the American Orthopaedic Society for Sports Medicine (AOSSM) to applicants and PDs of orthopaedic surgery sports medicine fellowship programs following the 2020-2021 fellowship application cycle., Results: A total of 40 responses were received from PDs for a response rate of 47% (40 of 85) and 72 responses were received from applicants for a response rate of 27% (72 of 271). All of the surveyed PDs (40/40, 100%) agreed/strongly agreed that the applicant's interview carries significant weight in determining where an applicant is ranked on the match list. Fifty-eight percent (23 of 40) of PDs agreed/strongly agreed that virtual interviews negatively affected their personal connection with the fellowship interviewee. The presence of virtual interviews allowed 80% (57 of 71) of applicants to go on more interviews. Seventy-three percent (51 of 70) of applicants were able to save greater than $5,000 on travel expenses and 63% (25 of 40) of fellowship programs were able to save greater than $2,500 by conducting virtual interviews., Conclusions: Virtual interviews allowed fellowship programs and applicants to complete more interviews, but both PDs and applicants stated that interviewing in-person was important for applicants to meet faculty and tour the institution where they may be spending a year. In contrast, significant financial savings resulted due to the transition to virtual interviews. Finally, both PDs and applicants were in favor of having the option of interviewing virtually, suggesting that virtual interviews may continue to play a role in future application cycles., Clinical Relevance: This study may be valuable to fellowship programs that will continue to implement virtual interviews into future application cycles., (© 2021 The Authors.)

Purpose: To identify the 50 most cited original articles on meniscus injury and surgery from 2000 to 2019, and to perform a bibliometric analysis of the identified articles., Methods: A Clarivate Web of Science search, completed in June 2020, generated a list of the most cited articles related to meniscus research. Articles were sorted by number of times cited, and review articles or those unrelated to the meniscus were removed. Articles were classified as basic science or assigned the appropriate level of evidence. Extracted data included title, authors, journal, year of publication, country/institution of origin, total number of citations, and number of citations per year., Results: The final list of 50 included articles with a range of 106 to 490 citations and a mean of 162.34 total or 11.91 citations per year. The most cited articles appeared in 8 of the most influential journals in the field per the Journal Citation Index. Twenty-nine (58%) originated from institutions within the United States, and only 13 (26%) were published in 2010 or later. Overall, 25 (50%) were classified as therapeutic, only 5 (10%) were therapeutic randomized controlled studies, and 17 (34%) were basic science. "Arthroscopic meniscal repair or meniscectomy" appeared most frequently, with 16 (32%) falling into this subclassification., Conclusion: This study of the most cited meniscus articles showed a strong predominance for therapeutic studies, studies generated and published within the United States, and studies focused on topics of arthroscopic repair or removal. Overwhelmingly, included articles were published before 2010, affirming the criticism that bibliometric analysis favors older articles., Clinical Relevance: This study provides information about which articles are driving the field relating to meniscus injuries and meniscus surgery in the last two decades., (© 2021 The Authors.)

Purpose: The purpose of this study was to determine the experiential benefit of completing a sports medicine fellowship for orthopaedic surgeons specializing in the treatment of sports injuries., Methods: Accreditation Council for Graduate Medical Education case logs were examined for sports medicine cases performed by orthopaedic surgery residents from 2006 to 2019 and for orthopaedic sports medicine fellows from 2010 to 2019. The average number of arthroscopic cases was evaluated for residents and fellows according to each body group. Additional data based on subcategorization of arthroscopic cases was analyzed as well. A Student t -test was conducted to compare the means between the groups., Results: Orthopaedic sports medicine fellows reported 274.9% more shoulder (260.6 ± 77.31 vs 94.8 ± 23.7, P < .0001), 685.6% more humerus/elbow (17.1 ± 6.14 vs 2.5 ± .508, P < .0001), 596.7% more pelvis/hip (41.4 ± 25.40 vs 6.9 ± 2.97, P < .0001), 188.1% more femur/knee (281.4 ± 57.85 vs 149.6 ± 34.09, P < .0001), and 264.1% more foot/ankle (16.9 ± 5.58 vs 6.4 ± .600, P < .0001) sports cases compared to orthopaedic surgery residents. Orthopaedic sports medicine fellows performed significantly more shoulder arthroscopy cases (126.8 ± 3.96 vs 86.0 ± 22.26, P  = .032) and knee arthroscopy cases (179.4 ± 8.98 vs 101.75 ± 33.51, P  = .015) than residents over a 5-year period., Conclusions: On average, orthopaedic sports medicine fellowships significantly increase sports case volume of orthopaedic trainees, especially in the upper extremity. Notable increases were in the shoulder, femur/knee, and pelvis/hip. We have demonstrated that orthopaedic sports medicine fellowships significantly increase exposure to sports medicine related cases., Clinical Relevance: It is important for case volume to be evaluated across orthopaedic sports medicine fellowships because they must ensure that fellows receive adequate training in orthopaedic sports medicine., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Over the last year, coronavirus disease 2019 (COVID-19) has spread across the world as a global pandemic, bringing unprecedented changes to the healthcare landscape for patients and physicians. Medical trainees have been similarly affected, as medical schools throughout the United States have implemented remote learning-based curriculums and withdrawn third- and fourth-year students from in-hospital clerkships. Of particular importance is the impact of COVID-19 on current orthopaedic surgery residents applying to subspecialty fellowship programs. Because of the highly transmissible nature of the virus and current social distancing restrictions, orthopaedic sports medicine fellowship interviews are being held virtually during the 2020-2021 application cycle. This transition to videoconference interviewing may de-emphasize an applicant's unique personality or interpersonal interactions that are traditionally captured in a variety of settings during the interview day. In turn, this may lead to increased prioritization of various aspects of the application, such as the applicant's residency program, letters of recommendation, and research productivity. Matching to a sports medicine fellowship program is an inherently competitive process and the COVID-19 pandemic presents novel challenges to orthopaedic residents in their efforts to successfully match. The purpose of this review is to describe the changes made to the orthopaedic sports medicine fellowship interview process resulting from COVID-19 during the 2020-2021 application cycle and discuss how these changes may impact the future fellowship application process. This review discusses the changes made to the orthopaedic sports medicine fellowship interview process caused by COVID-19 during the 2020-2021 application cycle. This review also assesses how such changes may impact the future application process and proposes potential adaptations to the current virtual interview format if it should become the new standard moving forward., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: To survey orthopaedic sports medicine fellowship program directors to determine the current research productivity of both fellows and faculty in Accreditation Council for Graduate Medical Education-accredited orthopaedic sports medicine fellowship programs in the United States., Methods: An anonymous 18-question survey was distributed via e-mail to all 95 Accreditation Council for Graduate Medical Education-accredited orthopaedic sports medicine fellowship program directors in the United States. Descriptive statistics were used for data analysis. Questions included whether fellows are required to complete a certain number of projects during their fellowship year and whether fellows have protected research time., Results: Of the programs, 31 (33%) responded to the survey. Twenty-four programs (80%) require fellows to complete 1 to 4 projects. Twenty-one programs (71%) provide 4 to 8 hours of weekly protected research time. Twenty-four programs (77%) publish 1 to 2 manuscripts per fellow during the fellowship. Twenty-two programs (71%) have fellows work on 1 to 2 projects at a time. Annually, 26 programs (84%) give 0 to 5 podium presentations, 24 (80%) present 0 to 5 posters, and 15 (48%) report 0 to 5 publications. Twenty-four programs (77%) have research fellows and/or assistants to help with research. The presence of dedicated research assistants and more than 25 annual fellowship program publications were found to be useful screening data for more than 2 and more than 4 average publications per fellow, respectively., Conclusions: The research productivity of orthopaedic sports medicine fellowship programs may be an important consideration for applicants. Applicants who desire to be productive in research during their fellowship year should consider programs with dedicated research assistants and/or programs that publish more than 25 times annually., Clinical Relevance: This is a descriptive epidemiologic study that helps define the research productivity landscape in orthopaedic sports medicine fellowships. A more accurate understanding of sports medicine fellowship research experience may facilitate a better match between a program's research expectations and an applicant's research interests., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: The purpose of this study was to examine how the implementation of Accreditation Council of Graduate Medical Education (ACGME) case minimums in 2013 has affected the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents during their clinical training., Methods: The ACGME orthopaedic surgery case log data from graduation years 2007 to 2019 was used to evaluate the number of shoulder and knee arthroscopies performed. The mean and median number of cases performed per resident were compared for the years prior to implementation of the ACGME case minimum (2007-2012) and after (2013-2019)., Results: The ACGME orthopaedic surgery case minimums resulted in a significant decrease in the mean number of shoulder and knee arthroscopies performed. The mean number of shoulder arthroscopies performed in the years before and after the case minimum requirement were 109.8 and 82.0 ( P  = .025), respectively. The mean number of knee arthroscopies performed in the years before and after the case minimum requirement were 178.6 and 124.8 ( P  = .006), respectively. Residents in the tenth percentile of cases performed still met the required ACGME case minimums each year. The mean total of all cases performed in the years before and after the case minimum requirement were 2045.5 and 1699.3 ( P  = .038), respectively., Conclusions: The number of shoulder and knee arthroscopies performed by orthopaedic surgery residents significantly decreased after the implementation of ACGME case minimums, which may be due to underreporting of cases., Clinical Relevance: This study may demonstrate the effect of the implementation of the ACGME case minimums on the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: To identify the factors considered most important by sports medicine fellowship applicants when deciding where to apply and ultimately interview., Methods: An anonymous, electronic survey was distributed in 2018 via e-mail to orthopaedic surgery residents who applied to a specific orthopaedic sports medicine fellowship program in 2015 and 2016. The survey included questions regarding the number of fellowships applications per respondent and the number of interviews they were offered and accepted. Questions regarding the application process were included. Participants also were asked to rank 9 criteria from most to least important (1 being most important; 9 being least important) when deciding where to apply or accept interviews. Each criterion's score reflects its average ranking among respondents., Results: Among the 99 orthopaedic surgery residents applying to this fellowship program, 42 (42.4%) completed the survey. The factors considered most influential included variety and complexity of surgical exposure (2.16), autonomy (3.72), and reputation of faculty members (4.05). The factors considered least important were program size (7.21), job placement of past fellows (7.07), and geographic location (5.68)., Conclusions: Variety and complexity of surgical exposure, operative autonomy, and program reputation were valued as the most important factors for orthopaedic surgery residents applying to sports medicine fellowship programs., Clinical Relevance: The information obtained in this study may provide sports medicine fellowship programs and orthopaedic residents with a better understanding of factors that are considered to be important by sports medicine fellowship applicants. This will improve training for future sports medicine specialists, thus improving the care that they provide to their patients., (© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America.)

Purpose: The purpose of this study was to assess the availability and variability of publicly accessible acromioclavicular (AC) joint reconstruction rehabilitation protocols., Methods: Protocols were identified by searching the websites of orthopedic surgery residency programs in the United States located from the Fellowship and Residency Electronic Interactive Database Access System. Private practice groups with publicly available protocols were also included., Results: Twenty-one protocols were included for review. Four of 14 (29%) protocols suggested starting passive range of motion (ROM) at postoperative week 2. Six of 20 (30%) protocols recommended initiation of full ROM at 6 weeks. Active ROM beginning at 6 weeks was recommended by 6 of 20 (30%) protocols. Six of 16 (38%) protocols recommended initiating active assisted ROM at 6 weeks. Sling immobilization for 6 weeks was recommended by 8 of 18 (44%) protocols. Shoulder isometric exercise initiated at 4 weeks was recommended by 4 of 13 (31%) protocols. Seven of 21 (33%) protocols recommended initiating shoulder strengthening at 12 weeks postoperatively. Return to sport time was included in 17 (81%) protocols with a range of 12 to 48 weeks (mean, 22 weeks)., Conclusions: There was substantial variability in publicly accessible AC joint rehabilitation protocols, including a wide range in the recommendations for appropriate time to return to sport. Although strengthening exercises, active ROM, and active assisted ROM were recommended by most protocols, there were considerable differences in recommendations for when to initiate these rehabilitation components., Clinical Relevance: Rehabilitation is important for outcomes of AC joint reconstruction. This study shows the variability present in rehabilitation recommendations among online-accessible AC joint reconstruction rehabilitation protocols., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Introduction: The purpose of this study was to determine which components of sports medicine fellowships are most important to applicants when reviewing fellowship websites during the application process., Methods: An anonymous survey was distributed to 492 fellowship applicants from the 2017-2018 and 2018-2019 cycles. The survey included questions about the importance of including components of fellow education, recruitment, and experience on program websites. The weighted average of responses determined each component's rank, with 5 being "very important" and 1 being "not at all important." Responses were analyzed by application cycle, current position, and sex using the Wilcoxon rank-sum test., Results: Sixty-five applicants participated in the survey and completed the demographics section, resulting in a 13.2% response rate. According to participants, the most important components to include on fellowship websites were exposure to advanced operative sports medicine techniques (weighted average, 4.62), complexity of cases performed (4.52), and number of cases performed (4.50). Analysis demonstrated statistically significant differences in opinion between application cycles for flexibility for conducting a remote interview ( P  = .0074), jobs obtained by previous fellows ( P  = .019), national rank of department ( P  = .021), program's geographic location ( P  = .026), protected academic time ( P  = .038), current positions for criteria for fellows' performance evaluations ( P  = .028), program's geographic location ( P  = .0097), and protected academic time ( P  = .0079). There were statistically significant differences in opinion between current positions regarding flexibility for conducting a remote interview ( P  = .0026), jobs obtained by previous fellows ( P  = .012), and national rank of department ( P  = .0013)., Conclusions: Orthopaedic sports medicine fellowship applicants believe that it is most important to include information about the volume and complexity of fellows' cases and their day-to-day commitments on program websites., Clinical Relevance: This information would enable applicants to identify programs that will support professional development and allow program directors to communicate expectations.

Purpose: To evaluate the process of applying to orthopaedic sports medicine fellowships from the applicant's perspective, with a focus on number of program applications, interviews, interview day importance, and financial burden., Methods: An anonymous electronic survey was distributed to all orthopaedic surgery residents who applied to orthopaedic sports medicine fellowships in the United States in 2016 and 2017. The survey contained 26 questions, with 10 pertaining to applicant demographics, accolades, and examination scores. A follow up e-mail was distributed at 2 and 4 weeks to increase participation., Results: The survey was distributed to 453 sports medicine fellowship applicants; 148 (34.1%) completed the survey. Of the respondents, 130 (87.8%) were male and 18 (12.2%) were female. When analyzing United States Medical Licensing Examination scores, respondents who scored above a 251 on Step 2 CK were more likely to receive more than 20 interviews compared with those who scored lower ( P  = .013). Previous collegiate or professional athlete status did not influence the number of interviews received. In total, 94 of 147 (64.0%) respondents applied to more than 20 programs, and 73 respondents (49.7%) attended between 11 and 15 interviews. The majority of respondents spent between $4001 and $6000 (49; 33.1%) throughout the application process. Interaction with faculty and case volume/complexity were the most important factors in ranking programs., Conclusions: The majority of orthopaedic surgery residents pursue at least 1 year of fellowship training following residency, with sports medicine being one of the most popular specialties. The application process for sports medicine fellowships is complex, competitive, and a financial burden for applicants. Most applicants apply to more than 20 programs, spend between $4000 and $6,000 over the course of the application process, and value faculty interaction and case volume/complexity over other factors associated with a program., Clinical Relevance: As other surgical fellowships have detailed their application process from the applicant's perspective, there remains a need for increased transparency of the sports medicine fellowship application in order to offer additional insight and guidance for future applicants., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: To determine whether differences in return-to-play (RTP) rate and performance-based outcomes exist following shoulder arthroscopy in athletes from the National Football League (NFL), National Basketball League (NBA), Major League Baseball (MLB), and National Hockey League (NHL)., Methods: Professional athletes from the NFL, NBA, MLB, and NHL who underwent shoulder arthroscopy between January 1998 and December 2016 were identified through an established review of injury reports and public archives. Sport-specific statistics were collected before and after shoulder arthroscopy for each athlete, providing a performance score. RTP was defined as the first game played postsurgery., Results: Of the 208 professional athletes who met the inclusion criteria, 167 (80.3%) returned to play following shoulder arthroscopy, with MLB players returning at a significantly lower rate than those of other sports ( P < .0001). NBA players had significantly shorter recovery times (201 days; P < .01) and MLB players had significantly longer recovery times (413 days; P < .001) when compared with athletes in other sports. The mean number of seasons played after shoulder arthroscopy was 3.7, 4.7, 4.8, and 5.8 for MLB, NFL, NHL, and NBA, respectively. NBA players performed worse in their first season postoperative compared with their preoperative performance ( P  = .0017), but their postoperative season 2 performance returned to their preoperative performance level ( P  = .1893). Similarly, NHL players performed worse in their postoperative season 1 compared with preoperative performance ( P  = .0274), but their postoperative season 2 performance improved upon their preinjury performance level ( P  = .0861)., Conclusions: There is a modest RTP rate among professional athletes following shoulder arthroscopy. MLB players have the longest average time to RTP and the shortest postinjury careers following shoulder arthroscopy. However, they demonstrate no significant decline in performance following their injury. Conversely, NBA players had the shortest average time to RTP and the longest post-injury career. Both NBA and NHL athletes experienced a decrease in performance in post-operative season one., Level of Evidence: Level III, retrospective comparative study., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: To compare and contrast the various rehabilitation protocols for medial patellofemoral ligament (MPFL) reconstruction and MPFL reconstruction plus tibial tubercle osteotomy (TTO) published online by academic orthopaedic surgery residency programs and private practice institutions throughout the United States., Methods: We performed a systematic electronic search of MPFL reconstruction rehabilitation protocols in academic orthopaedic surgery residency programs in the United States using Google's search engine (www.google.com) based on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA). Private practice organizations publishing MPFL reconstruction or MPFL reconstruction-TTO rehabilitation protocols that were found on the first page of search results were also included, but no comprehensive search for private practice protocols was performed. Protocols specifying an MPFL reconstruction with TTO were included for separate review because of altered weight-bearing status postoperatively. A list of comparative criteria was created to assess the protocols for the presence and timing of the various rehabilitation components., Results: From the list of 189 U.S. academic residency programs, as well as additional private practice protocols found in the Google search, 38 protocols were included for review (31 protocols for isolated MPFL reconstruction and 7 protocols for MPFL reconstruction plus TTO). A return to full range of motion by week 6 was recommended by 15 (48.4%) of the isolated MPFL reconstruction protocols and 6 (85.7%) of the MPFL reconstruction-TTO protocols. Six weeks of knee brace wear was recommended by 13 isolated MPFL reconstruction protocols (43.3%) and 4 MPFL reconstruction-TTO protocols (57.1%). Moreover, 6 isolated MPFL reconstruction protocols (19.4%) and 3 MPFL reconstruction-TTO protocols (42.9%) recommended use of a patellar stabilizing brace postoperatively., Conclusions: There is substantial variability among rehabilitation protocols after MPFL reconstruction, as well as MPFL reconstruction plus TTO, including postoperative range of motion, weight-bearing status, and time until return to sport. Furthermore, many online protocols from academic orthopaedic surgery residency programs and private practices in the United States fail to mention several of these parameters, most notably functional testing to allow patients to return to sport., Clinical Relevance: Proper rehabilitation after MPFL reconstruction with or without TTO is an important factor to a patient's postoperative outcome. This study outlines the variability in online rehabilitation protocols after MPFL reconstruction with or without TTO published online by academic residency programs and private practice institutions., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: To evaluate the presence of sex-specific analysis (SSA) in abstracts accepted for podium presentation at the Arthroscopy Association of North America (AANA) and American Orthopaedic Society for Sports Medicine (AOSSM) annual meetings from 2016 to 2019., Methods: Abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019 were selected for review. Studies that included sex as a variable in a multifactorial statistical model were considered to have performed adequate SSA. Secondary data collected included whether the abstract had a female lead or senior author, the degrees of the female authors, and the anatomic focuses of studies with SSA., Results: Of the 891 total abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019, 90 (10%) included SSA. There were 284 AANA abstracts, 24 (8%) of which reported SSA. Of the 607 AOSSM abstracts, 66 (11%) reported SSA. There were 43 female first authors (15%) and 33 female senior authors (12%) of the AANA abstracts compared with 92 female first authors (15%) and 39 female senior authors (6%) of the AOSSM abstracts. Of the 891 total abstracts, 135 (15%) listed a female lead author and 72 (8%) had a female senior author. Of the 135 female first authors, 92 (68%) had an M.D., whereas 40 of the 72 female senior authors (56%) had an M.D. Analysis of all abstracts combined showed a positive correlation between SSA and a female first author (Pearson correlation coefficient = 0.035, P  = .147), as well as between SSA and a female senior author (Pearson correlation coefficient = 0.052, P  = .059)., Conclusions: From 2016 to 2019, only 10% of abstracts accepted for podium presentation at the AANA and AOSSM annual meetings included SSA. Altogether, women represented 15% of first authors and 8% of senior authors., Clinical Relevance: This study highlights the low percentage of SSA in abstracts presented at the AANA and AOSSM annual meetings from 2016 to 2019. Future studies should attempt to perform SSA when relevant to better evaluate differences in outcomes between male and female patients., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Purpose: To determine how well the orthopaedic sports medicine literature reported sex-specific analysis (SSA) in 2011 and 2016., Methods: The 3 highest-impact orthopaedic sports medicine subspecialty journals ( American Journal of Sports Medicine ; Arthroscopy ; and Knee Surgery, Sports Traumatology , Arthroscopy ) were selected for review. Two independent investigators reviewed all journal issues published during 2 different calendar years (2011 and 2016). All randomized controlled, prospective and retrospective group, and case-control studies were included. Studies were stratified into those that involved SSA, where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or used sex-matched groups without further analysis., Results: A total of 960 studies evaluating 3,400,569 patients met criteria and were included in this review. Although 44.4% of the overall study population was female, only 293 (30.5%) studies included patient sex as variable in a multifactorial statistical model. The proportion of studies that performed SSA did not differ between 2011 (29.6%) and 2016 (31.1%; P  = .607), although publications from American Journal of Sports Medicine were likely to report SSA ( P < .05). Of the 293 studies that reported SSA, 91 (31%) demonstrated a significant difference in outcomes. The most commonly reported differences were in outcomes following anterior cruciate ligament, medial patellofemoral ligament, and posterior cruciate ligament reconstruction; autograft preparation; postoperative use of opiates following arthroscopy; and recovery after sports-related concussions., Conclusions: Although most sports medicine studies include approximately 50% female and 50% male patients, statistical analysis differentiating the 2 subsets is not routinely performed. Only 30.5% of all studies performed SSA, 31% of which reported a statistically significant difference in the data when comparing outcomes between male and female patients with the same treatment modalities., Clinical Relevance: The current study demonstrates that the orthopaedic sports medicine subspecialty literature is lacking in reporting SSA, and that there has been minimal improvement over a 5-year time period. In addition, this study highlights the high percentage of significant findings within the studies that performed SSA and underscores the differences in sex-specific injury patterns and treatment outcomes., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)