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Background: The purpose of this study was to develop a multifaceted examination to assess the competence of fellows following completion of a sports medicine fellowship. Methods: Orthopedic sports medicine fellows over 2 academic years were invited to participate in the study. Clinical skills were evaluated with objective structured clinical examinations, multiple-choice question examinations, an in-training evaluation report and a surgical logbook. Fellows' performance of 3 technical procedures was assessed both intraoperatively and on cadavers: anterior cruciate ligament reconstruction (ACLR), arthroscopic rotator cuff repair (RCR) and arthroscopic shoulder Bankart repair. Technical procedural skills were assessed using previously validated task-specific checklists and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale. Results: Over 2 years, 12 fellows were assessed. The Cronbach [alpha] for the technical assessments was greater than 0.8, and the interrater reliability for the cadaveric assessments was greater than 0.78, indicating satisfactory reliability. When assessed in the operating room, all fellows were determined to have achieved a minimal level of competence in the 3 surgical procedures, with the exception of 1 fellow who was not able achieve competence in ACLR. When their performance on cadaveric specimens was assessed, 2 of 12 (17%) fellows were not able to demonstrate a minimal level of competence in ACLR, 2 of 10 (20%) were not able to demonstrate a minimal level of competence for RCR and 3 of 10 (30%) were not able to demonstrate a minimal level of competence for Bankart repair. Conclusion: There was a disparity between fellows' performance in the operating room and their performance in the high-fidelity cadaveric setting, suggesting that technical performance in the operating room may not be the most appropriate measure for assessment of fellows' competence. Contexte : Le but de cette etude etait de concevoir un examen a plusieurs volets pour evaluer la competence des moniteurs cliniques a la fn de leur formation en medecine sportive. Methodes : Apres leur formation de 2 ans pour devenir orthopedistes en medecine sportive, les moniteurs cliniques ont ete invites a participer a l'etude. Leurs habiletes cliniques ont ete evaluees au moyen d'examens cliniques objectifs structures, de questionnaires a choix multiple, d'un rapport d'evaluation en cours de formation et d'un journal de bord chirurgical. Leur habilete a realiser 3 techniques chirurgicales differentes a ete evaluee au bloc operatoire et sur des cadavres : reconstruction du ligament croise anterieur (RLCA), reparation arthroscopique de la coiffe des rotateurs (RACR) et intervention de Bankart sous endoscopie pour l'epaule. Les habiletes techniques ont ete evaluees au moyen de listes de verification specifiques aux taches validees et au moyen de l'outil d'evaluation globale ASSET (Arthroscopic Surgical Skill Evaluation). Resultats : Sur une periode de 2 ans, 12 moniteurs ont ete evalues. Le coefficient [alpha] de Cronbach pour les evaluations techniques a ete superieur a 0,8, et la fabilite interexaminateurs pour l'evaluation des interventions sur des cadavres a ete superieure a 0,78, soit une fabilite jugee satisfaisante. Lors de l'evaluation au bloc operatoire, on a juge que tous les moniteurs detenaient le niveau minimum de competences pour executer les 3 techniques chirurgicales, a l'exception d'un seul qui n'a pas atteint le niveau de competence pour la RLCA. A l'evaluation de leurs competences pour les interventions sur des cadavres, 2 sur 12 (17 %) n'ont pas atteint le niveau minimum de competence pour la RLCA, 2 sur 10 (20 %) pour la RACR et 3 sur 10 (30 %) pour l'intervention de Bankart. Conclusion : On a note une disparite dans la competence des moniteurs entre le bloc operatoire et le contexte cadaverique haute fidelite, ce qui donne a penser que le rendement technique au bloc operatoire pourrait ne pas etre le moyen le plus approprie d'evaluer la competence des moniteurs cliniques., An increasing number of orthopedic surgeons have been undertaking fellowship training over the last 30 years; as of 2013, more than 90% of orthopedic surgeons in the United States were [...]

The purpose of this review was to determine whether there is a benefit to early weight bearing or mobilization in surgically treated ankle fractures. All randomized controlled trials that analyzed early vs delayed weight bearing and/or mobilization after an ankle surgery were included. The primary outcome measure was the pooled Olerud Molander Ankle Score 1 year postoperatively. No significant differences in ankle function were found at 1 year postoperatively between early and delayed weight bearing and mobilization. The 12-week results demonstrated superior early ankle function scores for patients who had early weight bearing. Patients who had early mobilization were at increased risk for postoperative complications. In surgically treated ankle fractures, early weight bearing resulted in improved short-term ankle function scores. [Orthopedics. 2024;47(2):71–78.] [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction (BFR) training has been shown to have beneficial effects in reducing quadriceps muscle atrophy and improving strength in patients with various knee pathologies. Furthermore, the effectiveness of BFR training in patients undergoing knee surgery has been investigated to determine if its use can improve clinical outcomes. Purpose/Hypothesis: The purpose of this study was to conduct a systematic review and meta-analysis to examine the effectiveness of BFR training in patients undergoing knee surgery. We hypothesized that BFR, before or after surgery, would improve clinical outcomes as well as muscle strength and volume. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: This systematic review and meta-analysis of peer-reviewed literature was conducted using PubMed, Embase, and Cochrane databases from 1980 to present. Search results were limited to those assessing BFR training in patients undergoing knee surgery published in a scientific peer-reviewed journal in English. Selected studies subsequently underwent data extraction, methodological quality assessment, and data analysis. Results: Eleven studies were eligible, including anterior cruciate ligament reconstruction (n = 10) and knee arthroscopy (n = 1). Two studies specifically assessed BFR use in the preoperative time frame. For the meta-analysis, including 4 studies, the primary outcome variables included the cross-sectional area of the quadratus femoris muscle group assessed with magnetic resonance imaging or ultrasonography, and patient-reported outcome measure scores. The results demonstrated that BFR use in the postoperative time period can lead to a significant improvement in the cross-sectional area when quantifying muscle atrophy. However, there were no significant differences found for patient-reported outcome measures between the included studies. It should be noted that 4 of the included papers in this review reported increases in clinical strength when using BFR in the postoperative setting. Last, preoperative BFR training did not show any significant clinical benefit between the 2 studies. Conclusion: This is the first systematic review and meta-analysis to study the effects of BFR in patients undergoing knee surgery. The results of this analysis show that BFR in the postoperative period after knee surgery can improve quadriceps muscle bulk compared with a control group. However, future research should examine the effects of preconditioning with BFR before surgery. Lastly, BFR protocols need to be further investigated to determine which provide the best patient outcomes. This will help standardize this type of treatment modality for future studies. [ABSTRACT FROM AUTHOR]

Background: Given recent evolving guidelines regarding postcall clinical relief of residents and emphasis on quality of life, novel strategies are required for implementing call schedules. The night float system has been used by some institutions as a strategy to decrease the burden of call on resident quality of life in level-1 trauma centres. The purpose of this study was to determine whether there are differences in quality of life, work-related stressors and educational experience between orthopedic surgery residents in the night float and standard call systems at 2 level-1 trauma centres. Methods: We conducted a prospective cohort study at 2 level-1 trauma hospitals comprising a standard call (1 night in 4) group and a night float (5 14-hour shifts [5 pm-7 am] from Monday to Friday) group for each hospital. Over the course of a 6-month rotation, each resident completed 3 weeks of night float. The remainder of the time on the trauma service consists of clinical duties from 6:30 am to 5:30 pm on a daily basis and intermittent coverage of weekend call only. Residents completed the Short Form-36 (SF-36) general quality-of-life questionnaire, as well as questionnaires on stress level and educational experience before the rotation (baseline) and at 2, 4 and 6 months. We performed an analysis of covariance to compare between-group differences using the baseline scores as covariates and Wilcoxon signed-rank tests (nonparametric) to determine if the residents' SF-36 scores were different from the age- and sex-matched Canadian norms. We analyzed predictors of resident quality of life using multivariable mixed models. Results: Seven residents were in the standard call group and 9 in the night float group, for a total of 16 residents (all men, mean age 35.1 yr). Controlling for between-group differences at baseline, residents on the night float rotation had significantly lower role physical, bodily pain, social function and physical component scale scores over the 6-month observation period. Compared with the Canadian normative population, the night float group had significantly lower SF-36 scores in all subscales except for bodily pain. There were no differences noted between the standard call group and Canadian norms at 6 months. No differences in educational benefits and stress level were measured between the 2 groups. Lack of time for physical activity was only significant in the night float group. Regression analysis demonstrated that the increased number of hours in hospital correlated with significantly lower SF-36 scores in almost all domains. Conclusion: Our study suggests that the residents in the standard call group had better health-related quality of life compared with those in the night float group. No differences existed in subjective educational benefits and stress level between the groups. Contexte: Compte tenu de l'evolution recente des directives concernant le repos des residents apres des gardes cliniques et l'insistance mise sur leur qualite de vie, de nouvelles strategies sont necessaires pour la mise en oeuvre des horaires de garde. Le systeme d'equipes de garde de nuit (night float) a ete utilise par certains etablissements comme strategie visant a soulager le fardeau des heures de garde pour la qualite de vie des residents dans des centres de traumatologie de niveau 1. L'objectif de cette etude etait de determiner s'il y avait des differences dans la qualite de vie, les facteurs de stress lies au travail et la formation de residents en chirurgie orthopedique entre les systemes d'equipes de nuit et le systeme habituel de garde sur appel dans 2 centres de traumatologie de niveau 1. Methodes: Dans 2 hopitaux de traumatologie de niveau 1, nous avons effectue une etude prospective de cohorte comportant 1 groupe de service de garde standard (1 nuit sur 4) et 1 groupe d'equipes de nuit (5 periodes de 14 heures [17 h a 7 h] du lundi au vendredi) dans chaque hopital. Au cours d'un stage de 6 mois, chaque resident a effectue 3 semaines en equipe de nuit. Le reste du temps passe dans le service de traumatologie comportait les taches cliniques quotidiennes de 6 h 30 a 17 h 30 et les heures de garde, en fin de semaine uniquement, par intermittence. Les residents ont rempli le questionnaire Short Form-36 (SF-36--formulaire abrege 36) au sujet de leur qualite de vie globale ainsi que des questionnaires sur leur niveau de stress et leur experience en termes de formation avant le debut du stage (point de reference), puis a 2, 4 et 6 mois. Nous avons effectue une analyse de covariance pour comparer les groupes en utilisant les resultats au point de reference comme covariables et le test des rangs signes de Wilcoxon (non parametrique) pour determiner si les resultats du SF-36 etaient differents des normes canadiennes appariees pour l'age et le sexe. Nous avons analyse les elements predictifs de la qualite de vie des residents au moyen de modeles mixtes multifactoriels. Resultats: Le groupe de garde standard comportait 7 residents et le groupe des equipes de nuit, 9 residents, soit un total de 16 residents (tous masculins; age moyen de 35,1 ans). Apres controle des differences entre les groupes au point de reference, les residents en equipe de nuit ont affiche des resultats significativement inferieurs au cours de la periode d'observation de 6 mois pour les composantes suivantes de l'echelle: etat physique lie a la fonction, douleur corporelle, vie sociale et etat physique general. Comparativement a la population canadienne de reference, le groupe des equipes de nuit a affiche des resultats significativement inferieurs dans toutes les sous-echelles du SF-36, sauf pour la douleur corporelle. On n'a constate aucune difference entre le groupe de garde standard et les normes canadiennes a 6 mois. Aucune difference en matiere de benefice de formation et de niveau de stress n'a ete observee entre les 2 groupes. Le manque de temps pour une activite physique n'a ete significatif que pour le groupe des equipes de nuit. Une analyse de regression a montre que l'augmentation du nombre d'heures passees a l'hopital etait correlee a des baisses significatives des resultats du SF-36 dans pratiquement tous les domaines. Conclusion: Notre etude suggere que les residents du groupe de garde standard avaient une meilleure qualite de vie en termes de sante que le groupe des equipes de nuit. Il n'y a eu aucune difference entre les 2 groupes sur le plan des avantages subjectifs pour la formation et le niveau de stress., The Accreditation Council for Graduate Medical Education instituted resident work-hour restrictions effective July 1, 2003. (1) The council mandates that residents work no more than 80 hours per week. Comparatively, [...]