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Diffusion tensor imaging (DTI) of the spinal cord has been extensively used to identify biomarkers for spinal cord pathology. Previously, the longitudinal ComBat (longComBat) technique was examined to reduce scanner effects in multi-site, multi-scanner spinal cord DTI data. This study aimed to assess its effectiveness on longitudinal scans using a single-scanner pediatric dataset, including healthy and spinal cord injury (SCI) subjects. Two identical datasets were collected from 42 healthy and 27 SCI subjects with a 2-hour interval between scans on a 3T Siemens MRI scanner. Axial DTI images of the entire cervical and thoracic spinal cord were obtained, and various average diffusion tensor metrics (FA, MD, RD, & AD) were measured at each vertebral level. Pearson correlation and intraclass correlation coefficients were used to evaluate inter- and intra-subject agreement pre- and post-harmonization. Minimal improvement in agreement was observed with the mean square residual (MSR) model, while the restricted maximum likelihood estimator (REML) model showed reduced intra-subject agreement in all the tensor metrics. The significant variability between longitudinal DTI scans within a single scanner was likely due to physiological motion rather than scanner effects. Post-harmonization using the longComBat MSR model showed limited improvement in agreement., Competing Interests: Additional information Competing interests The authors declare no competing interests.

Hypothesis and Background: A potential complication of distal biceps repair is heterotopic ossification (HO), which impacts both limb function and overall patient outcomes. Common HO prophylaxis methods include nonsteroidal anti-inflammatory drugs or localized radiation therapy. The purpose of this systematic review was to determine an effective means of providing HO prophylaxis following distal biceps repair., Methods: A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched for studies published after 1998: PubMed, Embase, and Cochrane Library. Studies were included if they compared patients who were placed on HO prophylaxis following distal biceps repair compared to those that were not placed on HO prophylaxis, were prospective randomized controlled trials or retrospective case-control studies, and evaluated HO prophylaxis regimens. Studies that were not written in English, analyzed animals or cadavers, and did not directly evaluate patients undergoing distal biceps repair, did not study HO rophylaxis, or had alternative study designs were excluded., Results: The initial search identified 134 studies, 4 of which met the inclusion criteria and were included in the study. Each of these 4 (100%) studies evaluated indomethacin, and 1 (25%) study evaluated both indomethacin and meloxicam. The included studies evaluated HO prophylaxis in the setting of both one- and two-incision distal biceps repairs. Overall, 2 of the 4 (50%) studies supported the use of indomethacin as HO prophylaxis, 1 of 4 (25%) did not support the use of indomethacin for HO prophylaxis, and 1 of 4 (25%) studies reported that indomethacin and meloxicam are similarly effective HO prophylaxis drugs. None of the studies meeting the inclusion criteria analyzed radiation therapy as a potential method for HO prophylaxis., Discussion and Conclusion: Indomethacin is commonly used as a prophylactic measure for HO following distal biceps repair; however, based on the results of this study, it is not necessary to use this routinely due to its limited efficacy in preventing HO and potential risks (eg, gastrointestinal upset, bleeding) associated with the medication. Future randomized studies should evaluate the use of other nonsteroidal anti-inflammatory drugs (eg, meloxicam) for HO prophylaxis in addition to not using any HO prophylaxis following either one- or two-incision distal biceps repairs., (© 2024 The Author(s).)

Purpose: To analyze factors that affect return to sport after medial patellofemoral ligament reconstruction (MPFLR), such as psychological factors, sport played, and a positive apprehension test following surgery, and to determine the average return to sport rates and time to return to sport., Methods: A literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies met the following criteria: patients underwent MPFLR for patellar instability, return to sport was recorded, and a factor that affected return to sport was mentioned. Search terms included medial patellofemoral ligament, tibial tubercle osteotomy, tibial tubercle transfer, return to play, and return to sport., Results: Eighteen of 632 identified studies met inclusion criteria, and 1,072 patients who underwent MFPLR were recorded. Return-to-sport rates and mean/median time ranged from 60.0% to 100% and 3 to 10.4 months, respectively. Of the patients, 55.6% to 84.0% returned to sport without decreasing the level of competition. Six of 12 studies (50.0%) reported fear of reinjury as the top reason for patients not returning or returning at a lower level of sport. Volleyball/handball had the lowest return to the same level following surgery (18.2%-50.0%)., Conclusions: Athletes who underwent MPFLR following recurrent patellar instability returned to sport at a range of 60.0% to 100%. Return to sport at the same level or higher was found to have a lower maximum rate at 55.6% to 84.0%. Fear of reinjury and sport played were found to have a substantial impact on ability to return to sport. Surgeons can use this information to advise patients on expectations following surgery., Level of Evidence: Level IV, systematic review of Level III and IV studies., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.K.M. is a consultant or advisor for Arthrex, has received speaking and lecture fees from Arthrex, and is a board member of the 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, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Ortho Info, Ruth Jackson Orthopaedic Society, Association of Bone and Joint Surgeons, and Journal of Bone and Joint Surgery. All other authors (P.C.R., I.C.C., V.K.I., K.P.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objectives: The proportion of women in orthopaedic surgery is low compared to other specialties, despite equal numbers of male and female students entering the medical profession. This gender disparity persists across various aspects of orthopaedic sports medicine, such as academic leadership, medical education, and on the sidelines. The purpose of this study was to conduct a comprehensive and updated global analysis of female representation in leadership positions within orthopaedic sports medicine and arthroscopy societies throughout the world., Methods: Publicly available websites for orthopaedic sports medicine societies throughout the world were evaluated. For societies that met inclusion criteria, the following data were collected: types of leadership positions available and breakdown of male and female orthopaedic surgeons in those positions., Results: There were a total of 55 societies analyzed from North America (5, 9.1%), South America (8, 14.5%), Europe (18, 32.7%), Asia (13, 23.6%), Africa (2, 3.6%), the Middle East (3, 5.5%) and Australia (3, 5.5%), as well as 3 international societies (5.5%). North America had the highest percentage of women in leadership positions with 19 of 97 positions (19.6%), followed by international societies with 11 of 92 (12.0%) positions filled by women. The Middle East and Australia had the fewest number of women, with all-male leadership. Globally, female orthopaedic surgeons served in 11 of 181 (6.1%) board of directors positions, 16 of 192 (8.3%) executive committees positions, 17 of 143 (11.9%) committee chair positions, 2 of 18 (11.1%) officer positions, 1 of 12 (8.3%) council positions, and 2 of 7 (28.6%) spokesperson positions., Conclusion: While some countries have higher representation than others, the number of women in leadership positions in orthopaedic sports medicine societies throughout the world is significantly less than their male counterparts. While this is a preliminary analysis, future studies should aim to evaluate these trends over time. Providing equitable opportunities for women to rise into high-ranking positions in orthopaedic sports medicine may contribute to the interest of women and other minorities in the field of sports medicine and help improve diversity., Level of Evidence: Level V., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: Mary Mulcahey, MD reports a relationship with Arthrex Inc that includes: consulting or advisory. Mary Mulcahey, MD reports a relationship with American Academy of Orthopaedic Surgeons that includes: board membership. Mary Mulcahey, MD reports a relationship with American Orthopaedic Association that includes: board membership. Mary Mulcahey, MD reports a relationship with American Orthopaedic Society for Sports Medicine that includes: board membership. Mary Mulcahey, MD reports a relationship with Arthroscopy Association of North America that includes: board membership. Mary Mulcahey, MD reports a relationship with The Association of Bone and Joint Surgeons that includes: board membership. Mary Mulcahey, MD reports a relationship with International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine that includes: board membership. Mary Mulcahey, MD reports a relationship with Ruth Jackson Orthopaedic Society that includes: board membership. American Journal of Sports Medicine Electronic Media: Editorial or governing board - M.M Journal of Bone and Joint Surgery – American: Editorial or governing board - M.M. Ortho Info: Editorial or governing board – M.M., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

» Bony Bankart lesions are fractures of the anteroinferior glenoid rim, commonly associated with a traumatic anterior shoulder dislocation, and are diagnosed through radiological imaging and physical examination. Young male athletes playing contact sports are at highest risk of these injuries. Early diagnosis and treatment are crucial because, if left untreated, recurrent anterior shoulder instability and glenoid bone loss can occur. Both nonsurgical and surgical treatment options are available depending on the size of the lesion, with arthroscopic repair being the most common treatment method. After repair, patients typically have favorable outcomes with low rates of recurrent instability. This review aims to discuss the etiology, diagnosis, and treatment of bony Bankart lesions.» Bony Bankart lesions are fractures of the anteroinferior glenoid rim and occur in up to 22% of first-time anterior shoulder dislocations.» Young men involved in contact sports or combat training are at the highest risk of sustaining bony Bankart lesions.» Diagnosis and treatment of bony Bankart lesions are essential to prevent long-term shoulder instability.» Bony Bankart lesions can be treated either nonoperatively or operatively (arthroscopic vs open repair), with the size of the glenoid defect being the primary determinant of treatment., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B89)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

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.

Background: Ulnar collateral ligament (UCL) reconstruction has been the standard surgical intervention for elite male athletes with UCL insufficiency. Recently, UCL repair and augmentation with an internal brace has been increasingly performed., Purpose: To evaluate the clinical and functional outcomes as well as return-to-sport rate after UCL repair in female athletes., Study Design: Case series; Level of evidence, 4., Methods: Included were 15 female athletes (mean age, 16.5 ± 3.5 years) who underwent UCL repair between 2011 and 2021 at a single institution. Data collected included age, sport played, competition level, symptom onset, previous surgeries, mechanism of injury, surgical intervention, and return to sport. Patients were contacted via phone at minimum 24-month follow-up, and postoperative outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE)., Results: Of the 15 female athletes, there were 4 cheerleaders, 3 softball players, 2 volleyball players, 2 soccer players, 1 gymnast, 1 tennis player, 1 dancer, and 1 javelin thrower. Ten of the 15 athletes (67%) competed at the high school level, 4 (26%) at the collegiate level, and 1 patient (7%) was a recreational volleyball player. In all patients, there was an acute onset of symptoms after injury. Ten patients underwent UCL repair with an internal brace (67% of athletes), while 5 underwent standard UCL repair. The median MEPS for athletes with and without an internal brace was 100 (range, 80-100). There was no significant difference of MEPS ( P = .826) or SANE scores ( P = .189) between the patients who received an internal brace and those who did not. Thirteen of the 15 athletes (86.7%) returned to sport., Conclusion: The UCL injuries in the female athletes in this study were the result of acute trauma. Primary UCL repair, both with and without internal bracing, was an effective surgical treatment for returning these athletes to sport., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported by the Tulane University School of Medicine ASPIRE summer research fellowship and the Tulane University School of Medicine DeBakey Scholar Program. M.J.O. has received research support from Smith & Nephew, Depuy, and Mitek and consulting fees from Smith & Nephew, DePuy, Mitek, and Stryker. M.K.M. has received education payments from Alon Medical Technology, consulting fees from Arthrex, and nonconsulting fees from Arthrex. F.H.S. has received consulting fees from Exactech, Medical Device Business Services, Smith & Nephew, Zimmer Biomet Holdings, Mitek, and Linvatec; nonconsulting fees from Smith & Nephew and Linvatec; royalties from Exactech, Linvatec, and Zimmer Biomet Holdings; and acquisitions from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Tulane University (ref No. 2020-965)., (© The Author(s) 2024.)

» Venous thromboembolism (VTE) after shoulder arthroscopy is rare (0.01%-0.38%) but impacts a significant number of patients because of the high procedure volume.» Studies found no significant benefit in reducing VTE risk with aspirin or low-molecular-weight heparins.» Current guidelines for thromboprophylaxis in shoulder arthroscopy lack consensus and need patient-specific considerations.» Further research is required to develop evidence-based thromboprophylaxis guidelines for shoulder arthroscopy., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B75)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

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 summarize sex-related differences in hip range of motion (ROM), including flexion, extension, abduction, adduction, internal rotation, and external rotation., Methods: We performed a systematic search of 3 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Embase). The search terms were as follows: hip, pelvis, range of motion, kinematic, men, and women. Included studies reported sex-specific data on hip ROM in healthy, uninjured adults. To generate hip ROM mean differences, a DerSimonian-Laird random-effects model was used. Effect sizes were pooled for each exercise. Subgroup analyses compared hip ROM by physical activity group: passive ROM, 1-leg hop or jump, 2-leg hop or jump, 2-leg drop or landing, 1-leg squat, 2-leg squat, walking, and jogging/running. Positive effect sizes represent greater ROM in women., Results: Thirty-eight studies with 3,234 total subjects were included; of these subjects, 1,639 were women (50.1%). The mean age was 25.3 years. An effect difference was considered statistically significant if P < .05 and clinically significant if the mean difference was greater than 4.0°. Women showed statistically and clinically significantly greater hip flexion in passive ROM (mean difference, 6.4°) and during the 1-leg hop or jump exercise (mean difference, 6.5°). Women also showed statistically and clinically significantly greater hip adduction during the 1-leg hop or jump (mean difference, 4.5°) and 1-leg squat (mean difference, 4.4°) exercises, as well as statistically and clinically significantly greater hip internal rotation in passive ROM (mean difference, 8.2°). In contrast, men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise (mean difference, -9.1°). No clinically significant differences in extension, abduction, or external rotation were found between women and men., Conclusions: On average, women showed statistically and clinically significantly greater flexion, adduction, and internal rotation during passive and 1-leg exercises whereas men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise., Level of Evidence: Level IV, meta-analysis and systematic review of Level II-IV studies., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

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.)

Introduction Social media outlets such as TikTok (TT) and Instagram (IG) have surged as a method to disseminate information. More recently, healthcare professionals have targeted this space as a means to provide medical education and advice. With the ever-growing content on these applications, there is significant variability and quality of material available, which can lead to the dissemination of misinformation. This study aims to evaluate the accuracy and popularity of content on common orthopaedic pathology on TT and IG. Methods Content on TT and IG related to six common orthopaedic conditions - achilles tendon tear, ACL tear, meniscus tear, tennis elbow, rotator cuff tear, and ankle sprains - was evaluated between April and June 2022. The top ten posts for the top two associated hashtags for each condition were reviewed. The quality of each post was analyzed using the DISCERN instrument, rating each on a scale of 1 to 5. Each post was characterized by the author's profession (physician, physical therapist, chiropractor, etc.) and content type (educational, testimonial, personal, promotional, and entertainment). Popularity and engagement metrics such as "comments," "likes," and "shares" were also collected. Results There were 165,666,490 views on TT and 9,631,015 views on IG amongst the six common aforementioned orthopaedic conditions. Content created by physicians had less overall engagement (16.1%) compared to content created by non-physicians (83.9%). The quality of content on average was low (mean misinformation index 2.04 ± 1.08 (1-5) 1 . Physician-created posts in comparison to non-physician posts were significantly more accurate (mean misinformation index score 3.38 ± 1.12 vs 1.89 ± 0.94, p<0.0001). Conclusions Common orthopaedic conditions such as Achilles tendon tears, ACL tears, and meniscus tears are frequently the focus of content posted on TT and IG; however, this information is often not medically accurate. Increased physician engagement may help to rectify this misinformation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kolade et al.)

Aims: The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process., Methods: This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous., Results: Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus., Conclusion: Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport., Competing Interests: S. L. Sherman reports royalties or licenses from CONMED Linvatec, consulting fees from Arthrex, BioVentus, JRF Ortho, Kinamed, Smith & Nephew, Vericel, CONMED Linvatec, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthex, Joint Restoration Foundation, Kinamed, Smith & Nephew, and Vericel, and stock or stock options from Epic Bio, Reparel, Sarcio, and Vivorte, all of which are unrelated to this study. J. Chahla reports consulting fees from Arthrex, CONMED Linvatec, Ossur, and Smith & Nephew, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Smith & Nephew, all of which are unrelated to this study. M. J. Alaia reports consulting fees from BodyCad, JRF Ortho, and Mitek, institutional grants from Orcosa, and royalties from Springer, all of which are unrelated to this study. M. J. Tanaka reports grants or contracts from FujiFilm, royalties or licenses from Verywell, and consulting fees from Depuy Synthes, all of which are unrelated to this study. J. L. Pace reports consulting fees from Arthrex and JRF Ortho, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex, and stock or stock options from OutcomeMD, all of which are unrelated to this study. L. M. Jazwari reports grants or contracts from Arthrex, Mitek, Smith & Nephew, and Wolters Kluwer Health, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Wolters Kluwer Health, and stock or stock options from Lazurite, all of which are unrelated to this study., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Objectives: Superior labrum anterior posterior (SLAP) tears can cause shoulder pain, disability, instability, and humeral head translation. YouTube has become an increasingly popular source of medical information, but little is currently known in terms of quality control of the uploaded content. The purpose of this study was to assess the quality of YouTube videos related to the diagnosis and treatment of Superior Labrum Anterior Posterior (SLAP) tears., Methods: YouTube was queried in August 2021 using the two predetermined keywords: 'SLAP tear' and 'superior labral tear.' The first 50 videos were analyzed by two independent reviewers and scored using 3 scoring systems: Global Quality Scale (GQS), the Journal of the American Medical Association (JAMA), and the Shoulder-Specific Score (SSS) to determine video accuracy and reliability. Title, number of views, video duration, video source, content type, views/day, number of likes, number of dislikes, days since upload, like ratio (Like × 100/ [Like + Dislike]) and Video Power Index (VPI) (Like ratio × View ratio/100) were all recorded and analyzed., Results: The scores of most videos were low, with a mean JAMA score of 2.5 (1-4, SD 0.73), a mean GQS of 2.66 (0.5-4.5, SD 0.99) and a mean SSS of 7.13 (0-18, SD 4.39). There were significantly higher mean scores for JAMA, GQS, and SSS in the academic and independent physician categories, with a mean JAMA score of 3.11, GQS score of 3.39, and SSS score of 11 for academic sources and a mean JAMA score of 2.83, GQS score of 3.23, and SSS score of 9.23 for independent physician sources. JAMA score was significantly and positively correlated with video duration (r = 0.405, p = 0.006). Views, likes, dislikes, publication dates, and VPI were not significantly correlated with any scoring scale., Conclusion: YouTube videos on the diagnosis and management of SLAP tears have low overall quality and reliability scores. Independent physician and academic institution sources received higher mean scores for JAMA, GQS, and SSS. Video quality was not correlated with number of views.

Introduction: The use of social media for marketing, education, and networking has increased among orthopaedic surgeons. Social media has played an important role in supporting women physicians and trainees, by allowing connections to be made across stages of training and geographic borders. The purpose of this study was to determine the perceptions of female orthopaedic surgeons, fellows, residents, and medical students regarding their usage of social media., Methods: A 22-question anonymous survey regarding the perceptions of social media usage was distributed to 1,189 female members of Ruth Jackson Orthopaedic Society via e-mail in July 2022. Data collection lasted a total of 4 weeks, from July to August 2022. Data analysis was performed using descriptive statistics., Results: A total of 207 responses were received (17% response rate). The respondents comprised 90 orthopaedic surgeons (43%), 60 medical students (29%), 49 residents (24%), and eight fellows (4%). Ninety one percent of participants (189 of 207) reported having a social media account, with 23% (43 of 189) having separate 'personal' and 'professional' accounts. Less than half of all participants reported altering (51 of 189; 27%) or deleting (20 of 189; 11%) profiles for interviews. Fifty three percent of participants (109 of 207) 'agreed' that social media is a good way to network. Twenty eight percent of participants (58 of 207) feared gaining attention to their profile when engaging with professional accounts. Forty percent of participants (62 of 207) agreed that personal life events on social media can be considered unprofessional and should be kept on a private profile., Conclusion: Social media can be used to network professionally within orthopaedic surgery, connecting women at different levels of training. Although concerns about professionalism of social media accounts exist, this may be mitigated by maintaining a separate private account from a public, professional profile. Future guidelines regarding social media usage and how to maintain professionalism while being active on social media may be beneficial., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Introduction: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration., Methods: A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for chondrotoxicity following antibiotic exposure., Results: The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported., Conclusions: This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use., (© 2023 The University of Kansas Medical Center.)

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.)

Glenohumeral osteoarthritis (OA) is one of the most common causes of shoulder pain. Conservative treatment options include physical therapy, pharmacological therapy, and biological therapy. Patients with glenohumeral OA present shoulder pain and decreased shoulder range of motion (ROM). Abnormal scapular motion is also seen in patients as adaptation to the restricted glenohumeral motion. Physical therapy is performed to (1) decrease pain, (2) increase shoulder ROM, and (3) protect the glenohumeral joint. To decrease pain, it should be assessed whether the pain appears at rest or during shoulder motion. Physical therapy may be effective for motion pain rather than rest pain. To increase shoulder ROM, the soft tissues responsible for the ROM loss need to be identified and targeted for intervention. To protect the glenohumeral joint, rotator cuff strengthening exercises are recommended. Administration of pharmacological agents is the major part next to physical therapy in the conservative treatment. The main aim of pharmacological treatment is the reduction of pain and diminution of inflammation in the joint. To achieve this aim, non-steroidal anti-inflammatory drugs are recommended as first-line therapy. Additionally, the supplementation of oral vitamin C and vitamin D can help to slow down cartilage degeneration. Depending on the individual comorbidities and contraindications, sufficient medication with good pain reduction is thus possible for each patient. This interrupts the chronic inflammatory state in the joint and, in turn, enables pain-free physical therapy. Biologics such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells have gathered increased attention. Good clinical outcomes have been reported, but we need to be aware that these options are helpful in decreasing shoulder pain but neither stopping the progression nor improving OA. Further evidence of biologics needs to be obtained to determine their effectiveness. In athletes, a combined approach of activity modification and physical therapy can be effective. Oral medications can provide patients with transient pain relief. Intra-articular corticosteroid injection, which provides longer-term effects, must be used cautiously in athletes. There is mixed evidence for the efficacy of hyaluronic acid injections. There is still limited evidence regarding the use of biologics., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

» The shoulder is the most commonly dislocated joint in the body, representing 50% of all major joint dislocations. This injury occurs most commonly in contact sports and may be treated either nonoperatively (rest, immobilization, and physical therapy) or surgically.» Several factors contribute to an athlete's recovery after shoulder injury, including psychological readiness that has been identified as having a significant impact on athlete's rate of return to sport. The psychological readiness of athletes can be quantified using patient-reported outcome measures and psychological assessment tools.» Managing priorities and expectations, mood, social support, and confidence have all been identified as factors that affect readiness to return to play. Kinesiophobia was the most common factor reported in patients interviewed after arthroscopic Bankart repair.» Psychological interventions including cognitive behavioral therapy and mindfulness are aimed at reducing the effects of psychological factors and mood states by decreasing stress, anxiety, and kinesiophobia. These interventions may also increase the rates of return to sport after shoulder instability., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B6)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: To compare postoperative complication rates between patients who underwent medial patellofemoral ligament reconstruction (MPFLR) and those who underwent MPFLR with tibial tubercle osteotomy (TTO) in a large-scale study. A secondary goal was to investigate demographic associations with outcomes., Methods: Patients who underwent MPFLR (n = 3,480) or MPFLR-TTO (n = 615) for patellar instability were identified in the PearlDiver database. Rates of surgery for infection, procedures for knee stiffness, patellar fracture, and revision MPFLR within 2 years postoperatively were compared using multivariable logistic regression. Demographic associations with outcomes were also investigated., Results: The MPFLR-TTO cohort exhibited a significantly lower rate of revision surgery at 2 years (0.8% vs 1.9%; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.10-0.80; P = .036) when compared with the MPFLR group. Independent of index procedure, patients younger than 21 years had significantly lower rates of requiring procedures for knee stiffness (OR, 0.35; 95% CI, 0.22-0.54; P < .001) and any complication at 2 years (OR, 0.59; 95% CI, 0.45-0.78; P < .001) when compared with older patients. Male patients displayed a significantly lower rate of requiring procedures for knee stiffness at 2 years than female patients (OR, 0.46; 95% CI, 0.25-0.78; P = .007). Tobacco use was associated with a significantly higher rate of postoperative infection at 2 years (OR, 2.35; 95% CI, 1.00-5.38; P = .046)., Conclusions: The MPFLR cohort exhibited higher rates of revision surgery at 2 years compared with the MPFLR-TTO cohort. Patient age under 21 years was associated with lower rates of any complication and requiring procedures for knee stiffness, male sex was associated with a lower rate of requiring procedures for knee stiffness, and tobacco use was associated with a higher rate of surgery for postoperative infection. This information can assist surgeons when counseling patients before these procedures are performed., Level of Evidence: Level III, retrospective, comparative prognostic trial., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The Association of American Medical Colleges and the American Academy of Orthopaedic Surgeons have incorporated diversity and inclusion as one of their primary goals. Orthopaedic surgery remains the least diverse medical specialty when measured for practicing physicians and trainees. The purpose of this study was to determine the number and distinct types of diversity, equity, and inclusion (DEI) positions within orthopaedic surgery residency programs in the United States., Methods: The Fellowship and Residency Electronic Interactive Database was used to obtain a list of all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs. The following was collected from 193 residency program websites between June 6, 2022, and June 26, 2022: program location, university or community based, allopathic or osteopathic recognition, number of faculty in the orthopaedic department, number of residents per year, diversity-related statements, and diversity-focused faculty positions., Results: Of the 193 programs evaluated, 74 (38.9%) included DEI statements on their website while only 42 (21.8%) had at least one DEI-specific faculty role (e.g., diversity committee, diversity liaison, vice chair for DEI). For 16 (8.3%) programs, the faculty role was nonspecific to the orthopaedic residency program. Nonspecific roles were primarily created by the affiliated school of medicine, but in 4 (2.1%) outlier cases, faculty members assumed DEI roles through a medical center, a graduate medical education program, or a department of surgery., Conclusions: Less than half of orthopaedic surgery residency programs currently advocate for DEI on their associated websites while fewer than 25% have a DEI faculty position. Previous studies have called for a greater number of DEI positions and committees among orthopaedic residencies because of the lower admittance rate of qualified Under Represented in Medicine (URiM) applicants. A role dedicated to DEI may increase the number of women and URiM applicants pursuing a career in orthopaedic surgery., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A537)., (Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Introduction: The highest rates of fatal and nonfatal injury due to firearms occur in the Southern United States. This study examined the epidemiology of gunshot wound (GSW) injuries and the association of injury severity with mortality., Methods: This is a retrospective cross-sectional analysis of 2016 to 2019 data from a mandatory reporting system for all licensed hospitals in Louisiana. Patients aged 18 years and older at the time of hospitalization for GSW were included. Injury severity was measured by the New Injury Severity Score (NISS). Primary outcomes assessed included mortality, length of stay, and total hospital charges., Results: There were 1,709 firearm injuries identified. The patient sample was 83.2% Black and 87.4% male, with a mean age of 34 years. Orthopaedics was the most frequently consulted surgical service. Total hospital visit charges for all GSW-associated care were $262.4 million. The multivariable adjusted odds ratio and 95% confidence interval for mortality associated with a high NISS was 16.32 (8.96, 29.72)., Conclusion: This study demonstrated the utility of NISS as a predictor of total hospital charges and length of stay, in addition to its well-established role as a predictor of mortality. Epidemiologic trends in GSW pathologies and associated procedures at a major urban trauma center were also reported., Level of Evidence: Level III, prognostic study., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Study Design: Preliminary explanatory or mechanistic cross-sectional study., Objectives: This preliminary cross-sectional study investigates the hypothesized serial mediating effects of bladder/bowel worry, social worry, and social participation in the relationship between bladder function or bowel function and emotional functioning in youth with spinal cord injury (SCI) from their perspective., Methods: The Bladder Function, Bowel Function, Worry Bladder Bowel, Worry Social, and Social Participation Scales from the PedsQL™ Spinal Cord Injury Module and the Emotional Functioning Scale from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed by 127 youth with SCI ages 8-24. Serial multiple mediator model analyses were conducted to test the hypothesized sequential mediating effects of bladder/bowel worry, social worry, and social participation as intervening variables separately for the cross-sectional association between bladder function or bowel function and emotional functioning., Results: The separate cross-sectional negative association of bladder function and bowel function with emotional functioning were serially mediated by bladder/bowel worry, social worry and social participation, accounting for 28% and 31%, respectively, of the variance in youth-reported emotional functioning (p < 0.001), representing large effect sizes., Conclusions: In this preliminary study, bladder/bowel worry, social worry, and social participation explain in part the cross-sectional negative association of bladder function and bowel function with emotional functioning in youth with SCI from the youth perspective. Identifying the hypothesized associations of bladder function and bowel function, bladder/bowel worry, social worry, and social participation with emotional functioning may help inform future clinical research and practice for youth with SCI., (© 2023. The Author(s), under exclusive licence to International Spinal Cord Society.)

Orthopaedic surgery has become one of the most competitive specialties to match into among medical students applying to residency. The purpose of this study was to compare match rates to orthopaedic surgery residency programs among first-time vs. repeat applicants., Methods: Data were obtained from the National Resident Matching Program from 2018 to 2022. For each year, the total number of applicants to orthopaedic surgery residency programs was obtained, as well as the number of applicants who successfully matched into orthopaedics. The match rate was compared between first-time vs repeat applicants. A subanalysis was performed on allopathic graduates (MDs) and osteopathic graduates (DOs)/international medical graduates (IMGs). In addition, the match rate for first-time applicants and reapplicants was compared between MD and DO/IMG applicants., Results: Overall, there was a significantly higher match rate among first-time applicants (89.8%) vs. repeat applicants (22.5%, p < 0.0001). When substratified by MD and DO/IMG applicants, first-time applicants still matched at a significantly higher rate than reapplicants within each group (p < 0.0001 for each). Among first-time applicants, MDs (93.1%) matched at a significantly higher rate than DOs/IMGs (68.6%, p < 0.0001). Among reapplicants, DOs/IMGs (25.3%) matched at a significantly higher rate than MDs (20.1%, p < 0.01)., Conclusion: First-time applicants to orthopaedic surgery residency programs have a significantly higher rate of matching compared with reapplicants, irrespective of degree. In recent years, first-time MD applicants have matched at a significantly higher rate than first-time DO/IMG applicants., (Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

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.)

» Educational programs on concussion have been demonstrated to improve knowledge for athletes, families, athletic trainers, and coaches about concussion, with the goal of reducing concussion incidence, duration, severity, and complications.» Despite the widespread availability and often mandatory concussion education provided to high school and collegiate athletes, there has not been an adequate change in knowledge, attitudes, and self-reporting behavior in this population.» Recently published studies suggest improving concussion education by emphasizing athletes' symptom reporting behavior, to contrast with current emphasis on knowledge-based outcomes.» Future educational programs about concussions for athletes, families, athletic trainers, and coaches should aim to emphasize cultural and behavioral changes that demonstrate outcome changes rather than solely evaluating knowledge improvements to determine effective programming., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A960)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

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.)

Orthopaedic surgery is recognized as one of the most popular but least diverse medical subspecialties. Although significant efforts have been made in recent years to improve gender diversity, orthopaedic surgery continues to lag behind other surgical subspecialties. A recent study predicted that it would take 217 years for orthopaedic surgery to reach gender parity matching the 36.3% of practicing female physicians in the United States. The purpose of our study was to evaluate the annual percentages of female medical student applicants in orthopaedic surgery over the past 15 years and to determine when this gender parity percentage may be reached among residency applicants., Methods: The Electronic Residency Application Service was queried for orthopaedic residency applicant data from 2007 to 2022. The annual percentage of female applicants as well as the annual change in percentage of female applicants was recorded. A best-fit trendline was calculated and extrapolated to predict future rates of female applicants., Results: The percent of female applicants has increased from 11.8% in 2007 to 23.0% in 2022. Between 2007 and 2022, there were 9 years with annual increases in percentage of females applying into orthopaedic surgery with a statistically significant increase in 4 of those years (2008, 2014, 2019, and 2022). There were 6 years with annual decreases in percentage of females applying to orthopaedic surgery, none of which were statistically significant. The best-fit curve is exponential with a correlation coefficient of 0.8 (p < 0.001). This predicts reaching the predetermined gender parity percentage of 36.3% in 16 years., Conclusion: In the past 15 years, there has been a near-doubling in the percentage of female medical students applying to orthopaedic surgery residency. Although orthopaedic surgery remains the least gender-diverse field of medicine, these trends are encouraging and support the initiatives currently in place including early education and increased mentorship to help close the gender gap in orthopaedic surgery., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A516)., (Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

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.)

Introduction: Bullying is a notable problem in surgery, creating a hostile environment for surgeons and trainees, and may negatively affect patient care. However, specific details regarding bullying in orthopaedic surgery are lacking. The primary aim of this study was to determine the prevalence and nature of bullying within orthopaedic surgery in the United States., Methods: A deidentified survey was developed using the survey created by the Royal College of Australasian Surgeons and the validated Negative Acts Questionnaire-Revised survey tool. This survey was distributed to orthopaedic trainees and attending surgeons in April 2021., Results: Of the 105 survey respondents, 60 (60.6%) were trainees and 39 (39.4%) were attending surgeons. Although 21 respondents (24.7%) stated they had been bullied, 16 victims (28.1%) did not seek to address this behavior. Perpetrators of bullying were most commonly male (49/71, 67.2%) and the victims' superior (36/82, 43.9%). Five bullying victims (8.8%) reported the behavior, despite 46 respondents (92.0%) stating that their institution has a specific policy against bullying., Conclusion: Bullying behavior occurs in orthopaedic surgery, with perpetrators being most commonly male and the victims' superiors. Despite the fact that an overwhelming majority of institutions have policies against bullying, the reporting of such behavior is lacking., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Introduction: There is a bias in the medical community that allopathic training is superior to osteopathic training, despite the lack of substantiation. The orthopedic in-training examination (OITE) is a yearly exam evaluating educational advancement and orthopedic surgery resident's scope of knowledge. The purpose of this study was to compare OITE scores between doctor of osteopathic medicine (DO) and medical doctor (MD) orthopedic surgery residents to determine whether any appreciable differences exist in the achievement levels between the 2 groups., Methods: The American Academy of Orthopedic Surgeons 2019 OITE technical report, which reports the scores from the 2019 OITE for MDs and DOs, was evaluated to determine OITE scores for MD and DO residents. The progression of scores obtained during various postgraduate years (PGY) for both groups was also analyzed. MD and DO scores throughout PGY 1-5 were compared with independent t-tests., Results: PGY-1 DO residents outperformed MD residents on the OITE (145.8 vs 138.8, p < 0.001). The mean scores achieved by DO and MD residents during PGY-2 (153.2 vs 153.2), 3 (176.2 vs 175.2), and 4 (182.0 vs 183.7) did not differ (p = 0.997, 0.440, and 0.149, respectively). However, for PGY-5, the mean scores for MD residents (188.6) were higher than those of DO residents (183.5, p < 0.001). Both groups had trends of improvement seen throughout PGY 1 to 5 years, with both groups showing an increase in average PGY scores when compared to each preceding PGY., Conclusion: This study provides evidence that DO and MD orthopedic surgery residents perform similarly on the OITE within PGY 2 to 4, thus displaying equivalencies in orthopedic knowledge within the majority of PGYs. Program directors at allopathic and osteopathic orthopedic residency programs should take this into account when considering applicants for residency., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to analyze the content, interaction, and use of posts related to women surgeons on Instagram and Twitter, with specific analysis of female orthopedic surgeon related content., Design: A retrospective search of Instagram and Twitter from March 14, 2022, to June 16, 2022 was conducted using the hashtags, #womeninortho, #womeninorthopedics, #ilooklikeasurgeon, #womensurgeons, and #womeninsurgery. Additional searches were performed on Twitter that consisted of #orthotwitter in combination with #ilooklikeasurgeon, #womensurgeons, and #womeninsurgery. Once identified, posts were analyzed for the hashtag used, number of likes, number of comments, number of retweets (Twitter only), source type, type of post, and medical specialty. Descriptive statistics were used to analyze the data., Results: Over the 3-month period, a total of 3248 posts were identified that included 1669 Instagram (50.5%) and 1639 Twitter (49.6%) posts. The majority of overall posts and Instagram posts were made by general (32.3%, 28.9%), plastic (12.7%, 22.1%), and orthopedic surgeons (8.3%, 7.8%). On Twitter, general surgeons tweeted the most (35.6%), followed by orthopaedic surgeons (8.8%). Instagram had a greater mean number of and comments per post than Twitter. For orthopedic hashtags, #womeninortho was used more than #womeninorthopedics (78.0% vs. 22.0%, p < 0.001). On #orthotwitter, #ilooklikeasurgeon was used more than #womeninsurgery and #womensurgeons (75.0% vs. 23.6% vs. 1.4%, p < 0.001)., Conclusions: This study demonstrated that both Instagram and Twitter are regularly used to promote women surgeons. Instagram is the preferred platform of physicians for promoting women surgeons via personal and outcome-based content, while Twitter is used more by students and primarily includes outcome-based posts. Female orthopedic surgeons should continue to use the preferred hashtag, #womeninortho, to maximize the reach of this content. By promoting women surgeons on social media, practicing surgeons can converse, collaborate, and provide mentorship to the next generation of surgeons., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Anterior cruciate ligament (ACL) tears are a common sports injury, and typically require a prolonged post-operative rehabilitation. The purpose of this study was to survey members of the American Orthopaedic Society for Sports Medicine (AOSSM) to determine their return to sport (RTS) criteria after primary ACL reconstruction (ACLR)., Methods: A 23-question, anonymous survey hosted through Google ® Docs was distributed electronically to AOSSM members. This survey included questions regarding the timing, as well as any functional tests or other metrics used to determine when an athlete is ready to RTS., Results: A total of 863 surgeons responded over four months. The most popular graft choice was bone patellar tendon bone autograft (63%). For non-pivoting sports, 43% of respondents allowed RTS at five to six months, while 31% allowed RTS at seven to eight months. For pivoting sports, 34% of respondents allowed RTS at seven to eight months, while 36% allowed RTS at nine to ten months. The most common criteria for return to non-pivoting sports include full knee motion (89%) and time after ACLR (76%). The most common criteria for return to pivoting sports include full knee motion (87%) and passing a hop test (80%). Only 21% of respondents assessed for psychological readiness to RTS., Conclusions: RTS occurred sooner in non-pivoting than pivoting sports, with similar RTS criteria in both groups. Most respondents did not assess for psychological readiness to RTS., (© 2023 The University of Kansas Medical Center.)

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: The purpose of this study was to evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete analysis of gender diversity within this subspecialty., Methods: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America (AANA) 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 five years., Results: Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021-2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (p<0.001). Within the past five years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (p<0.001). There was no significant difference in the gender composition of current fellows compared to the composition of fellows within the last 5 years (p=0.74). When examining gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (p<0.001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared to 83 men in such positions (85.6%) (p<0.001) 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 to those who graduated in the last five years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Orthopaedic Residency Directors advised against visiting subinternship rotations in the peak of the pandemic. To adapt, programs offered multiple virtual experiences. The purpose of this study was to evaluate programs and applicants perceptions regarding the value of virtual experiences during the 2020 to 2021 application cycle and their utility in future application cycles., Methods: A survey was disseminated to 31 residency programs gathering data about virtual experiences offered in this cycle. A second survey was disseminated to interns who have successfully matched at those programs to identify how interns think to have benefited from the experiences., Results: Twenty-eight programs completed the survey (90% response rate). One hundred eight new interns completed the survey (70% response rate). Virtual information sessions and resident socials were the highest attended (94% and 92%, respectively). Interns and leadership agreed that virtual rotations provided students with a good understanding of program culture and what the programs offer educationally. Neither the leadership nor the interns would recommend replacing in-person aways with virtual experiences., Conclusion: Virtual experiences helped bridge the gap after away rotations were canceled. Alongside in-person aways, virtual experiences are likely to play a role in future cycles. However, virtual experiences remain incomparable to in-person away rotations and are not recommended as a replacement., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Objectives: Hip/groin running-related injuries (RRIs) are relatively uncommon. It is unclear if runners of either sex are disproportionately affected. Our objective was to systematically review differences in hip/groin RRIs between males and females., Data Sources: A structured and comprehensive search of four medical literature databases was performed (PubMed, Embase, Ovid Medline, and CINAHL). Terms searched were as follows: risk, epidemiology, hip injury, groin injury, overuse injury, running, sprinting, and track and field., Study Selection: Studies reporting sex-specific data on hip/groin RRIs in adult runners were included. Data was extracted and reviewed independently by two authors., Study Appraisal and Data Synthesis: Sex-specific injury rates, risk factors, and return to sport (RTS) following hip/groin RRI were extracted. Risk of bias was assessed using the Joanna-Briggs Institute Critical Appraisal Tool., Results: Ten studies with 7,353 total runners were included: 2,315 (47%) males and 2,559 (53%) females. The mean age of the included runners was 37.3 ± 8.9 years and the mean weekly running distance was 10.4 ± 8.4 km. Hip/groin injuries comprised 10.1% (491/4,874) of total RRIs, including 6.3% of RRIs sustained by males and 11.0% by females. Three studies reported significantly higher rates of hip/groin RRIs in female runners. One study reported significantly higher rates of gluteus medius and adductor RRIs for females and males, respectively. One study identified female sex as an independent risk factor for hip/groin RRIs. Three studies reported on RTS after hip/groin RRIs: the pooled RTS rate was 81.4% (57/70) at 1 to 368 days after injury., Limitations: Data was pooled when possible; however, there was considerable clinical, methodological, and statistical heterogeneity across studies., Conclusions: Hip/groin RRIs comprise a greater percentage of total injuries among injured female runners relative to males. Females may be at a higher risk for sustaining hip/groin RRIs though more research on risk factors and RTS is needed.

Background: The extent to which concomitant osteotomy provides an improvement in clinical outcomes after cartilage repair procedures is unclear., Purpose: To review the existing literature to compare clinical outcomes of patients undergoing cartilage repair of the tibiofemoral joint with versus without concomitant osteotomy., Study Design: Systematic review; Level of evidence, 4., Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify studies that directly compared outcomes between cartilage repair of the tibiofemoral joint alone (group A) versus cartilage repair with concomitant osteotomy (high tibial osteotomy [HTO] or distal femoral osteotomy [DFO]) (group B). Studies on cartilage repair of the patellofemoral joint were excluded. The search terms used were as follows: osteotomy AND knee AND ("autologous chondrocyte" OR "osteochondral autograft" OR "osteochondral allograft" OR microfracture). Outcomes in groups A and B were compared based on reoperation rate, complication rate, procedure payments, and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale [VAS] for pain, satisfaction, and WOMAC)., Results: Included in the review were 5 studies (1 level 2 study, 2 level 3 studies, 2 level 4 studies) with 1747 patients in group A and 520 patients in group B. The mean patient ages were 34.7 and 37.5 years in groups A and B, respectively, and the mean lesion sizes were 4.0 and 4.5 cm 2 , respectively. The mean follow-up time was 44.6 months. The most common lesion location was the medial femoral condyle (n = 999). Preoperative alignment averaged 1.8° and 5.5° of varus in groups A and B, respectively. One study found significant differences between groups in KOOS, VAS, and satisfaction, favoring group B. The reoperation rates were 47.4% and 17.3% in groups A and B, respectively ( P < .0001)., Conclusion: Patients undergoing cartilage repair of the tibiofemoral joint with concomitant osteotomy might be expected to experience greater improvement in clinical outcomes with a lower reoperation rate compared with those undergoing cartilage repair alone. Surgeons preparing for cartilage procedures of the knee joint should pay particular attention to preoperative malalignment of the lower extremity to optimize outcomes., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.K.M. has received consulting fees and speaking fees from Arthrex. A.J.S. has received research support from Isto Biologics, consulting fees from DePuy/Medical Device Business Services, and has stock/stock options in Biomet, ConMed, Johnson & Johnson, Pfizer, Smith & Nephew, and Stryker. P.C.M. has received research support from Arthrex and Smith & Nephew and consulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

Female physicians have been historically underrepresented in orthopaedic surgery residencies. The purpose of this study was to determine whether sex diversity among orthopaedic residency programs and faculty is associated with an increased number of female residents matriculating into that program. In addition, we sought to analyze female resident matriculation trends in the past 5 years., Methods: The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all allopathic orthopaedic surgery residency programs during the 2021 to 2022 academic year. The number of female residents and interns; the number of female faculty, professors, and associate professors; and the number of women in leadership positions were compared with data from the academic year 2016 to 2017. Continuous data were analyzed with independent t-tests, and significance was set at p < 0.05., Results: A total of 696 female residents (19.2%) were identified from 3,624 orthopaedic residents, an increase from 13.5% in 2016. Programs in the top quartile of female residents had 3 times the number of female residents per program when compared to other quartiles and almost double the number of female interns per program. Programs in the top quartile of female residents had a significantly greater number of female faculty per program than the lower quartiles; 5.76 vs. 4.18. Compared with 2016 to 2017, there were significant increases in female faculty per program from 2.77 to 4.54 along with female full professors from 0.274 to 0.694. These increases contribute to the overall growth in the number of women in leadership positions per program over the past 5 years to 1.01 from 0.35 (p < 0.001)., Conclusion: In the past 5 years, the percentage of female residents has increased from 13.5% to 19.2%. Furthermore, women make up 22.1% of interns. Orthopaedic surgery residency programs with higher percentages of female faculty had higher numbers of female residents. By encouraging programs to promote female representation within leadership and residents, we may continue to see the gap in orthopaedic sex diversity close., Level of Evidence: III., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A486)., (Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

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.)

Background: Recovery from shoulder arthroscopy may vary between professional pitchers and position players in Major League Baseball (MLB). The time that it takes to return to play (RTP) and the level of skills to be regained after surgery are important factors for an athlete to consider when making career decisions., Purpose: To identify MLB players who had arthroscopic shoulder surgery and observe their rates of RTP to MLB and the minor league, as well as to compare pre- and postinjury performance statistics and career metrics., Study Design: Descriptive epidemiology study., Methods: Public records (press releases, http://www.prosportstransactions.com, http://www.baseball-reference.com) were searched and analyzed to determine the number of days from shoulder arthroscopy to RTP and pre- and postinjury statistics for pitchers and position players in the MLB and minor league from 1998 to 2018. To meet inclusion criteria, a player must have undergone shoulder arthroscopy after having played at least 1 game in the MLB and had no identifiable concomitant injuries., Results: Of 134 players, 89 (66.4%) returned to MLB. Fifty-four of 89 pitchers (60.7%) and 35 of 45 position players (77.8%) returned to MLB ( P = .048). Forty-nine of 54 pitchers (90.7%) and 23 of 35 position players (65.7%) who returned to MLB returned to the minor league first. The mean time to RTP was 469.6 days (range, 100-1079 days) for pitchers and 301.6 days (range, 94-1488) for position players ( P = .002). The WAR statistic (wins above replacement) for the pitchers decreased significantly ( P = .004) after shoulder arthroscopy., Conclusion: MLB position players returned to play at higher rates and more quickly than did pitchers. The WAR statistic declined in pitchers during the first season of RTP. Players undergoing arthroscopic shoulder surgery should be aware of these possible outcomes in time to RTP and postoperative performance., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.K.M. has received education payments from Alon Medical Technology, Arthrex, and Quest Medical and nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

The COVID-19 pandemic has necessitated new practices in sports medicine patient care. Telehealth has been validated as a reliable tool for consultations and physical examinations and increases access to care in a cost-efficient manner. Social distancing and avoiding team members who have tested positive are the most effective ways to reduce spread. For screening, daily self-reported symptom checklists and fever monitoring help identify potentially infected athletes who should be instructed to isolate and seek care. Polymerase chain-reaction (PCR) testing for the virus via nasopharyngeal swab is not recommended for screening and should be reserved for symptomatic individuals with fever, cough, or shortness of breath. Face masks and personal protective equipment (PPE) may be beneficial in high-risk settings, but there is little evidence to support use in athletic populations. Median return to play after COVID-19 in elite athletes has been reported as 18 days (range: 12 to 30), with 27% not fully available at 28 days. Chest pain at diagnosis was the only symptom associated with time loss longer than 28 days. Finally, canceled competitions or time loss results in grief, stress, and frustration for athletes, as well as loss of a social support network and routine training regimens. Mental health support services may be indicated., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Doximity residency rankings are used to compare training programs. Reputation is a component of Doximity rankings and is based on physician surveys. Outcomes-based measures allow for objective program comparison and may be more appropriate when assessing programs. This study evaluated how Doximity rankings of orthopaedic surgery residency programs compare with an outcomes-based ranking of programs based on academic productivity. This study also evaluated whether program size and type were associated with academic productivity., Methods: Orthopaedic program rankings, size, type, and research productivity were recorded from Doximity. An academic productivity score was calculated by averaging the mean percentage of alumni clinical trials and alumni publications. Analysis of variance and post hoc analyses were performed to determine whether academic productivity was associated with program reputation, size, and type., Results: One hundred seventy-five orthopaedic residency programs were included. Program rankings, size, and type had a statistically significant association with academic productivity (p < 0.0001). The 44 orthopaedic programs in the top quartile had an academic productivity score of 79.1 ± 13 in comparison with programs in the bottom quartile, who had a score of 38.3 ± 12.1 (p < 0.0001). Of the programs in the top quartile of reputation rankings, 32 (73%) were also in the top quartile for academic productivity. Programs with more residents demonstrated greater academic productivity than smaller programs. Twenty-three programs (13%) had more than 30 residents and a mean academic productivity of 76.2 ± 14.8. In comparison, 13 programs (7.5%) had 10 or fewer residents with an academic productivity score of 40.6 ± 16.3 (p < 0.0001). An academic productivity score differed significantly based on program type: university (63.9 ± 14.8), military (54.7 ± 16.9), university/community (46.3 ± 15.6), and community (38.7 ± 15) (p < 0.0001)., Conclusions: Academic productivity among orthopaedic residency programs is associated with Doximity ranking, program size, and type. This information can be used by medical students, residents, and physicians to understand the Doximity rankings and how they correlate with this objective measure., Level of Evidence: III., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A453)., (Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)