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

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

Background: In patients undergoing cartilage restoration of the knee, limited information is available regarding clinically important difference (CID) and Patient Acceptable Symptomatic State (PASS) estimates for commonly used patient-reported outcome measures (PROMs). Purpose: The objective of this study was to determine the CID and PASS in the population with knee cartilage restoration for the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC) score, and the Lysholm score. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between 2012 and 2017, patients who underwent a cartilage restoration procedure were prospectively enrolled. Patients completed the KOOS, IKDC, and Lysholm, all of which were scored from 0 to 100, and completed relevant anchor questions at baseline and 1 year postoperatively. Receiver operating characteristic curve analyses were conducted to determine CID and PASS cutoff points. Multivariable regression analyses were performed to determine the effect of age, sex, and baseline score on likelihood of achieving CID and PASS. Results: Of the 113 patients enrolled, 53 (47%) were male, and the mean age was 36 years. The CID values for the PROMs were 10.7 for KOOS Symptoms, 8.3 for KOOS Pain, 8.8 for KOOS Activities of Daily Living (ADL), 30.0 for KOOS Sports and Recreation, 18.8 for KOOS Quality of Life (QOL), 9.2 for IKDC, and 13.0 for Lysholm. The PASS values were 71.5 for KOOS Symptoms, 72.2 for KOOS Pain, 86.8 for KOOS ADL, 43.8 for KOOS Sports and Recreation, 50.0 for KOOS QOL, 62.1 for IKDC, and 70.0 for Lysholm. Patients with higher baseline scores were more likely to achieve PASS for the IKDC (odds ratio, 2.28; P =.03). Baseline score did not have an effect on the likelihood of achieving CID. Younger age was an independent predictor of achieving PASS and CID across all outcomes (P <.05), but sex did not have such an effect. Conclusion: This study determined CID and PASS values for the KOOS, IKDC, and Lysholm scores among patients treated with knee cartilage restoration. Younger age was a positive prognostic variable, and higher baseline scores implied achieving PASS for the IKDC. The information in this study can be used in designing randomized controlled trials, counseling individual patients as to anticipated outcomes, and conducting responder analyses when evaluating new cartilage technology from a regulatory perspective. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement is a common and debilitating source of hip pain in young adults. Although physiotherapy is used as a mainstay of nonoperative care for femoroacetabular impingement, the evidence regarding different physiotherapy practices is poorly understood. Purpose: To collect and synthesize the best available evidence and arrive at a summary estimate of treatment effect for the utility of physiotherapy in the management of femoroacetabular impingement. Study Design: Meta-analysis. Methods: A systematic review was performed on February 2, 2019, of PubMed, EMBASE, and Cochrane Library databases using "femoroacetabular impingement OR hip pain" and "physiotherapy OR nonoperative management" and their synonyms as search terms. Central treatment themes were identified across protocols, and pooled analyses were conducted to assess for differences in patient-reported outcome measures across these themes. Results: A total of 5 randomized controlled trials met our inclusion criteria. The studies included 124 patients with a mean age of 35 years, of whom 24% were male. The average follow-up was 9.4 weeks (range, 6-12 weeks), and the follow-up rate across all participants was 86%. Among these 5 studies, 4 studies used a physiotherapy protocol that focused on core strengthening versus no core strengthening, 4 studies compared active strengthening versus passive modalities, and 3 studies compared supervised versus unsupervised physiotherapy. Pooled analysis across all studies demonstrated improved outcomes in the treatment groups compared with the controls (standardized mean difference [SMD], 0.76; 95% CI, 0.38-1.13; P <.0001). Core strengthening (SMD, 0.82; 95% CI, 0.39-1.26; P =.0002), active physiotherapy (SMD, 0.70; 95% CI, 0.29-1.10; P =.0008), and supervised physiotherapy (SMD, 0.58; 95% CI, 0.14-1.03; P =.01) were found to result in statistically significant improvements in functional outcomes compared with no core strengthening, passive modalities, and unsupervised care, respectively. Conclusion: Supervised physiotherapy programs focusing on active strengthening and core strengthening are more effective than unsupervised, passive, and non–core focused programs. Future studies with longer term follow-up and validated femoroacetabular impingement specific outcome measures are required to determine prognostic factors for success with nonoperative care as well as to determine the ideal patient profile and structured rehabilitation protocol. [ABSTRACT FROM AUTHOR]

Background: The accuracy of surgeons in utilizing the clock face method for anchor placement has never been investigated. Our hypothesis was that shoulder arthroscopy surgeons would be able to place suture anchors at predetermined positions with accuracy and reliability. Methods: Ten cadaveric shoulders were used. Five fellowship-trained shoulder arthroscopy surgeons were directed to place a suture anchor at 3:30, 4:30, and 5:30 clock in two shoulders each. The position of the anchors was determined with computed tomography. The accuracy of placement was calculated and data analyzed with one-way analysis of variance. The intraclass correlation coefficients were calculated. Results: The overall accuracy was 57%. The accuracy of anchor placement at the 3:30 position was 40% (average position 2:24 o'clock), it was 50% at the 4:30 position (average position 3:42 o'clock) and 80% at the 5:30 position (average position 5:03 o'clock). No statistical difference in accuracy between the placement of the superior, middle, and inferior anchors (p = 0.145) was seen. The intraclass correlation coefficient for inter-surgeon reliability was 0.4 (fair) while the intraclass correlation coefficient for intra-surgeon reliability was 0.6 (moderate). Discussion: The findings of this study suggest a moderate degree of accuracy and fair to moderate inter- and intra-surgeon reliability when using the clock face system to guide anchor placement. [ABSTRACT FROM AUTHOR]