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Background: Infection following wrist arthroplasty (WA) or wrist fusion (WF) is an uncommon but difficult complication often resulting in explantation and prolonged courses of antibiotics. The purposes of this study are to: (1) characterize the demographic trends of individuals undergoing WA and WF; (2) determine the incidence of postoperative infection; and (3) identify risk factors for postoperative infection. Methods: The PearlDiver database was used to query 100% Medicare Standard Analytic files from 2005 to 2014. Patients undergoing WA or radiocarpal WF were identified using Current Procedural Terminology (CPT) codes. Diagnosis for infection within 1 year of operative intervention was assessed by International Classification of Diseases, Ninth Revision codes or CPT codes related to infection. Multivariable logistic regression analyses were performed to evaluate the risk factors for postoperative infection. Results: Of the 6641 patients included, 1137 (17.1%) underwent arthroplasty and 5504 (82.9%) underwent arthrodesis. Within 1 year of the index procedure, 3.5% had a diagnosis of, or procedure for, postoperative infection (WA: n = 40 of 1137; WF: n = 192 of 5504). Risk factors for infection following WA include age >85, tobacco use, depression, diabetes mellitus, and chronic kidney disease. Risk factors following radiocarpal WF include male sex, age >85, body mass index <19 kg/m2, depression, diabetes mellitus, and chronic kidney disease. Posttraumatic origin of wrist arthritis was a risk factor for infection following both WA and WF. Conclusions: Infection following WA and WF is relatively uncommon in a nationally representative Medicare database cohort. Risk factors common to both WA and WF include age >85, depression, diabetes mellitus, chronic kidney disease, and posttraumatic arthritis. [ABSTRACT FROM AUTHOR]

Background: Measurement properties of the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR) are not established in individuals after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine the extent to which the KOOS-JR measures the construct of knee health in individuals post-ACLR using Rasch analysis.Hypothesis: The KOOS-JR will fit the Rasch model, but significant ceiling effects will be present.Study Design: Cross-sectional study.Level Of Evidence: Level 3.Methods: Rasch analysis of the KOOS-JR from 166 individuals 10 months post-ACLR was conducted. Unidimensionality, a key criterion of the Rasch model, was evaluated using confirmatory factor analysis. Model fit of the rating scale, items, and persons were evaluated. Mean square fit statistics ≥1.6 and standardized z-scores ≥2.0 were indicative of person or item misfit. Additionally, reliability indicators including person reliability and separation indices were examined.Results: The KOOS-JR fit the criteria of unidimensionality. All items demonstrated model fit; however, ceiling effects were noted (n = 36; 22%). Person reliability was low (0.47). Calculation of person strata revealed that the KOOS-JR did not separate participants into more than 1 stratum. The mean person measure was 3.56 logits higher than the mean item measure, indicating that this sample is skewed toward increased knee health.Conclusion: Although the KOOS-JR represented a unidimensional construct with items and persons fitting the Rasch model, several limitations were noted: ceiling effects, low person reliability, and poor person differentiation. Ceiling effects indicate that many individuals in this sample experienced better knee health than the KOOS-JR items were able to measure.Clinical Relevance: Evaluating the measurement properties of the KOOS-JR is necessary to determine its clinical value in sports medicine. In later stages after ACLR recovery, administration of the KOOS-JR may not be adequate. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This study sought to quantify the tunnel widening associated with quadriceps tendon (QT) autograft after anterior cruciate ligament reconstruction (ACLR) and compare it to bone–patellar tendon–bone (BTB) autografts.A retrospective review of each ACLR performed at a single academic institution from 2011 to 2021 were reviewed. Subjects with repeat ipsilateral knee magnetic resonance imaging (MRI) studies performed after ACLR were included. Two reviewers independently measured the maximum diameter of the femoral and tibial tunnels 1 cm from the aperture. Tunnel widening was calculated as the difference between the initial drilled diameter and the measured diameters.Seventy‐five patients (38 BTB and 37 QT autografts) were identified including 42 females and 33 males. With respect to graft type (QT vs. BTB), there was no statistically significant difference in median patient age (19.0 (16.0–31.5) years vs. 20.0 (16.8–30.0) years respectively; p = n.s.) or median time to MRI (12.0 [9.0–19.5] months vs. 13.0 [7.0–43.3] months respectively, p = n.s.). Mean tunnel diameter changes or widening was statistically significantly greater for QT autografts than BTB autografts at the tibial tunnel: (0.4 [±0.6] mm] vs. −0.4 [±1.1 mm; p < 0.001). Similarly, the mean tunnel diameter change was also significantly greater at the femoral tunnel for QT compared to BTB. (0.2 [±0.6] mm vs. −0.4 [±0.8] mm; p < 0.001) However, no patients with QT grafts demonstrated tibial or femoral tunnel diameters >12 mm.Although QT autografts had a statistically significant greater amount of tunnel widening compared to BTB autografts; the mean tibial and femoral net widening of 0.4 mm and 0.2 mm, respectively, does not meet previously reported clinically significant values. Thus, the tunnel widening presented in this study is unlikely to affect clinical outcomes and should not preclude the use of either graft.Level III (Retrospective comparative study). [ABSTRACT FROM AUTHOR]

Background: The recruitment of high-quality applicants is critical to the vitality of the sports medicine physician workforce., Objective: To analyze changes in the total number of available training positions, applicants, and unfilled training positions in the Sports Medicine Match from 2012 to 2022., Design: This was a retrospective cohort study of sports medicine fellowship applicants., Setting: Accreditation Council for Graduate Medical Education-accredited sports medicine fellowship training programs., Participants: A total of 3763 individuals applying for sports medicine fellowship training from 2012 to 2022., Interventions: Not applicable., Main Outcome Measures: Annual number of applicants, training positions, and number of unfilled training positions., Results: From 2012 to 2022, the annual number of training positions in sports medicine increased from 177 to 353 (99% increase, p < .001) while the annual number of applicants increased from 256 to 428 (67% increase, p < .001). The annual applicant-to-training position ratio decreased (1.4 to 1.2, p < .001). Annual match rates increased for both U.S. MD graduates (64% to 86%, p < .001) and non-U.S. MD graduates (64% to 77%, p < .001). U.S. MD graduates had higher match rates than non-U.S. MD graduates in 2021 (79% vs 70%, p < .05) and 2022 (86% vs 77%, p < .05). The percentage of applicants who matched at their first (36%-36%, p > .05), second (14%-15%, p > .05), and third (9%-8%, p > .05) ranked programs did not change. The percentage of applicants who did not match decreased (33%-19%, p < .001). The percentage of available fellowship training positions that went unfilled decreased (8%-2%, p < .001)., Conclusions: Interest in sports medicine fellowship training is increasing as evidenced by an increasing number of applications and decreasing rate of unfilled training positions. Continued monitoring of future match cycles is important given projected shortages in the physician workforce., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed knee operations. An "all-inside" technique creates bone sockets for ACL graft passage, as opposed to more traditional full bone tunnels, and typically incorporates suspensory fixation instead of screw fixation to secure the graft. This technique may be indicated for any ACL reconstruction surgery, where adequate bone stock exists to drill sockets and to use cortical fixation. The technique may be used with all soft tissue, as well as bone plug ACL grafts and autograft hamstring or quadriceps tendon; most allograft tendon options may be performed with an all-inside technique. Advantages include anatomic tunnel/socket placement, decreased postoperative pain and swelling, minimal hardware, appropriate graft tensioning and retensioning, and circumferential graft to bone healing. Tips for successful all-inside surgery include matching graft diameter to socket diameter, drilling appropriate length sockets based on individual graft length, so as not to "bottom out" the graft and confirming cortical button fixation intraoperatively. Potential complications include graft-socket mismatch, full-tunnel reaming, and loss of cortical fixation. Multiple studies have shown the all-inside technique to have similar or superior biomechanical properties and clinical outcomes compared to the more traditional full-tunnel ACL reconstruction techniques., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Slipped capital femoral epiphysis (SCFE) is a common hip condition in adolescents, most commonly treated with in-situ cannulated screw fixation. We report two cases of cannulated screw failure within the femoral neck following SCFE fixation. To our knowledge, this is the first reported case in the literature of cannulated screw failure within the femoral neck following in-situ screw fixation for unstable SCFE., Level of Evidence: Level IV.

Focal fibrocartilaginous dysplasia (FFCD) is an uncommon, yet well documented, cause of long-bone angular deformities in children. We report two unusual cases of FFCD involving the tibia: one within the proximal tibia inducing genu valgum and one apparent FFCD lesion of the distal tibia that generated a varus deformity of the distal tibia. To our knowledge, this is the first reported case of FFCD in the distal tibia. Each lesion led to an angular deformity that required surgical management.