Faculty Bibliography

BACKGROUND/UNASSIGNED:Although the incidence of osteochondritis dissecans (OCD) of the knee may be low, an overview and comparison of sports-related outcomes with current surgical management techniques are needed. PURPOSE/UNASSIGNED:To summarize the available evidence regarding outcomes for different surgical treatment options for unstable OCD of the knee in both skeletally mature and immature patients by calculating the return to sports (RTS) rate, the mean RTS time, and other sports-related postoperative outcome measures. STUDY DESIGN/UNASSIGNED:Systematic review; Level of evidence, 4. METHODS/UNASSIGNED:A systematic review of studies on RTS after surgical correction of unstable OCD within the knee was conducted utilizing PubMed, Embase, and the Cochrane databases. Included were studies discussing the treatment of unstable OCD with minimum 1-year follow-up outcomes. Multivariate analysis was used to compare studies grouped together based on RTS and skeletal maturity. RESULTS/UNASSIGNED:Of 2229 articles, 6 studies (197 patients; 198 knees) met the inclusion criteria and were included in our analysis. The percentage of patients who returned to the previous level of sport ranged from 52% to 100%; those returning to any level of sport ranged from 87% to 100%. Clinical outcomes did not differ between patients with open versus closed physes. Osteochondral Autograft Transfer System (OATS) procedures had a 100% RTS rate across several studies with skeletally mature and mixed cohorts, and microfracture had the lowest overall RTS rate (52%). For skeletally immature patients, all examined studies that utilized either open or arthroscopic reduction and internal fixation, 77% and 78%, respectively, had acceptable RTS rates. Arthroscopic fixation had a higher rate of revision surgery in both skeletally mature and immature patients. CONCLUSION/UNASSIGNED:Our analysis indicated that the treatment of unstable OCD lesions using the OATS technique demonstrated high RTS rates across several studies, while microfracture alone exhibited the lowest RTS rate. Both arthroscopic and open internal fixation utilizing bioabsorbable screws yielded satisfactory RTS rates for juvenile patients with OCD.

BACKGROUND/UNASSIGNED:Preoperative coracoid dimensions may affect the size of the bone graft transferred to the glenoid rim and thus the postoperative outcomes of Latarjet coracoid transfer. PURPOSE/UNASSIGNED:To determine the effect of coracoid length and width as measured on preoperative magnetic resonance imaging (MRI) on outcomes after Latarjet treatment of anterior shoulder instability. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:test, Mann-Whitney test, chi-square test, and Fisher exact test were used to compare outcomes between groups, and univariate correlation coefficients were calculated to evaluate the relationships between demographics and coracoid dimensions. RESULTS/UNASSIGNED:≥ .05 for all). CONCLUSION/UNASSIGNED:Patients undergoing Latarjet coracoid transfer had similar postoperative outcomes regardless of preoperative coracoid dimensions. These findings should be confirmed in a larger cohort before further clinical recommendations are made.

BACKGROUND:Female surgeons, representing 6.5% of the American Academy of Orthopaedic Surgeons, are particularly vulnerable to work-family conflict. This conflict may deter women from considering orthopaedic surgery as a specialty. The study objective was to identify differences in work-family integration between female and male orthopaedic surgeons in the United States. METHODS:An anonymous survey collecting data within the domains of work, family, and satisfaction was completed by 347 orthopaedic surgeons (153 female, 194 male). Differences in responses between males and females were identified. RESULTS:Female surgeons were younger than males (mean, 41.1 versus 50.1 years; p < 0.001) and earlier in their careers, with 60.3% of males in practice >10 years compared with 26.1% of females (p < 0.001). Consulting (7.8% versus 31.4%; p < 0.001), course faculty positions (19.0% versus 39.2%; p < 0.001), and academic and leadership titles (30.7% versus 47.4%; p = 0.002) were significantly less common among females. There was a significant income disparity between females (mean yearly income, $300,000 to $400,000) and males (mean, $400,000 to $500,000; p < 0.001). Females were more likely to have never married (12.4% versus 2.6%; p < 0.001), or they married at a later mean age (30.2 ± 4.7 versus 28.3 ± 3.9 years; p < 0.001). Females were more likely to have no children (29.4% versus 7.8%; p < 0.001), require fertility treatment (32.0% versus 11.9%; p < 0.001), and not have children until after completing their medical training (63.0% versus 31.1%; p < 0.001). Female surgeons reported more responsibility in parenting (p < 0.001) and household duties (p < 0.001) than males. Work-family balance satisfaction was 72.3% in females and 82.1% in males (p = 0.081). CONCLUSIONS:This study highlights deficiencies in work-family integration that appear to uniquely impact female orthopaedic surgeons. Female surgeons delay starting a family, more frequently require fertility treatments, carry more responsibility at home, have fewer academic and leadership roles, earn lower incomes, and are less satisfied with work-family balance relative to males. The discrepancy in work-family integration must be addressed to attract, support, and retain women as successful orthopaedic surgeons.

INTRODUCTION/BACKGROUND:There has been recent interest in throwing from flat-ground versus the mound regarding stress on the elbow. Typical throwing progression programs begin with flat-ground work and progress to mound work. METHODS:All baseball pitchers of ages 10 to 17 years who completed a 15-week pitching mechanics and velocity-training program were included. Players' pitch velocity was tested at four time points during training. Average velocity and maximum velocity of pitches from flat-ground were compared with those of mound, and change in velocity between testing sessions was also compared. RESULTS:Thirty-six male pitchers (average age: 14.4 ± 1.6 years) were included. Fastball velocity increased by an average of 5.2 mph (95% confidence intervals 2.0 to 8.8 mph) at the end of the training program. When change in average and maximum velocity was compared between the four testing sessions, the most notable increase in velocity occurred between the third and fourth testing sessions. Both sessions were thrown from the mound. CONCLUSION/CONCLUSIONS:The 15-week baseball pitcher-training program markedly improved pitching velocity. Throwing from a mound compared with flat-ground resulted in the largest velocity increase. Therefore, when attempting to increase a pitcher's velocity, throwing from the mound should be an integral part of any velocity program.

Background/UNASSIGNED:The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. Purpose/Hypothesis/UNASSIGNED:The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. Study Design/UNASSIGNED:Cohort study; Level of evidence, 3. Methods/UNASSIGNED:An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). Results/UNASSIGNED:= .001). Conclusion/UNASSIGNED:MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.

CASE:This report describes a case of bilateral femoral head avascular necrosis during pregnancy with a subsequent anterior dislocation of the femoral head during labor in a 40-year-old woman. CONCLUSIONS:Many physiologic and hormonal changes occur during pregnancy. Although rare, hip pathologies may cause life-changing health outcomes, demonstrating a need for more research and careful monitoring throughout pregnancy.

PURPOSE:The purpose of this study is to further evaluate the construct validity and interobserver reliability of a hip arthroscopy virtual simulator using the Arthroscopic Surgery Skill Evaluation Tool (ASSET) global rating scale. METHODS:Thirty participants (23 male/7 female) completed a diagnostic arthroscopy and a loose body retrieval simulation on the VirtaMed Arthros Hip Simulator (Zurich, Switzerland) twice at a minimum of 1 week apart. Subjects consisted of 12 novices (medical students, postgraduate year [PGY] 1-2), 5 intermediate trainees (PGY3-4), 9 senior trainees (PGY5 and fellows), and 4 attending faculty. Simulator metrics were recorded and then compiled to generate a total simulator score (TSS). The loose body retrieval was graded using the ASSET scoring tool. Inter-rater and intrarater reliability for the ASSET for 2 blinded raters and construct validity of the ASSET and the TSS were calculated. Correlation between the TSS, ASSET and individual simulator metrics was determined. RESULTS:Prior simulation experience (P ≤ 0.01) correlated with higher TSS and higher ASSET, while video game experience correlated with higher TSS on the diagnostic module only (P = 0.004). There was a significant difference in ASSET score among all experience groups (P < 0.04). Novices had the lowest mean ASSET whereas experts had the highest mean ASSET with a difference of 17.4 points. Overall performance on the surgical module significantly correlated with the ASSET score (r = 0.444, P = 0.016). There was a significant positive correlation among higher ASSET and number of loose bodies retrieved, operation time, camera path and grasper path length, and percentage of cartilage injury. ASSET demonstrated excellent intrarater reliability and showed substantial or better inter-reliability in 8 of 9 domains. CONCLUSION:The VirtaMed hip arthroscopy simulator demonstrated good construct validity and excellent reliability for simulator-based metrics and ASSET score. Use of both simulator metrics and ASSET offers a more comprehensive performance assessment on hip arthroscopy simulation than either measure alone. CLINICAL RELEVANCE:As virtual reality simulation for arthroscopy becomes more commonplace in orthopaedic training, evaluation of the most effective objective and subjective measures of performance is necessary to optimize simulation training.

INTRODUCTION/BACKGROUND:Orthopedic instrumentation is generally made as one-size-fits-all. The purpose of this study was to evaluate the effects of hand size and sex on ease of use and injury rates from orthopedic tools and surgical instruments. METHODS:An anonymous 21-item online survey was distributed to orthopedic trainees and attendings. Questions regarding demographics, physical symptoms and treatment, perceptions, and instrument-specific concerns were included. The analysis included statistics comparing responses based on sex, height, and glove size, with significance as p<0.05. RESULTS:There were 204 respondents: 119 female and 84 male. Male and female respondents differed significantly in height (mean difference 5.4 in, p<0.001) and glove size (median size 6.5 size for females, size 8 for males, p<0.001). While 69.8% of respondents reported physical discomfort or symptoms they attributed to their operating instruments, female surgeons were significantly more likely to endorse symptoms (87.3% female vs. 45.2% male, p<0.001). Of those reporting symptoms, 47.7% had undergone treatment, with no significant difference by surgeon sex (p=0.073). Female surgeons were significantly more likely than their male counterparts to have negative attitudes toward orthopedic surgical instruments and to report specific surgical instruments as difficult or uncomfortable to use. CONCLUSION/CONCLUSIONS:Female orthopedic surgeons are more likely than their male counterparts to report physical symptoms attributed to orthopedic surgical instruments, to have negative attitudes toward instruments, and to identify a larger number of common instruments as difficult or uncomfortable to use. Further emphasis on ergonomic instrument design is needed to allow all orthopedic surgeons to operate as safely and effectively as possible.

INTRODUCTION/BACKGROUND:The optimal tuberosity repair method in reverse total shoulder arthroplasty for fracture is unknown. METHODS:Eight matched pairs of cadaver shoulders were randomly assigned to a stem-based tuberosity repair technique or a nonstem-based repair (Boileau technique) and mechanically tested with a 10 kN load cell. Cyclic loading was performed between 10 and 100 N for 500 cycles at 1 Hz, followed by static pull to failure at 33 mm/s. Ultimate load was determined from the maximum load reached during the pull to failure. A paired Student t-test was used to compare the means of the ultimate load and average cyclic displacement of the two sample groups. RESULTS:The ultimate load to failure for the stem-based tuberosity repair technique was significantly higher than the nonstem-based technique (668 ± 164 N versus 483 ± 67 N; P = 0.032). The average cyclic displacement for the stem-based tuberosity repair technique was significantly less than the nonstem-based technique 0 (0.83 ± 0.67 mm versus 3.36 ± 2.36 mm; P = 0.017). CONCLUSION/CONCLUSIONS:The stem-based tuberosity repair technique afforded higher ultimate load to failure with less average cyclic displacement than the nonstem-based technique. Consideration to the stem-based technique should be given when performing a tuberosity repair in the setting of reverse total shoulder arthroplasty for fracture. LEVEL OF EVIDENCE/METHODS:Level III.

Background/UNASSIGNED:Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. Historically, this surgical procedure was performed on an inpatient basis. There has been a recent trend in performing TSA on an outpatient basis in the proper candidates. Methods/UNASSIGNED:All patients who underwent outpatient TSA performed by a single surgeon between 2015 and 2017 were included. Demographic information and clinical outcome scores, as well as data on complications, readmissions, and revision surgical procedures, were recorded. This group of patients was then compared with a matched cohort of patients who underwent inpatient TSA over the same period. Results/UNASSIGNED:Overall, 94 patients (average age, 60.4 years; 67.0% male patients) underwent outpatient TSA and were included. Patients who underwent outpatient TSA showed significant improvement in all clinical outcome scores at both 1 and 2 years postoperatively. The control group consisted of 77 patients who underwent inpatient TSA (average age, 62.6 years; 53.2% male patients). No significant differences in complications or improvements in clinical outcome scores were found between the inpatient and outpatient groups. Conclusion/UNASSIGNED:TSA performed in an outpatient setting is a safe and reliable procedure that provides significant improvement in clinical outcome scores and no difference in complication rates compared with inpatient TSA.