Faculty Bibliography

INTRODUCTION/BACKGROUND:The purpose of the current study was to evaluate resident, fellow, and attending perspectives on the use of e-learning as part of orthopaedic surgery education. METHODS:A survey was created evaluating (1) overall attitudes toward e-learning, (2) multi-institutional e-learning/e-conferences, (3) national/regional e-conferences, and (4) future directions with e-learning. The survey was distributed to all the orthopaedic surgery residency program directors in the United States, and they were asked to circulate the survey to their program's faculty and trainees. RESULTS:A total of 268 responses were collected, including 100 attendings and 168 trainees. Overall satisfaction with e-learning compared with in-person learning was higher among trainees than attending faculty, with 51.4% of trainees favoring e-learning, as opposed to 32.2% of attendings (P = 0.006). Both groups felt they were more likely to pay attention with in-person learning (P = 0.89). During the COVID-19 pandemic, 85.7% of residents have used e-learning platforms to join a conference in their specialty of interest while off-service. Most attendings and trainees felt e-learning should play a supplemental role in standard residency/fellowship education, with a low number of respondents feeling that it should not be used (86.6% versus 84%, and 2.1% versus 0.6%, respectively, P = 0.28). CONCLUSION/CONCLUSIONS:E-learning has been an important modality to continue academic pursuits during the disruption in usual education and training schedules during the COVID-19 pandemic. Most trainees and attendings surveyed felt that e-learning should play a supplementary role in resident and fellow education moving forward. Although e-learning does provide an opportunity to hold multi-institutional conferences and makes participation in meetings logistically easier, it cannot fully replicate the dynamic interactions and benefits of in-person learning.

BACKGROUND:Given the relatively low incidence of infection, the role of prophylactic antibiotics for infection prevention in arthroscopic surgery is unclear. Without established evidence-based guidelines, it becomes important to understand the trends and common practices in the field. HYPOTHESIS/OBJECTIVE:We hypothesized that a majority of surgeons would use preoperative intravenous antibiotics and that postoperative antibiotics would be rarely used. METHODS:A web-based link containing a questionnaire on perioperative antibiotic use for arthroscopic surgery of the knee and shoulder was sent to sports medicine surgeons at several institutions in the New York tri-state region. The questionnaire addressed antibiotic use both preoperatively and postoperatively and the type of medication used. RESULTS:During the study period, 86 surgeons responded to the knee portion of the survey and 139 surgeons responded to the shoulder portion of the survey. A significant majority (94.24% for knee and 93.02% for shoulder) of the respondents routinely preferred to use preoperative intravenous antibiotics for both shoulder and knee surgery. The antibiotic of choice for a majority of the respondents was cefazolin (98.1% respondents). In patients with penicillin allergies, most preferred to use clindamycin. Most respondents (84.5%) did not routinely use postoperative oral antibiotics. CONCLUSION/CONCLUSIONS:There is significant consensus among orthopedic surgeons performing knee and shoulder arthroscopic surgery regarding use of preoperative antibiotics, with the majority routinely prescribing preoperative intravenous antibiotics for prophylaxis and cefazolin being the most commonly used antibiotic. The majority of surgeons prefer not to use postoperative oral antibiotics. CLINICAL RELEVANCE/CONCLUSIONS:This study describes the current trends in the use of perioperative antibiotics among orthopedic surgeons for routine arthroscopic procedures in the shoulder and knee.

Introduction/UNASSIGNED:The traditional nociceptive approach to pain identifies the mind and body as functionally separate. However, the biopsychosocial model accounts for the impact of social, psychological and physical factors on the patient experience. The purpose of this study was to determine the relationship between diagnosis, physical disability, and psychological distress among patients with anterior knee pain-one of the most common complaints in an orthopedic clinic. Methods/UNASSIGNED:This was a single-center, cross-sectional study. Patients presenting for initial evaluation of knee pain completed the Pain Catastrophizing Scale, Kujala Anterior Knee Pain Scale, and SF-12 questionnaires. Statistical analysis was performed using SPSS Version 24. Results/UNASSIGNED:207 patients, 108 (52.2%) females and 99 (47.8%) males, with a mean age 44.5 ± 15.4 years were enrolled. The osteoarthritis cohort had the highest pain catastrophizing score (17 ± 14.5), lowest Kujala score (48.3 ± 18.1), lowest SF-12 PCS (37.5 ± 8.3), and lowest SF-12 MCS (50.8 ± 11.0). Across all diagnoses, there was a statistically significant negative correlation between the total Pain Catastrophizing Score (PCS) and the Kujala, SF-12 Physical, and SF-12 Mental Component Scores. Bivariate and multivariate analysis demonstrated a correlation between PCS and duration of symptoms and African-Americans. The Kujala and SF-12 PCS demonstrated a statistically significant correlation with age, smoking, and the Asian Indian ethnicity. The SF-12 MCS showed a significant relationship with the Asian Indian ethnicity. Bivariate analysis also showed a statistically significant relationship between the SF-12 PCS and the SF-12 MCS. Conclusion/UNASSIGNED:Knee pain patients presenting to an orthopedic sports medicine clinic demonstrate diminished physical quality of life and psychological reserves. This study determined an association between catastrophizing behavior and other patient reported outcomes measuring pain, physical distress, quality of life and mental/emotional well-being. To optimize patient outcomes, psychological domain should be managed contemporaneously to orthopedic pathology.

PURPOSE/OBJECTIVE:The purpose of the current study is to meta-analyze the current evidence in the literature to compare arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation. METHODS:A literature search of MEDLINE, EMBASE and The Cochrane Library, was performed based on the PRISMA guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value of < 0.05 was considered statistically significant. RESULTS:= 0, p = 0.002). CONCLUSION/CONCLUSIONS:Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play compared to conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely for first-time dislocators who participate in sports.

Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Preoperative planning is critical to identify and characterize bone tunnel pathology. Choice of technique, graft, and implant are influenced by numerous patientrelated and technical factors. Despite this complexity, a variety of strategies are available to help manage and navigate common bone tunnel problems. Among these include alternative techniques for reaming, bone grafting, and fixation. This review provides a modern evidence-based and practical guide to equip the orthopedic surgeon with a systematic approach to the evaluation and management of bone tunnel-related issues encountered during revision anterior cruciate ligament reconstruction.

PURPOSE/OBJECTIVE:In recent years, meniscal allograft transplantation (MAT) has been established as an effective option for young patients with symptomatic meniscus insufficiency with goals of functional improvement and joint preservation. Currently, there is little available information on return-to-play among patients in this cohort. The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return-to-play guidelines, and subsequent rates of return-to-play following MAT. METHODS:MEDLINE, EMBASE and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find studies on MAT. Studies were included if they reported return-to-play data or rehabilitation protocols. The rate and timing of return-to-play was assessed. The rehabilitation protocols were recorded, including time to start range of motion (ROM), full ROM, partial weight bearing (WB), and full WB. RESULTS:Overall, 67 studies met the inclusion criteria. Eleven studies, including 624 patients, reported 483 out of 624 patients (77.4%) returning to play, with 326 out of a reported 475 patients (68.6%) returning to the same/higher level, at a mean time to return of 9.0 months. There was significant variability in the reported rehabilitation protocols, but the most commonly reported time to begin ROM exercises was within the first week by 42 out of 60 studies (70.0%) and full ROM at 8 weeks by 18 out of 46 studies (39.1%). Partial weight bearing was most commonly begun in the fourth week by 20 out of 46 studies (43.5%), and for full WB the sixth week by 43 out of 65 studies (66.1%). Time elapsed following surgery was the most commonly reported criteria for return-to-play by 44 out of 48 studies (91.6%), with 6 months being the most common time point utilized by 17 out of 45 studies (37.8%). A small proportion of studies, 16 out of 48 (33.3%), advised against returning to competitive/collision sports altogether following MAT. CONCLUSIONS:In conclusion, there is a high rate of return-to-play following MAT, with the majority of patients returning to the same level of play. However, there is significant variability in reported rehabilitation protocols, and poor-quality reporting in return-to-play criteria in the literature indicates a need for further study and the development of an evidence-based consensus statement for this patient population. The results from this study can be used to better inform patients on their expected outcomes and provide a more informed consent process. LEVEL OF EVIDENCE/METHODS:IV.

Injuries to the posterolateral corner of the knee are rare but significant injuries that occur most commonly in the context of a multiligamentous knee injury. The structures of the posterolateral corner serve as a primary restraint to varus and external rotation and as a secondary restraint to posterior translation. Contemporary reconstructive techniques focus on anatomic restoration of function of the posterolateral corner and excellent long-term results have been demonstrated.

Meniscus surgery has dramatically changed over the last 20 years. This article reviews the advances and current evidence in meniscus repair.

AIM/OBJECTIVE:There is a shortage of high-level evidence regarding periarticular fractures affect outcomes after MLKIs. The purpose of this study was to determine whether concomitant periarticular fractures with mutliligament knee injuries (MLKIs) predict worse patient-reported outcomes (PROMs) when compared to MLKIs without concomitant periarticular fractures after surgical repair and/or reconstruction. MATERIALS AND METHODS/METHODS:Medical records of patients who sustained MLKIs from January 1, 2009 to June 1, 2014 were retrospectively reviewed. All patients aged 18-65 years with grade III injuries of two or more knee ligaments and 1-year minimum follow-up were included. Patients with injuries or surgeries to either knee before their MLKIs were excluded. Radiographs and computed tomography imaging obtained at the time of injury were used to detect concomitant periarticular fractures. Patients with and without concomitant periarticular fractures were matched on a 1:2 basis, respectively. Multiple PROMs were collected, including the IKDC Subjective Knee Form (IKDC-SKF), and Knee Injury and Osteoarthritis Outcome Score (KOOS). The independent t-test was used to compare PROMs between patients with and without periarticular fractures. RESULTS:Eighteen patients (10 males, 8 females) with a mean follow-up of 4.0 years (range 1.1-8.6 years) were included in the final analysis, with six patients having MLKIs and concomitant periarticular fractures. Compared to patients with isolated ligamentous MLKIs (n   =  12), patients with concomitant periarticular fracture (n = 6) demonstrated significantly worse outcomes on the IKDC-SKF (54.2 ± 13.3 vs. 74.0 ± 19.6, p = 0.04) and KOOS-Sports and Recreation subscale (41.2 ± 32.4 vs. 70.8 ± 19.4, p = 0.03). CONCLUSION/CONCLUSIONS:The presence of a periarticular fracture predicted significantly worse clinical outcomes in the setting of MLKI. These findings may be useful in determining the prognosis of MLKI with concomitant periarticular fractures treated with surgical repair and/or reconstruction.

OBJECTIVE:To report radiographic features and complications of coracoclavicular ligament reconstruction and the association of radiographic features with symptomatology. MATERIALS AND METHODS/METHODS:Retrospective picture archiving and communication system query (1/2012-8/2018) identified subjects with prior coracoclavicular ligament reconstruction. Post-operative radiographs were reviewed with attention to the following: (1) acromioclavicular alignment, (2) coracoclavicular width, (3) distal clavicular osteolysis, (4) osseous tunnel widening, and (5) hardware complication or fracture. Medical records were reviewed to determine purpose of imaging follow-up (symptomatic versus routine). Statistical analysis determined associations between binary features and outcomes, and inter-reader agreement. RESULT/RESULTS:Review of 55 charts identified 32 subjects (23 male, 9 females; age range 24-64; imaged 1-34 months following surgery) meeting inclusion criteria. Loss of acromioclavicular reduction was the most common imaging finding (n = 25, 78%), with 76% progressing to coracoclavicular interval widening. Distal clavicular osteolysis was seen in 21 cases (66%) and was significantly associated with loss of acromioclavicular joint reduction (p = 0.032). Tunnel widening occurred in 23 patients (82%) with more than one follow-up radiograph. Six (19%) had hardware complication or fracture. No radiographic feature or complication had significant correlation with symptomatology (p values 0.071-0.721). Inter-reader agreement was moderate to substantial for coracoclavicular interval widening and hardware complication, fair to substantial for tunnel widening, and fair to moderate for loss of acromioclavicular reduction and distal clavicular osteolysis. CONCLUSION/CONCLUSIONS:Loss of acromioclavicular joint reduction, coracoclavicular interval widening, distal clavicular osteolysis, and tunnel widening are common radiographic features after coracoclavicular ligament reconstruction; however, they do not necessarily correlate with symptomatology.