Faculty Bibliography

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.

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.

PURPOSE/OBJECTIVE:This study systematically reviewed the literature for outcomes following revision surgery for a failed prior Latarjet procedure. METHODS:Two independent reviewers performed the literature search based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies in which the Latarjet procedure was performed as a revision procedure following failed prior shoulder instability surgery were included. Clinical outcomes analyzed were: 1. functional outcomes, 2. recurrent instability, 3. range of motion, and 4. COMPLICATIONS/RESULTS:Statistical analysis was performed using IBM SPSS. RESULTS:There were seven studies with 161 patients (162 shoulders) included. Four studies used a bone-block procedure, three used arthroscopic soft-tissue stabilization, and the mean follow-up was 49.8 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean average of 79.7, with 82.9% of patients having good to excellent outcomes. Return to play was possible for 73.8% of patients, with 64.2% of those returning to at least the same level of competition. The overall recurrence rate was 9.5%, with 3.6% and 5.9% experiencing recurrent dislocations and subluxations, respectively. The overall revision rate was 4.2%, with all patients undergoing revisions due to recurrence. There were no reported neurovascular complications. Instability arthropathy was reported in 43.3% of patients. CONCLUSION/CONCLUSIONS:Surgical management following a failed Latarjet procedure results in moderate rates of recurrent instability and has a low intraoperative and postoperative complication rate. Additionally, the results across all techniques appear similar, with no procedure being identified as the gold-standard in the literature. However, there was a concerning rate of instability arthropathy, which may be related to the failure of a bony procedure.

BACKGROUND:Traumatic anterior shoulder instability is a common clinical problem among athletic populations, with several surgical treatment options available. The optimal treatment remains undetermined. Currently the main current treatment options are the Latarjet procedure or open or arthroscopic Bankart repair. The purpose of this study was to network meta-analyze the recent evidence to ascertain if the open Latarjet procedure and open or arthroscopic Bankart repair result in lower recurrence rates and subsequent revision procedures. The results were ranked with the P-score. METHODS:A literature search was performed based on the PRISMA guidelines. Cohort studies comparing any of the open Latarjet procedure and open or arthrosopic Bankart repair for anterior shoulder instability were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. RESULTS:Twenty-nine studies with 2,474 patients were included. The open Latarjet procedure resulted in lower rates of recurrent instability and revisions due to recurrence compared to both open and arthroscopic Bankart repairs. The open Latarjet procedure resulted in the highest rate of return to play. However, the open Latarjet procedure also resulted in the highest complication rate. CONCLUSION/CONCLUSIONS:Our network meta-analysis found the open Latarjet procedure had the lowest recurrence rates, lowest revisions rates, and highest rates of return to play in the surgical treatment of anterior shoulder instability. However, the Latarjet procedure has been shown to result in a higher complication rate, which needs to be considered when deciding which stabilization procedure to perform.

BACKGROUND:Patients with anterior cruciate ligament (ACL) injuries and reconstruction are at an increased risk of developing osteoarthritis requiring total knee arthroplasty (TKA). There have been few studies analyzing the impact of prior ACL reconstruction (ACLR) on surgical time and perioperative complications following TKA. PURPOSE/OBJECTIVE:The purpose of the current study was to compare surgical time and the rate of select early postoperative complications following TKA in patients with a history of ACLR to patients without prior ligament reconstruction. METHODS:We identified 116 patients who underwent TKA at our institution with a history of ACL reconstruction on the operative knee. These patients were propensity score matched to a control cohort of 348 patients undergoing TKA without a prior ACLR based on age, body mass index, sex, race, smoking status, surgeon, and year of surgery. Outcomes of interest for the current analysis were surgical time, incidence of postoperative wound complications, length of stay, discharge disposition, and 30-day readmission rate. RESULTS:There was no statistically significant difference between the ACLR and non-ACLR groups with respect to surgical time (108.23 ± 45.57 minutes vs. 102.72 ± 38.73 minutes, p = 0.205). There was also no significant difference in length of hospital stay, discharge disposition, incidence of postoperative wound complications, 30-day readmission rate, or reoperation rate. CONCLUSION/CONCLUSIONS:In this matched cohort analysis, we found no difference between patients undergoing TKA after ACLR and patients undergoing TKA for primary osteoarthritis with respect to perioperative complications and select postoperative outcomes, including the rate of reoperations. The current data demonstrates no significant impact of prior ACLR on the surgical time required to perform the arthroplasty.

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.

BACKGROUND/UNASSIGNED:Medial patellofemoral ligament (MPFL) reconstruction is being performed more frequently in athletes experiencing recurrent patellar instability. PURPOSE/HYPOTHESIS/UNASSIGNED:The purpose was to systematically review the evidence in the orthopaedic sports medicine literature to determine both the rate and timing of return to play after MPFL reconstruction and the rate of further patellar instability. Our hypothesis was that there would be a high rate of return to play after MPFL reconstruction. STUDY DESIGN/UNASSIGNED:Systematic review. METHODS/UNASSIGNED:A systematic literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which utilized EMBASE, MEDLINE, and the Cochrane Library databases. Inclusion criteria for literature included clinical studies reporting on return to play after MPFL reconstruction. Rate of return to play, level of return, timing of return, rate of recurrent instability, and patient-reported outcomes were evaluated. Statistical analysis was performed using SPSS. RESULTS/UNASSIGNED:Our review found 27 studies including 1278 patients meeting our inclusion criteria. The majority of patients were women (58%), and the total group had a mean age of 22.0 years and a mean follow-up of 39.3 months. The overall rate of return to play was 85.1%, with 68.3% returning to the same level of play. The average time to return to play was 7.0 months postoperatively. The rate of recurrent instability events following reconstruction was 5.4%. There was an improvement in both mean visual analog scale, pain scores (preoperative: 4.3, postoperative: 1.6) and Tegner activity scores (preoperative: 4.8, postoperative: 5.5). CONCLUSION/UNASSIGNED:The overall rate of return to play was high after MPFL reconstruction for the treatment of recurrent patellar instability. However, a relatively high percentage of those patients were unable to return to their preoperative level of sport. Additionally, there was a moderate time taken to return to play, at approximately 7 months after the procedure.

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.

INTRODUCTION/BACKGROUND:Students seek gap years to enhance knowledge and improve chances of professional success. Although many institutions offer research opportunities, no studies have examined outcomes after these experiences. This study evaluates a dedicated year of orthopaedic research on a cohort's ultimate orthopaedic surgery match rate. METHODS:From 2001 to 2018, 129 learners spent a year with our Department of Orthopedic Surgery at a major academic medical center. The students were either completing a gap year after college, during or after medical school, or after an unsuccessful match. Participants were asked to respond to a survey, which included demographics, educational information, and metrics related to the program. For the subcohort of students who ranked orthopaedic surgery, the match rate was compared with the mean for the US orthopaedic surgery match rates from 2006 to 2018 using a chi-square analysis. In addition, a Mann-Whitney U test was used to compare the number of publications before and after the year. RESULTS:One hundred three students (80%) returned completed questionnaires. Of all learners who applied to and ranked orthopaedic surgery, 91% matched into an orthopaedic surgery residency program. These results compared favorably with the US orthopaedic match from 2006 to 2018 (67.9%; P < 0.001), despite a 4-point lower United States Medical Licensing Examination (USMLE) Step 1 score for the research cohort. Finally, the research cohort had a greater percentage of women (23%) and minorities (40%) than the proportion of woman and minority practicing orthopaedic surgeons. CONCLUSION/CONCLUSIONS:Students who completed a gap year in research matched into orthopaedics at a higher rate than the national average, despite a lower Step score. Mentors may also target traditionally underrepresented groups to help increase the pool of diverse applicants.

As the world grapples with the COVID-19 pandemic, we as health care professionals thrive to continue to help our patients, and as orthopedic surgeons, this goal is ever more challenging. As part of a major academic tertiary medical center in New York City, the orthopedic department at New York University (NYU) Langone Health has evolved and adapted to meet the challenges of the COVID pandemic. In our report, we will detail the different aspects and actions taken by NYU Langone Health as well as NYU Langone Orthopedic Hospital and the orthopedic department in particular. Among the steps taken, the department has reconfigured its staff's assignments to help both with the institution's efforts and our patients' needs from reassigning operating room nurses to medical COVID floors to having attending surgeons cover urgent care locations. We have reorganized our residency and fellowship rotations and assignments as well as adapting our educational programs to online learning. While constantly evolving to meet the institution's and our patient demands, our leadership starts planning for the return to a new "normal".