Expert United Kingdom consensus on the preservation of joint health in people with moderate and severe haemophilia A: A modified Delphi panel.

AIM: For people with haemophilia A (PwHA), bleeding in the joints leads to joint damage and haemophilia-related arthropathy, impacting range of motion and life expectancy. Existing guidelines for managing haemophilia A support healthcare professionals (HCPs) and PwHA in their efforts to preserve joint health. However, such guidance should be reviewed, considering emerging evidence and consensus as presented in this manuscript. METHODS: Fifteen HCPs experienced in the management of PwHA in the UK participated in a three-round Delphi panel. Consensus was defined at ≥70% of panellists agreeing or disagreeing for Likert-scale questions, and ≥70% selecting the same option for multiple- or single-choice questions. Questions not reaching consensus were revised for the next round. RESULTS: 26.8% (11/41), 44.8% (13/29) and 93.3% (14/15) of statements reached consensus in Rounds 1, 2 and 3, respectively. HCPs agreed that prophylaxis should be offered to patients with a baseline factor VIII (FVIII) level of ≤5 IU/dL and that, where there is no treatment burden, the aim of prophylaxis should be to achieve a trough FVIII level ≥15 IU/dL and maintain a longer period with FVIII levels of ≥20-30 IU/dL to provide better bleed protection. The aspirational goal for PwHA is to prevent all joint bleeds, which may be achieved by maintaining normalised (50-150 IU/dL) FVIII levels. CONCLUSION: The panel of experts were largely aligned on approaches to preserving joint health in PwHA, and this consensus may help guide HCPs.

Bone Marrow Edema Injury Patterns in the Pediatric Knee: An MRI Study.

Background: Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns. Purpose: We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion. Methods: We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan. Results: After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases. Conclusions: The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.

Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients.

BACKGROUND: The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients' baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR. METHODS: This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered "high grit". Patients below the 50th percentile were considered "low grit". Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05. RESULTS: A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score ( P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) ( P = 0.006). CONCLUSIONS: This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients' likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated. LEVEL OF EVIDENCE: Level IV; retrospective cohort study.

Severe Thrombocytopenia in a Case of Epstein-Barr Virus-Induced Infectious Mononucleosis.

Epstein-Barr virus (EBV) infections have variable presentations ranging from asymptomatic to the triad of fever, pharyngitis, and adenopathy in infectious mononucleosis. Although haematological abnormalities are commonly seen in EBV infections, severe EBV-associated thrombocytopenia is a rare presentation, complicating clinical diagnosis and requiring appropriate management. Here we describe a case of a 14-year-old female with severe thrombocytopenia (platelet count of 5 x109/L) and spontaneous haemorrhage, accompanied by periorbital oedema, an uncommon symptom in EBV-associated infectious mononucleosis. She was treated with intravenous immunoglobulins and a four-day course of methylprednisolone. Treatment resulted in progressive platelet count recovery, and the patient was discharged seven days post-admission with a platelet count of 143 x109/L. The case highlights the need to consider EBV infection as a differential diagnosis in patients presenting with acute severe thrombocytopenia.

Is Grit Associated with Burnout and Well-being in Orthopaedic Resident and Faculty Physicians? A Multi-institution Longitudinal Study Across Training Levels.

BACKGROUND: Grit has been defined as "perseverance and passion for long-term goals" and is characterized by maintaining focus and motivation toward a challenging ambition despite setbacks. There are limited data on the impact of grit on burnout and psychologic well-being in orthopaedic surgery, as well as on which factors may be associated with these variables. QUESTIONS/PURPOSES: (1) Is grit inversely correlated with burnout in orthopaedic resident and faculty physicians? (2) Is grit positively correlated with psychologic well-being in orthopaedic resident and faculty physicians? (3) Which demographic characteristics are associated with grit in orthopaedic resident and faculty physicians? (4) Which demographic characteristics are associated with burnout and psychologic well-being in orthopaedic resident and faculty physicians? METHODS: This study was an institutional review board-approved interim analysis from the first year of a 5-year longitudinal study of grit, burnout, and psychologic well-being in order to assess baseline relationships between these variables before analyzing how they may change over time. Orthopaedic residents, fellows, and faculty from 14 academic medical centers were enrolled, and 30% (335 of 1129) responded. We analyzed for the potential of response bias and found no important differences between sites in low versus high response rates, nor between early and late responders. Participants completed an email-based survey consisting of the Duckworth Short Grit Scale, Maslach Burnout Inventory-Human Services (Medical Personnel) Survey, and Dupuy Psychological Well-being Index. The Short Grit Scale has been validated with regard to internal consistency, consensual and predictive validity, and test-retest stability. The Psychological Well-being Index has similarly been validated with regard to reliability, test-retest stability, and internal consistency, and the Maslach Burnout Inventory has been validated with regard to internal consistency, reliability, test-retest stability, and convergent validity. The survey also obtained basic demographic information such as survey participants' age, gender, race, ethnicity, marital status, current year of training or year in practice (as applicable), and region of practice. The studied population consisted of 166 faculty, 150 residents, and 19 fellows. Beyond the expected age differences between sub-populations, the fellow population had a higher proportion of women than the faculty and resident populations did. Pearson correlations and standardized ß coefficients were used to assess the relationships of grit, burnout, psychologic well-being, and continuous participant characteristics. RESULTS: We found moderate, negative relationships between grit and emotional exhaustion (r = -0.30; 95% CI -0.38 to -0.21; p < 0.001), depersonalization (r = -0.34; 95% CI -0.44 to -0.23; p < 0.001), and the overall burnout score (r = -0.39; 95% CI -0.48 to -0.31; p < 0.001). The results also showed a positive correlation between grit and personal accomplishment (r = 0.39; 95% CI 0.29 to 0.48; p < 0.001). We also found a moderate, positive relationship between grit and psychologic well-being (r = 0.39; 95% CI 0.30 to 0.49; p < 0.001). Orthopaedic surgeons with 21 years or more of practice had higher grit scores than physicians with 10 to 20 years of practice. Orthopaedic surgeons in practice for 21 years or more also had lower burnout scores than those in practice for 10 to 20 years. Married physicians had higher psychologic well-being than unmarried physicians did. CONCLUSION: Among orthopaedic residents, fellows, and faculty, grit is inversely related to burnout, with lower scores for emotional exhaustion and depersonalization and higher scores for personal accomplishment as grit increases. CLINICAL RELEVANCE: The results suggest that grit could be targeted as an intervention for reducing burnout and promoting psychologic well-being among orthopaedic surgeons. Other research has suggested that grit is influenced by internal characteristics, life experiences, and the external environment, suggesting that there is potential to increase one's grit. Residency programs and faculty development initiatives might consider measuring grit to assess for the risk of burnout, as well as offering curricula or training to promote this psychologic characteristic.

Orthopaedic Surgery Residency Match After an Early-Exposure Research Program for Medical Students.

INTRODUCTION: The purpose of this study was to determine the proportion of students matching in orthopaedic surgery after a structured, early-exposure mentored research program and what factors were associated with those students compared with participants who matched in other specialties. METHODS: Program data were reviewed from 2007 to 2015. Multivariable binary logistic regression analysis was used to evaluate student and research factors associated with orthopaedic surgery match. RESULTS: Of 174 students, 117 (67%) matched into surgical residency programs, with 49% (n = 85) matching into orthopaedic surgery. The percentage of women matching into orthopaedic surgery (37%) was less than that of men (53%), which, however, increased over the study period. Students who matched in orthopaedic surgery had greater numbers of publications (3.55 [range 0 to 17] average publications) compared with students who matched in other specialties (1.98 (range 0 to 11) average publications). The average number of publications per student increased from 0.79 (±1.44, range 0 to 10, 40%) preprogram to 1.95 (±2.28, range 0 to 11, 71%) postprogram. Measured factors associated with orthopaedic surgery match were publications with program mentor, postprogram first authorship, and total publications. DISCUSSION: Approximately half of the participants matched into orthopaedic surgery. Analysis showed that research productivity increased after program participation and was statistically associated with increased likelihood of orthopaedic surgery match.

The Feasibility of Blinding Intraoperative Electro-Auricular Acupuncture Under Neuraxial Anesthesia.

Objective: Demand for complementary medicine, in particular, acupuncture, has increased over the past few years but widespread acceptance has been limited, in part, by the lack of high-quality studies, including lack of blinding. Acupuncture studies traditionally have difficulty with blinding as sham acupuncture can have up to a 40%-50% analgesic effect. This study randomized patients between Acupuncture and No Acupuncture (standard of care) without using sham needles. The primary outcome was adequate blinding of electro-auricular acupuncture in the intraoperative setting with secondary outcomes of pain/nausea control. Materials and Methods: Forty patients undergoing anterior cruciate ligament reconstruction were enrolled. Subjects were randomly assigned to receive acupuncture (Enhanced Electro-Auricular Trauma Protocol) or No Acupuncture during their surgeries. All patients received spinal anesthesia and intravenous midazolam, ketamine, and propofol for sedation. 1000 mg of intravenous (IV) acetaminophen and up to 30 mg of IV ketorolac were given at closure. No opioids or peripheral nerve blocks were administered intraoperatively. Results: Bang's Blinding indices were 0.2 (95% confidence interval [CI]: -0.02, 0.42) in the Acupuncture group, and 0.11 (95% CI: -0.10, 0.31) in the No Acupuncture group on postoperative day 1. Both groups had adequate blinding. There were no differences in pain scores, nausea/vomiting incidence, opioid consumption 0-24 hours, or patient satisfaction. Five patients in the No Acupuncture group received rescue blocks, while no patients in the Acupuncture group needed a rescue block (Fisher's exact test: p = 0.047). Conclusions: This study proved the primary hypothesis that adequate blinding of intraoperative acupuncture can be performed when patients are under sedation and neuraxial anesthesia. This research is registered at ClinicalTrials.gov as Clinical Trial Registration #: NCT03711734.

Novel manifestations of immune dysregulation and granule defects in gray platelet syndrome.

Gray platelet syndrome (GPS) is a rare recessive disorder caused by biallelic variants in NBEAL2 and characterized by bleeding symptoms, the absence of platelet α-granules, splenomegaly, and bone marrow (BM) fibrosis. Due to the rarity of GPS, it has been difficult to fully understand the pathogenic processes that lead to these clinical sequelae. To discern the spectrum of pathologic features, we performed a detailed clinical genotypic and phenotypic study of 47 patients with GPS and identified 32 new etiologic variants in NBEAL2. The GPS patient cohort exhibited known phenotypes, including macrothrombocytopenia, BM fibrosis, megakaryocyte emperipolesis of neutrophils, splenomegaly, and elevated serum vitamin B12 levels. Novel clinical phenotypes were also observed, including reduced leukocyte counts and increased presence of autoimmune disease and positive autoantibodies. There were widespread differences in the transcriptome and proteome of GPS platelets, neutrophils, monocytes, and CD4 lymphocytes. Proteins less abundant in these cells were enriched for constituents of granules, supporting a role for Nbeal2 in the function of these organelles across a wide range of blood cells. Proteomic analysis of GPS plasma showed increased levels of proteins associated with inflammation and immune response. One-quarter of plasma proteins increased in GPS are known to be synthesized outside of hematopoietic cells, predominantly in the liver. In summary, our data show that, in addition to the well-described platelet defects in GPS, there are immune defects. The abnormal immune cells may be the drivers of systemic abnormalities such as autoimmune disease.

Development of Parsonage-Turner Syndrome After Heat Stroke in Firefighters: A Report of 2 Cases.

CASE: Two firefighters developed Parsonage-Turner syndrome (PTS) shortly after sustaining episodes of heat stroke. Patient 1 was a 40-year-old man who presented with shoulder pain and supraspinatus and infraspinatus weakness. Patient 2 was a 35-year-old man who presented with shoulder pain and absent external rotation strength. Both had electrodiagnostic testing and magnetic resonance imaging findings consistent with PTS. Both demonstrated partial but incomplete recovery at 1- and 2.5-year follow-ups, respectively. CONCLUSIONS: PTS should remain on the differential diagnosis for any patient presenting with sudden onset shoulder pain and neurological deficits after an episode of heat-related illness.

Generational Differences in Grit, Self-Control, and Conscientiousness Among Orthopaedic Surgeons: From Millennials to Baby Boomers.

BACKGROUND: The training process and practice of orthopaedic surgery is demanding and arduous. Accordingly, grit, self-control, and conscientiousness are desirable qualities in orthopaedic surgeons. Some established orthopaedists have expressed concern that the future generation of surgeons may not possess the same level of grit as their predecessors. The purpose of this study was to evaluate levels of grit among attending orthopaedic surgeons, identify predictors of grit in orthopaedic surgeons, and compare grit scores between attending surgeons and orthopaedic residency applicants. We hypothesized that applicants would demonstrate lower grit and self-control scores but greater conscientiousness scores than attending surgeons. METHODS: A total of 2,342 attending orthopaedic surgeons and 895 orthopaedic residency applicants from the 2016-2017 National Resident Matching Program (NRMP) were given surveys that quantified their grit, self-control, and conscientiousness. Demographic and career information also was collected. RESULTS: Assessments were completed by 655 (28%) of 2,342 practicing orthopaedic surgeons and 455 (50.8%) of 895 orthopaedic residency applicants. The residency applicants demonstrated higher mean grit scores (4.12 of 5.0) than the attending orthopaedic surgeons (4.03) (p < 0.01). These average scores placed applicants and attending surgeons at the 70th and 65th percentile, respectively, when compared with the general population. There were no differences in self-control (p = 0.68) or conscientiousness (p = 0.93) between the 2 groups. Attending surgeons with more publications had increased grit (p < 0.01), self-control (p = 0.04), and conscientiousness (p = 0.01) scores. Attending surgeons who had been inducted into the Alpha Omega Alpha honor society as medical students demonstrated greater conscientiousness scores than those who were not members (p = 0.04). CONCLUSIONS: Orthopaedic residency applicants were at least as gritty, consistent in their interest, persevering in their efforts, and ambitious as currently practicing orthopaedic surgeons. Although these results may be encouraging and diverge from some preconceived perceptions of "millennials," it is unclear if they will be predictive of career success in the next generation of orthopaedists.

Is Grit the New Fit?-Assessing Non-Cognitive Variables in Orthopedic Surgery Trainees.

OBJECTIVE: The purpose of this study was to determine overall levels of grit, self-control, and conscientiousness among orthopedic surgery residents, to compare levels of grit across orthopedic resident training levels, and to identify common applicant variables which may correlate with these valuable noncognitive attributes. DESIGN: A cross-sectional study composed of a confidential electronic survey consisting of a 17-item Grit scale, 10-item Self-control scale, and 9-item Conscientiousness scale was completed by Orthopedic residents and fellows. SETTING: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; a tertiary medical center. PARTICIPANTS: Grit, ambition, consistency of interest, perseverance of effort, self-control, and conscientiousness were assessed in orthopedic surgery residents and fellows. The survey was distributed to program coordinators of ACGME accredited Orthopedic Surgery residency programs and fellowship. 431 (431 out of 621, 69.4%) respondents completed the assessment. RESULTS: Orthopedic residents demonstrated high baseline levels of grit (4.0 of 5.0), self-control (3.8 of 5.0), and conscientiousness (4.4 of 5.0). The grit score of 4.0 places them in the 65th percentile of the general adult population. There were no significant differences in scores between training levels of orthopedic residents and fellows. Significantly higher self-control scores were seen in female trainees (p = 0.042), inductees of Alpha Omega Alpha honor society (p = 0.008), and those with higher numbers of publications (p = 0.037). Orthopedic trainees with more publications scored higher in the ambition sub-score (0 publications: 4.0 ± 0.7; 1-3 publications: 4.2 ± 0.5, 3 or more publications: 4.3 ± 0.5; p < 0.001). CONCLUSIONS: Orthopedic surgery residents demonstrated high levels of grit compared to the general population. Key objective variables utilized in the residency application process including Alpha Omega Alpha status and volume of research publications were predictive of these qualities.

Objective Predictors of Grit, Self-Control, and Conscientiousness in Orthopaedic Surgery Residency Applicants.

INTRODUCTION: The purpose of this study was to identify objective predictors of grit, self-control, and conscientiousness in orthopaedic surgery residency applicants. METHODS: The following attributes were assessed in 455 applicants: grit, self-control, conscientiousness, consistency of interest, perseverance of effort, and ambition. These measures were correlated with standard, objective demographics obtained during the application process. RESULTS: Alpha Omega Alpha status, additional degrees, and number of publications did not predict any of the studied attributes. Grit increased with age (P < 0.001) but decreased with increasing board scores (P = 0.004). Former collegiate athletes demonstrated greater grit (P < 0.001), consistency of interest (P = 0.007), perseverance (P = 0.006), and self-control (P = 0.019). Female applicants demonstrated more grit (P = 0.044), consistency of interest (P = 0.003), and conscientiousness (P = 0.029) than males. Applicants with military experience had increased ambition (P = 0.033) and conscientiousness (P = 0.001). CONCLUSION: Overall, orthopaedics applicants possess increased grit compared with the general public, and a number of objective variables reliably predicted the studied attributes. LEVEL OF EVIDENCE: Level III, Cross-sectional study.

Firefighters Have a Higher Incidence of Trochlear Chondral Lesions than the Normal Population.

BACKGROUND: Firefighters' knees are subjected to significant dynamic and static forces, resulting in increased knee complaints and a higher relative risk of osteoarthrosis, compared with aged-matched office workers. Firefighters wear or carry a total of 80 to 100 lbs. of gear while performing intensive physical activity. PURPOSE/QUESTION: The purpose of this study was to determine whether a central femoral trochlear lesion was observed in firefighters undergoing knee arthroscopy for other diagnoses. METHODS: A retrospective chart review of 159 knees in 146 firefighters undergoing arthroscopy for treatment of acute meniscal injury or anterior cruciate ligament reconstruction over a 14-year period was undertaken. Patient demographics, physical examination results, trochlear lesion size and grade, and firehouse type (engine vs. ladder company) and firefighter position (seniority) were recorded. Comparisons of characteristics in those with and without trochlear lesions were performed. RESULTS: The average patient age was 42.2 years (range, 27 to 64 years). Ninety-eight knees (62%) had trochlear lesions and 33 knees (51%) had matching patellar lesions. Patients with lesions were older (43.2 vs. 40.5 years). Mean trochlear lesion size was 19.5 ± 13.7 mm by 18.9 ± 12.4 mm. Lesion grade distribution was grade 1 or 2 in 24 knees (24%) and grade 3 or 4 in 67 knees (44%). Trochlear lesion presence was associated with a body mass index of over 30. Current engine company members had more advanced lesions. CONCLUSIONS: A "firefighter's trochlea" was present in the majority of firefighters undergoing knee arthroscopy. Higher age and longer tenure as a firefighter prior to surgery were associated with more advanced lesions. Firefighters working in engine companies at the time of arthroscopy were at a greater risk of developing low-grade lesions but not high-grade lesions. Firefighters move between ladder and engine companies, thus a definitive association with company type cannot be reached in this retrospective study. This lesion may reflect the increase in patellofemoral biomechanical stresses secondary to the physical demands of the occupation.

How Variable Are Achilles Allografts Used for Anterior Cruciate Ligament Reconstruction? A Biomechanical Study.

BACKGROUND: Allograft tendon used in anterior cruciate ligament reconstruction (ACLR) requires sterilization before implantation. Low-dose gamma irradiation is a means of sterilization that may minimize tissue damage. PURPOSE: To quantify the variability in mechanical properties between low-dose irradiated Achilles tendon allografts used for ACLR. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 15 intact outer-third Achilles tendon allograft specimens were collected from the remains of full Achilles allografts used for intraoperative ACLR at a single hospital. All grafts were obtained from a single tissue bank and underwent proprietary disinfection and low-dose gamma irradiation (1.5-2.5 Mrad). Biomechanical testing was carried out to measure tendon elongation, failure location during tensile testing, maximum stress, maximum strain, and modulus of elasticity. The mean and standard deviation were calculated for each outcome measure, and the variability between specimens was calculated by the coefficient of variation (CV). The effect of donor age on graft material properties was examined by use of linear regression. One-way analysis of variance was performed to compare differences in the mechanical properties across failure locations. RESULTS: During cyclic testing, tendon elongation averaged 1.4% ± 1.6% with a CV of 118%. During failure testing, the maximum stress averaged 12.2 ± 4.1 MPa, maximum strain averaged 21.0% ± 6.3%, and modulus of elasticity averaged 95.5 ± 30.8 MPa. The CVs for maximum stress, maximum strain, and modulus of elasticity were 34%, 30%, and 32%, respectively. Ten tendons failed in the midsubstance and 5 failed at the tendon-bone enthesis. No differences were noted in mechanical properties between grafts that failed in the midsubstance versus those that failed at the enthesis. Donor age did not correlate with allograft elongation during cyclic load or any of the material property measures during failure testing. CONCLUSION: The variabilities in the material properties and graft elongation during cyclic loading of Achilles tendon allografts used in ACLR fall within the range of properties reported in the literature for other ACLR allografts. Material properties do not differ by donor age or graft failure location observed during failure testing. CLINICAL RELEVANCE: Surgeons should be aware that there exists considerable variation in the mechanical properties of Achilles allograft tendons used for ACLR. This variability is difficult to detect by tissue bank screening or the treating surgeon's inspection and may contribute to the heterogeneity in outcomes of allograft ACLR.

Comparative Assessment of Grit, Conscientiousness, and Self-Control in Applicants Interviewing for Residency Positions and Current Orthopaedic Surgery Residents.

OBJECTIVE: The purpose of this study was to quantify grit, conscientiousness, and self-control in orthopaedic residency applicants and current orthopaedic surgery residents. As part of a continual reassessment of the selection process, this study will help to improve this process by assessing the introduction of these non-cognitive assessments. This is the first study to both evaluate and compare the applicants' scores to those of current residents. This introduction will allow selection of not only the current top performers but those who have the wherewithal (read grit) to sustain their efforts throughout their residency. DESIGN: A cross-sectional study composed of a confidential electronic survey consisting of a 17-item Grit scale, 10-item Self-control scale, and 9-item Conscientiousness scale was completed by medical school applicants and orthopaedic residents. SETTING: Department of Orthopaedic Surgery, Hospital for Special Surgery. PARTICIPANTS: Fifty-six (100%) medical student applicants (mean age = 27) were invited to participate in our study following a full day of interviews. Forty-five residents (mean age = 31) were asked and 32 (72%) completed the same surveys 4 months later. RESULTS: There was a significant difference in grit for medical students (M = 4.19, SD = 0.34) and residents (M =3.86, SD = 0.48); t(86) = 3.76, p = 0.000. All grit subscales were also significantly different for medical students versus residents. Medical students (conscientiousness M = 4.60, SD = 0.41; self-control M = 3.51, SD = 0.30) and residents (conscientiousness M = 4.42, SD = 0.53; self-control M = 3.31, SD = 0.73) scored similarly in the conscientiousness t(86) = 1.75, p = 0.084 and self-control scales t(86) = 1.74, p = 0.086. Academic performance indicators such as the USMLE scores and residency ranking were also compared among medical student applicants. CONCLUSIONS: The similar and above average levels of conscientiousness and self-control demonstrate the persevering nature of the individual who elects to pursue an orthopaedic residency program. Although the grit levels were different between medical school student and residents, they were above average for both groups, again demonstrating the type of individual willing to pursue an orthopaedic residency program. This study was the first to demonstrate varying degrees of grit for high-performing students versus residents in a competitive program, which seems to suggest that grit can vary over time. Future studies will investigate the validity of these non-cognitive variables in predicting achievement prospectively in a residency program.

The effect of variation in donor platelet function on transfusion outcome: a semirandomized controlled trial.

The effect of variation in platelet function in platelet donors on patient outcome following platelet transfusion is unknown. This trial assessed the hypothesis that platelets collected from donors with highly responsive platelets to agonists in vitro assessed by flow cytometry (high-responder donors) are cleared more quickly from the circulation than those from low-responder donors, resulting in lower platelet count increments following transfusion. This parallel group, semirandomized double-blinded trial was conducted in a single center in the United Kingdom. Eligible patients were those 16 or older with thrombocytopenia secondary to bone marrow failure, requiring prophylactic platelet transfusion. Patients were randomly assigned to receive a platelet donation from a high- or low-responder donor when both were available, or when only 1 type of platelet was available, patients received that. Participants, investigators, and those assessing outcomes were masked to group assignment. The primary end point was the platelet count increment 10 to 90 minutes following transfusion. Analysis was by intention to treat. Fifty-one patients were assigned to receive platelets from low-responder donors, and 49 from high-responder donors (47 of which were randomized and 53 nonrandomized). There was no significant difference in platelet count increment 10 to 90 minutes following transfusion in patients receiving platelets from high-responder (mean, 21.0 × 109/L; 95% confidence interval [CI], 4.9-37.2) or low-responder (mean, 23.3 × 109/L; 95% CI, 7.8-38.9) donors (mean difference, 2.3; 95% CI, -1.1 to 5.7; P = .18). These results support the current policy of not selecting platelet donors on the basis of platelet function for prophylactic platelet transfusion.