Impact of the Radiology Scholars Certificate Program: Does It Persist Years After Program Completion?

RATIONALE AND OBJECTIVE: The Radiology Scholars Certificate Program (RSCP) is an elective course for preclinical medical students which aims to improve radiology knowledge, dispel misconceptions regarding the field, and train future clinicians who have a greater understanding of the scope of the field. Previously, we have shown that students demonstrate improved knowledge of radiological topics as well as improved perception of radiology as a field after completing the program. In this study we attempt to determine whether these effects persist up to two years following program completion. MATERIAL AND METHODS: A two-part questionnaire was sent to all third- and fourth-year medical students at our institution in order to assess their objective ability to select appropriate imaging studies and interpret basic imaging findings, as well as evaluate their subjective attitudes and comfort level with radiology topics. Statistical analysis compared students who completed the RSCP to non-RSCP controls. RESULTS: A total of 54 students responded to the survey (34 had previously completed the RSCP). RSCP participants were significantly more likely to select appropriate imaging workups and correctly interpret imaging findings compared to controls (p < 0.001). Furthermore, RSCP participants reported significantly higher confidence in their ability to order imaging (p < 0.001) and significantly higher satisfaction with their radiology education (p < 0.001). RSCP participants were less likely to agree with negative stereotypes regarding radiology and reported more favorable perceptions of the field. CONCLUSION: Preclinical radiology-driven medical student education programs like the RSCP offer the potential for lasting improvements in students' understanding of and attitudes toward radiology as a field. We believe that such programs will help address challenges facing the field of radiology regarding recruitment, diversity, and interdisciplinary understanding.

Return to Sport After Arthroscopic Capsular Repair in Elite Baseball Players.

Background: Chronic attritional midsubstance capsular tears arising from repetitive throwing stress are a rare but important source of pain and dysfunction in elite baseball players; however, little is known regarding outcomes after arthroscopic capsular repair. Purpose: To evaluate the patient-reported outcomes and return-to-sport (RTS) rates after arthroscopic capsular repair in elite baseball players. Study Design: Case series; Level of evidence, 4. Methods: We identified 11 elite-level baseball players who were treated with arthroscopic repair for a midsubstance glenohumeral capsular tear by a single surgeon with a uniform approach and a standardized postoperative protocol between 2012 and 2019. All players had at least 2 years of follow-up data. Demographic data and concomitant surgical procedures were recorded. Preoperative and postoperative Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and Single Assessment Numeric Evaluation (SANE) scores were collected in a subset of the cohort, and statistical comparisons were made. A telephone survey was conducted to determine the patients' RTS level and outcome scores. Statistical comparisons between preoperative and postoperative outcomes scores were made using t tests. Results: Eight major league players, 1 minor league player, and 2 collegiate players were included. There were 9 pitchers, 1 catcher, and 1 outfielder. All patients had debridement of the posterosuperior labrum and rotator cuff. Two pitchers underwent a rotator cuff repair, and 1 outfielder underwent a posterior labral repair. The mean age at the time of surgery was 26.9 years (range, 20-34 years), with a mean follow-up of 3.5 years (range, 2.6-5.9 years). There were significant preoperative versus postoperative improvements in the mean KJOC (20.6 vs 89.8; P = .0002) and SANE (28.3 vs 86.7; P = .001) scores. All patients reported a high degree of satisfaction. At a mean of 16.3 months (range, 6.5-25.4 months), 10 of 11 (90.1%) players met the Conway-Jobe good or excellent criteria for RTS. Conclusion: Arthroscopic capsular repair provided significant improvements in functional outcomes in elite baseball players, high levels of patient satisfaction, and high levels of RTS.

Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With and Without Suture Augmentation.

BACKGROUND: A common concern associated with elbow ulnar collateral ligament (UCL) reconstruction is the amount of time required for recovery and rehabilitation. For example, for Major League Baseball pitchers, the average time to return to competition ranges from 13.8 to 20.5 months. Suture tape augmentation has shown the ability to provide additional soft tissue stability across other joints in the body. By providing an additional checkrein to the UCL reconstruction while the graft is healing, it may be possible to accelerate the rehabilitation process in overhead athletes and thus effect a quicker return to sports. PURPOSE: To compare elbow valgus stability and load to failure between UCL reconstruction with and without suture tape augmentation. STUDY DESIGN: Controlled laboratory study. METHODS: Fresh-frozen cadaveric elbows (N = 24) were dissected to expose the UCL. Medial elbow stability was tested with the UCL intact, deficient, and reconstructed utilizing the 3-strand docking technique with or without suture augmentation. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion-tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, reconstructed specimens were loaded to failure at 70° of elbow flexion. RESULTS: UCL-deficient elbows demonstrated significantly greater valgus rotation when compared with intact and internally braced reconstructed elbows at every angle of flexion tested and when compared with unbraced UCL-reconstructed elbows at 50° to 120° of flexion (P < .05). There were no significant differences between intact and UCL-reconstructed elbows with and without suture augmentation at any flexion angle tested. When loaded to failure, unbraced reconstructed elbows failed at a significantly lower torque as compared with elbows with UCL reconstruction with suture tape augmentation (P < .01). CONCLUSION: In this cadaveric model, 3-strand UCL reconstruction with suture augmentation did not overconstrain the elbow throughout all flexion angles when compared with the native state and UCL reconstruction alone, while providing greater load to failure. CLINICAL RELEVANCE: Suture tape augmentation may provide the additional strength necessary to accelerate rehabilitation after UCL reconstruction.

High Prevalence of Lumbosacral Pathology in Patients with Greater Trochanteric Pain Syndrome.

PURPOSE: To establish prevalence of lumbar and lumbosacral pathologies in patients with hip abductor tendon disorders. METHODS: A retrospective review of patients' charts was conducted over a 5-year period, January 2013 to October 2018, using the S76 and M76 International Classification of Diseases Tenth Revision (ICD-10) codes. Patients with symptomatic and radiologically confirmed hip abductor tendon disorders (partial and full-thickness tear of the gluteus medius tear with or without gluteus minimus tearing) were included in the study. No exclusion criteria were applied. Patient medical history was examined for concurrent diagnoses of lumbar and lumbosacral pathologies (radiculopathy, lumbar stenosis, degenerative disc disease, and neurogenic claudication). RESULTS: One-hundred and three patients with hip abductor tendon disorders were identified. Forty-seven (45.6%) patients had low-grade partial abductor tears, while 56 (54.4%) of patients had a high-grade partial or complete abductor tear. Fifty (48.5%) patients carried a concomitant lumbosacral diagnosis, with 20 (19.4%) patients being diagnosed with lumbar stenosis and 45 (43.7%) being diagnosed with degenerative disc disease. CONCLUSION: Patients with hip abductor tendon disorders were associated with a high prevalence of underlying lumbar and lumbosacral pathologies. Nevertheless, a causal relationship between these conditions cannot be established. LEVEL OF EVIDENCE: Level IV. Retrospective Case Series.

Effect of Patient Height and Sex on the Patellar Tendon and Anterior Cruciate Ligament.

BACKGROUND: Graft-tunnel mismatch is an avoidable complication in anterior cruciate ligament (ACL) reconstruction. Patient height and sex may be predictors of patellar tendon length (PTL) and intra-articular ACL length (IAL). Understanding these relationships may assist in reducing graft-tunnel mismatch during ACL reconstruction with bone-patellar tendon-bone (BTB) autograft. PURPOSE: To determine the association of patient height and sex with PTL and IAL. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Magnetic resonance imaging (MRI) studies were obtained on the healthy knees of 100 male and 100 female patients. Patients with prior surgery, open physes, significant degenerative changes, ACL rupture, or extensor mechanism injury were excluded. Three independent readers measured PTL, IAL, and Caton-Deschamps Index (CDI) on MRI. Bivariate and linear regression analysis was performed to detect the association of anthropometric data with anatomic parameters measured on MRI studies. RESULTS: The mean age and body mass index were not significantly different between the male and female patients; however, male patients were significantly taller than female patients (1.75 vs 1.72 m, respectively; P < .001). There was a substantial agreement between the 3 readers for all parameters (κ > 0.75). Overall, female patients had significantly longer PTL (47.38 vs 43.92 mm), higher CDI (1.146 vs 1.071), and shorter IAL (33.05 vs 34.39 mm) (P < .001 for all). Results of the linear regression analysis demonstrated that both height and female sex were predictive of longer PTL. Further, height was independently predictive of IAL but sex was not. CONCLUSION: PTL was correlated more with patient sex than height. IAL was also correlated with patient sex. Longer BTB grafts are expected to be harvested in female patients compared with male patients of the same height despite shorter IAL. These associations should be considered during BTB ACL reconstruction to minimize graft-tunnel mismatch.

A method for calculating the fragility index of continuous outcomes.

OBJECTIVE: Clinicians' overdependence on p-values to determine significance in clinical trials is common yet potentially misleading. The Fragility Index (FI) describes how robust a significant result is by determining the number of events the statistical significance hinges on. However, this concept cannot be applied to nondichotomous variables. We describe a method to calculate a Continuous Fragility Index (CFI) for continuous variables. We further provide a method to estimate CFI when original data is not available. STUDY DESIGN AND SETTING: An iterative substitution algorithm is described to calculate CFI prospectively from data or retrospectively from summary statistics and its response to variations in the data is reported. We then apply this method to a previously published review as a proof-of-concept. RESULTS: The CFI increases linearly with sample size, logarithmically with mean difference, and decreases exponentially with standard deviation. Forty-eight studies were included of which 30 had significant non-dichotomous outcomes. CFI and FI were uncorrelated and mean CFI was significantly higher than FI (9 vs. 2, P< 0.001). CONCLUSION: Our algorithm extends fragility to continuous outcomes, expanding the applications of the fragility concept. The fragility of outcomes within a single study may vary based on variable type and should be evaluated independently.

Outside-In Capsulotomy of the Hip for Arthroscopic Pincer Resection.

Hip surgical techniques have evolved significantly, transitioning from open techniques to arthroscopic techniques. Hip arthroscopy has many advantages over open techniques, including reduced trauma to surrounding tissues, reduced risk of infection, and improved patient-reported outcome measures. Hip arthroscopic techniques are now commonly used for pathologies such as femoroacetabular impingement (FAI). FAI can include cam, pincer, or mixed impingement. Through hip arthroscopy, FAI may be treated with a femoroplasty and acetabuloplasty along with addressing any labral pathology that may exist. Owing to the capsule playing an integral role in hip stability, surgeons are now mindful of the initial approach and closure on completion of the intra-articular procedure. The most common approach for capsulotomy is the inside-out approach. However, this approach can be difficult in patients with a large pincer deformity. The authors describe an outside-in approach to arthroscopic hip capsulotomy. This capsular approach helps protect the labrum and articular cartilage while preserving capsular tissue.

The Impact of COVID-19 on the Sports Medicine Fellowship Class of 2020.

BACKGROUND: In response to the COVID-19 pandemic, many US health systems suspended elective surgery at the recommendation of the US Surgeon General. This dramatically decreased case volumes for orthopaedic sports medicine fellows at academic institutions. PURPOSE: To describe how the COVID-19 pandemic has affected the education of the sports medicine fellowship class of 2020 as well as the subsequent effects on their career plans and psychological well-being. STUDY DESIGN: Cross-sectional study. METHODS: A 33-item survey was distributed via email to all American Orthopaedic Society for Sports Medicine (AOSSM) 2020 fellow members on April 22, 2020. Frequencies are presented as raw totals and percentages of respondents. The Fisher exact test was used to determine statistical significance between nominal variables, with significance set at P < .05. RESULTS: Of 210 registered fellows, 101 (48.1%) responded. Before the COVID-19 outbreak, the typical case volume per week for most fellows (47.5%) was 11 to 15 cases. From the enactment of COVID-19 mitigation policies to the date of survey completion, 90.1% of fellows had performed fewer than 20 cases. A total of 32 fellows were presented with redeployment options by their fellowship program, with 10 redeployed mandatorily to other hospital departments. Fellows reported that web-based didactics (n = 100) and web-based journal clubs (n = 72) were utilized as alternative supplements in the absence of clinical education. There were 8 respondents who had either their prior contract or job offer rescinded, while 1 had a signed contract voided. As a result, 6 fellows now plan to matriculate into a previously unplanned fellowship. Also, 10 respondents' intended practice start date was being delayed by their employer. Respondents whose postfellowship plans were affected were statistically more likely to experience doubts about readiness for practice (58.8% vs 20.3%, respectively; P = .005), anxiety about future career plans (94.4% vs 63.8%, respectively; P = .01), anxiety about their financial situation (86.7% vs 50.8%, respectively; P = .018), stress in personal relationships (58.8% vs 29.9%, respectively; P = .045), and signs or symptoms of depression (41.2% vs 11.1%, respectively; P = .007) compared with those whose plans were not affected. CONCLUSION: This survey illustrates that during the early stages of the COVID-19 pandemic and the subsequent suspension of elective surgery, there have been downstream effects to this group's education, careers, board certification timeline, and potentially their social and/or emotional well-being.

Anterior Cruciate Ligament Repair Using a Knotless Suture Implant.

Recent orthopedic literature has shown that primary repair for femoral-sided avulsion tears of the anterior cruciate ligament (ACL) can be successful. Primary ACL repair avoids invasive reconstruction techniques, graft-site morbidity, and the loss of native anatomy while producing excellent results in appropriately selected patients. Here we describe our patient selection parameters, ACL repair technique, and rehabilitation protocol.

Results of hip arthroscopy in elite level water polo players with femoroacetabular impingement: return to play and patient satisfaction.

Water polo places significant stress on the hip joint requiring repetitive hip flexion and rotation to elevate the body out of water for passing, shooting and blocking. Femoroacetabular impingement (FAI) is common in water polo athletes; however, no study to date has investigated the results of hip arthroscopy in this patient population. The purpose of this study was to determine return to play rates and satisfaction following hip arthroscopy for FAI in a cohort of elite level water polo players. A retrospective review of our surgical database was performed. Collegiate water polo players with clinical and radiographic FAI who underwent hip arthroscopy were identified. Pre- and post-operative modified Harris hip scores (mHHSs) were obtained. Patient surveys were administered to determine return to play rates, level of return to play, timing of return and patient satisfaction. A Wilcoxon ranked sum test was performed to compare pre- and post-operative outcome scores. Ten patients met inclusion criteria. Average age was 19.5 years old (SD ±1.08). All patients were male Division 1 collegiate water polo players. Median mHHS improved from 66.0 (SD ±7.9) pre-operatively to 89.5 (SD ±3.2) at average 1.6 years (range: 0.4-3.6 years) post-operatively. Patient survey responses demonstrated a 100% return to water polo and 100% return to the same level of play (NCAA Division 1) at mean 5.75 months (SD ±1.8). All patients (10/10) reported being satisfied with their surgical result. Our study results, suggest that return to sport rates and patient satisfaction are high in water polo players who undergo hip arthroscopy for FAI.

Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation: A Surgical Technique.

The anterior cruciate ligament (ACL) is the most common ligamentous knee injury and often is encountered in those participating in multidirectional sports. ACL reconstruction is the most commonly performed knee ligament reconstruction and employs a variety of surgical techniques but still is challenged by residual laxity and graft rupture. To help address and prevent future ACL failures, new repair and reconstruction techniques have been employed that incorporate suture augmentation (InternalBrace; Arthrex, Naples, FL), which protects the graft during healing and ligamentization. Our goal of this article is to provide a surgical technique of suture augmentation with ACL reconstruction.