Males and Females Exhibit Comparable Outcomes Following Treatment of Osteochondritis Dissecans Lesions of the Knee: A Systematic Review.

PURPOSE: The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a systematic review of current evidence. METHODS: This review was conducted according to the PRISMA guidelines using the PubMed, PubMed Central, Embase, Ovid Medline, Cochrane Libraries, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Relevant outcomes included functional (e.g., International Knee Documentation Committee and Subjective Knee Evaluation, Lysholm Knee Score) and clinical outcomes (e.g., symptom/pain resolution, reoperation rates) for males and females after operative or nonoperative treatment of knee OCD lesions. RESULTS: Ten articles with a total of 691 (73%) males and 260 (27%) females were included. Mean age ranged from 11.3 ± 2.1 years to 34.5 ± 10.3 years, and follow-up ranged from 6 months to 16.3 years. In four studies reporting functional outcomes, no significant differences were found between males and females in any metric assessed (all P > .05). Seven studies reported clinical outcomes after treatment of knee OCD lesions. One study determined males were more likely to have a successful nonoperative outcome than females (OR: 1.85, 95% CI: 1.00-3.40). Another study found males had a lower risk of developing symptomatic knee pain following operative or nonoperative treatment at a mean 14-year follow-up (HR: 0.24; 95% CI: 0.07-0.81). The remaining 5 studies reported statistically comparable clinical outcomes between males and females (all P > .05). CONCLUSION: The present systematic review found mostly comparable clinical and functional outcomes between males and females following treatment of knee OCD lesions. Despite sex-related differences in the prevalence of these lesions and limited evidence of differences in clinical outcomes, these data suggest that sex does not independently predict outcomes after treatment. LEVEL OF EVIDENCE: III, systematic review of Level II and III studies.

Allopathic and Osteopathic Residents Perform Similarly on the Orthopedic In-Training Examination (OITE).

INTRODUCTION: There is a bias in the medical community that allopathic training is superior to osteopathic training, despite the lack of substantiation. The orthopedic in-training examination (OITE) is a yearly exam evaluating educational advancement and orthopedic surgery resident's scope of knowledge. The purpose of this study was to compare OITE scores between doctor of osteopathic medicine (DO) and medical doctor (MD) orthopedic surgery residents to determine whether any appreciable differences exist in the achievement levels between the 2 groups. METHODS: The American Academy of Orthopedic Surgeons 2019 OITE technical report, which reports the scores from the 2019 OITE for MDs and DOs, was evaluated to determine OITE scores for MD and DO residents. The progression of scores obtained during various postgraduate years (PGY) for both groups was also analyzed. MD and DO scores throughout PGY 1-5 were compared with independent t-tests. RESULTS: PGY-1 DO residents outperformed MD residents on the OITE (145.8 vs 138.8, p < 0.001). The mean scores achieved by DO and MD residents during PGY-2 (153.2 vs 153.2), 3 (176.2 vs 175.2), and 4 (182.0 vs 183.7) did not differ (p = 0.997, 0.440, and 0.149, respectively). However, for PGY-5, the mean scores for MD residents (188.6) were higher than those of DO residents (183.5, p < 0.001). Both groups had trends of improvement seen throughout PGY 1 to 5 years, with both groups showing an increase in average PGY scores when compared to each preceding PGY. CONCLUSION: This study provides evidence that DO and MD orthopedic surgery residents perform similarly on the OITE within PGY 2 to 4, thus displaying equivalencies in orthopedic knowledge within the majority of PGYs. Program directors at allopathic and osteopathic orthopedic residency programs should take this into account when considering applicants for residency.

Sex-related differences in hip and groin injuries in adult runners: a systematic review.

OBJECTIVES: Hip/groin running-related injuries (RRIs) are relatively uncommon. It is unclear if runners of either sex are disproportionately affected. Our objective was to systematically review differences in hip/groin RRIs between males and females. DATA SOURCES: A structured and comprehensive search of four medical literature databases was performed (PubMed, Embase, Ovid Medline, and CINAHL). Terms searched were as follows: risk, epidemiology, hip injury, groin injury, overuse injury, running, sprinting, and track and field. STUDY SELECTION: Studies reporting sex-specific data on hip/groin RRIs in adult runners were included. Data was extracted and reviewed independently by two authors. STUDY APPRAISAL AND DATA SYNTHESIS: Sex-specific injury rates, risk factors, and return to sport (RTS) following hip/groin RRI were extracted. Risk of bias was assessed using the Joanna-Briggs Institute Critical Appraisal Tool. RESULTS: Ten studies with 7,353 total runners were included: 2,315 (47%) males and 2,559 (53%) females. The mean age of the included runners was 37.3 ± 8.9 years and the mean weekly running distance was 10.4 ± 8.4 km. Hip/groin injuries comprised 10.1% (491/4,874) of total RRIs, including 6.3% of RRIs sustained by males and 11.0% by females. Three studies reported significantly higher rates of hip/groin RRIs in female runners. One study reported significantly higher rates of gluteus medius and adductor RRIs for females and males, respectively. One study identified female sex as an independent risk factor for hip/groin RRIs. Three studies reported on RTS after hip/groin RRIs: the pooled RTS rate was 81.4% (57/70) at 1 to 368 days after injury. LIMITATIONS: Data was pooled when possible; however, there was considerable clinical, methodological, and statistical heterogeneity across studies. CONCLUSIONS: Hip/groin RRIs comprise a greater percentage of total injuries among injured female runners relative to males. Females may be at a higher risk for sustaining hip/groin RRIs though more research on risk factors and RTS is needed.

Educational demographics of orthopaedic surgery department chairs.

Background: Becoming chair of an academic clinical department is a tremendous achievement that takes many years of experience and clinical excellence. Objective: The purpose of this study was to determine the educational demographics of current orthopaedic surgery department chairs in the United States. Methods: A complete list of orthopaedic surgery residency programs was obtained from the Accreditation Council for Graduate Medical Education (ACGME) 2019-2020 list of residency programs. Department chairs were identified through an online search. Educational data, including where the department chair went to medical school, residency, fellowship, and type of fellowship completed were obtained. Results: A total of 145 orthopaedic department chairs were identified. The most attended medical schools by department chairs were Baylor (6 of 145, 4.1%) and Northwestern (6 of 145, 4.1%). The University of Rochester was the most common orthopaedic residency attended (9 of 145, 6.2%) and Harvard was the most common orthopaedic clinical fellowship (20 of 133, 15.0%). On average, it took 17.9 years from completion of clinical training to being named department chair. Conclusion: This study provides insight into the academic credentials, length of clinical experience, and research productivity of current orthopaedic surgery department chairs. Certain training programs may be more likely to produce department chairs and, in general, an orthopaedic surgeon is more likely to become chair at an institution where he/she previously trained. Finally, research productivity is clearly an important factor in becoming chair, as most chairs have high h-indices and a consistent track record of research excellence.

Preoperative Optimization and Tips to Avoiding Surgical Complications Before the Incision.

In preparation for surgery, it is important for surgeons to have a detailed discussion with patients about the risks, benefits, and alternatives to surgery. Patient optimization, ensuring the patient is in the best medical condition before surgery, is also an important aspect of patient care that the surgeon must consider. Although complications cannot be eliminated, there are often opportunities to optimize patients, so these risks can be minimized based on current evidence-based medicine. To minimize the risk of complications, the surgeon should take an active role in each step of the patient's care beginning with the history and physical examination, obtaining the correct preoperative labs, and continuing through positioning, draping, and prepping before making an incision.

Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis.

BACKGROUND: Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults. HYPOTHESIS: Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients. STUDY DESIGN: Epidemiological research. LEVEL OF EVIDENCE: Level 3. METHODS: Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis. RESULTS: Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI <30 kg/m2, 37.1%). A greater proportion of female patients with stress fracture were older (P < 0.001) and had foot stress fractures (P < 0.001), while a greater proportion of male patients with stress fracture were younger than 19 years (P < 0.001) and had metatarsal (P < 0.001), hip (P = 0.002), and tibia stress fractures (P < 0.001). CONCLUSION: Stress fractures commonly occur in women and older adults with low BMIs. Metatarsal and tibia stress fractures were the most common, and a greater proportion of women had foot stress fractures. CLINICAL RELEVANCE: Our study examined the large-scale prevalence of different lower extremity stress fractures among a wide patient population sample of varying ages and BMIs. These findings can help clinicians identify active populations at greater risk for stress fracture injuries.

Women in Leadership in State and Regional Orthopaedic Societies.

INTRODUCTION: Female representation in orthopaedics remains low compared with other specialties. Recently, several studies have examined the membership composition and leadership roles of women in orthopaedic societies. However, there is a paucity of information on the possible connection between the number of women within state and regional orthopaedic societies and women who serve in leadership roles within these societies. METHODS: Authors invited executive directors of 51 state and four regional orthopaedic societies to participate in an anonymous 14-question web-based survey about female members and women in leadership positions within these societies. The survey asked about female membership composition, the percentage of male and female practicing orthopaedic surgeons in the state/region (if available), and female representation on the Board of Directors of these societies. Data were analyzed for relationships between ordinal variables. RESULTS: Forty-nine executive directors (89.1%) responded to the survey. Among respondents, there was a statistically significant positive correlation between the percentage of female members and women leaders (P = 0.015). Thirty-two executive directors (68.1%) reported between 1% and 10% female members, 7 (14.9%) had between 11% and 20% female members, and 2 (4.3%) had no female members. Twenty-five societies (52.1%) have never had a female president. Of 17 societies (32.7%) that had female presidents, 15 (75.0%) reported having just one female president. In addition, of these 17 societies, 12 (70.6%) reported having at least one acting female president within the past 10 years. DISCUSSION: Our study demonstrates a positive correlation between female members and women on the Board of Directors in regional and state orthopaedic societies. Twelve societies had female presidents within the past 10 years. Female representation in leadership positions may help with the recruitment of female orthopaedic surgeons and improve diversity in orthopaedics. Future studies should evaluate different methods of increasing female membership and leadership positions in state and regional orthopaedic societies.

Patients Report A Positive Experience on Social Media After Bankart Repair.

Purpose: The purpose of this cross-sectional study was to analyze publicly available posts on Instagram and Twitter to gain an understanding of patients' perspectives regarding Bankart injuries and repair. Methods: Public posts on Instagram and Twitter were queried from June 1, 2019, to June 1, 2020, with the following hashtags: #Bankart #Bankartrepair #Bankartlesion #labrumrepair #labralrepair #shoulderdislocation. Posts that did not contain those hashtags were excluded. In addition, posts that included that hashtag but displayed content unrelated to Bankart repair were excluded. A binary categorical system was used for media format (picture or video), perspective (patient, family or friend, physician, hospital or physical therapy group, professional organization, news media, or industry), timing (preoperative, postoperative, nonoperative), tone (positive, negative, or neutral), content (surgical site, hospital or surgeon, imaging, rehabilitation, activities of daily living [ADLs], return to work, surgical instruments, or education), post popularity (number of likes), and geographic location. Results: 1,154 Instagram posts were identified. 722/1,154 posts (62.6%) were made by patients. 600 (52.0%) of the post tones were positive, 407 (35.3%) were neutral, and 667 (57.8%) were postoperative. The most common content included in Instagram posts were ADLs (577; 50.0%), education (233; 20.2%), and rehabilitation (226; 19.6%). Overall, posts had an average of 117 likes and had geotags from 49 different countries. 155 tweets were identified, 92 of which (59.4%) were made by physicians, 113 (72.9%) were neutral, 127 (81.9%) were nonoperative, and the most common type of content posted was education (130; 83.9%). Overall, posts on Twitter had an average of 3.2 likes and had geotags from 4 different countries. Conclusions: Instagram posts were made mostly by patients postoperatively and focused on ADLs. The tone of the Instagram posts indicates that a majority of patients have a positive experience with Bankart repair. The majority of tweets were made by physicians and provided educational information with a neutral tone. Clinical Relevance: Exploring patient's experiences with Bankart repair on social media provides insight into their overall experience with the surgery. The majority of patients reported a positive experience.

The relationship between the orthopedic job market and sports medicine fellowship applications between 2010 and 2017.

Objectives: More than 90% of graduating orthopedic residents pursue at least one year of fellowship training. There are no studies to date that examine the trends for sports medicine positions in the orthopedic job market. The purpose of this study was to evaluate trends in orthopedic sports medicine positions using postings from four orthopedic journals. Methods: Print advertisements for job positions in three American orthopedic journals (Journal of Bone and Joint Surgery, Journal of the American Academy of Orthopaedic Surgeons, and American Journal of Sports Medicine) between 2010 and 2017 were reviewed. The results were compared to sports medicine fellowship match trends. Results: Between 2010 and 2017, there were a total of 403 postings for orthopedic sports medicine positions, 186 in Journal of Bone and Joint Surgery, 113 in Journal of the American Academy of Orthopaedic Surgeons, and 52 in American Journal of Sports Medicine. There was a 43% decline in print sports medicine advertisements from 2010 to 2015. The number of job advertisements for sports medicine positions remained consistent (approximately 10%) from 2010 to 2015, then dropped to 2.1% (57/2698) and 1.4% (66/4735) in 2016 and 2017, respectively. Conclusion: There is no direct correlation between job positions advertised in orthopedic journals and sports medicine fellowship positions offered. Additionally, there has been an increase in job advertisements requiring fellowship training, indicating an increased demand for sub-specialty trained orthopedic surgeons. Lastly, the drop in total orthopedic advertisements in the years proceedi ng 2015 may serve as a harbinger for the transition to largely online content, and job postings in journals may not be the most reliable source of job opportunities, but further investigation should be done in relation to this topic.

Leadership in Orthopaedic Surgery: A Survey of the Value of Leadership Development for Orthopaedic Surgery Faculty.

INTRODUCTION: The purpose of this study was to survey current orthopaedic department chairs at ACGME-accredited orthopaedic surgery programs in the United States to determine whether department chairs valued the importance of formal leadership training and, if so, to understand the leadership development opportunities available along with the benefits of these program for their orthopaedic faculty. METHODS: An anonymous online, voluntary, self-administered questionnaire containing 27 questions was distributed to current orthopaedic department chairs at ACGME-accredited orthopaedic surgery programs in the United States. RESULTS: Thirty-eight responses were received for a response rate of 27.1%. Twenty-three of 38 (60.5%) department chairs believed leadership training is very important for their orthopaedic faculty. Thirty-six of 38 (94.7%) department chairs did not believe that all their current faculty have strong leadership skills. Twenty-eight of 38 (73.6%) respondents have specific training programs for leadership development at their institution. DISCUSSION: Most department chairs (92.1%) viewed leadership training for their orthopaedic faculty as either important or very important. Seventy-four percent of orthopaedic surgery department chairs surveyed indicated that they had a leadership development program in place, with 59.1% being developed within the past 10 years. Benefits of these programs included improved listening and communication skills and management of staff.

ACGME Case Volume Minimums Decrease the Number of Shoulder and Knee Arthroscopies Performed by Residents.

PURPOSE: The purpose of this study was to examine how the implementation of Accreditation Council of Graduate Medical Education (ACGME) case minimums in 2013 has affected the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents during their clinical training. METHODS: The ACGME orthopaedic surgery case log data from graduation years 2007 to 2019 was used to evaluate the number of shoulder and knee arthroscopies performed. The mean and median number of cases performed per resident were compared for the years prior to implementation of the ACGME case minimum (2007-2012) and after (2013-2019). RESULTS: The ACGME orthopaedic surgery case minimums resulted in a significant decrease in the mean number of shoulder and knee arthroscopies performed. The mean number of shoulder arthroscopies performed in the years before and after the case minimum requirement were 109.8 and 82.0 (P = .025), respectively. The mean number of knee arthroscopies performed in the years before and after the case minimum requirement were 178.6 and 124.8 (P = .006), respectively. Residents in the tenth percentile of cases performed still met the required ACGME case minimums each year. The mean total of all cases performed in the years before and after the case minimum requirement were 2045.5 and 1699.3 (P = .038), respectively. CONCLUSIONS: The number of shoulder and knee arthroscopies performed by orthopaedic surgery residents significantly decreased after the implementation of ACGME case minimums, which may be due to underreporting of cases. CLINICAL RELEVANCE: This study may demonstrate the effect of the implementation of the ACGME case minimums on the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents.

Social media as a tool for engaging medical students interested in orthopaedic surgery.

OBJECTIVE: Instagram and Twitter are two of the most popular social media platforms today. Beyond social communication, these platforms also have the potential to enhance medical education by providing early exposure and mentorship to students and residents in training. The purpose of this study was 1) to investigate orthopaedic surgery related content posted on Instagram and Twitter 2) to analyze who posts orthopaedic surgery related content and 3) to better understand how social media may be used to supplement medical education and exposure for students interested in orthopaedics. DESIGN: Three hashtags, #Orthopedics, #OrthopedicSurgery, and #OrthopedicSurgeon were searched on Instagram and Twitter from March 8 to March 18, 2020. Posts on both platforms were analyzed for the hashtag used, number of likes, source type (e.g. physician, company promoting a product), and type of post (e.g. advertisement, educational). Descriptive statistics were used to analyze the results. SETTING: This study was performed at the Tulane University School of Medicine, New Orleans, LA, by medical students, with guidance and supervision from faculty in the Tulane University Department of Orthopaedics. RESULTS: Data was collected from 212 (47.2%) Instagram and 237 (52.8%) Twitter posts over a 10-day period. Significantly more Instagram posts used the hashtags #Orthopedicsurgeon and #Orthopedicsurgery (P<.001), while more Twitter posts used the hashtag #Orthopedics (72.0% P<.001). Companies using these hashtags posted more frequently on Twitter than Instagram (P<.001), while a higher number of physicians, orthopaedic practices, and personal accounts utilized Instagram (P<.001). There was significantly more advertising content on Twitter (P<.001), while Instagram included more personal anecdotes, medical imaging and procedures (P<.001). CONCLUSION: This study demonstrated that content related to orthopaedic surgery is regularly posted on both Instagram and Twitter. Instagram is a visually driven platform that more frequently posted educational and personal content from medical professionals and individuals, while Twitter predominantly published advertisements from companies and orthopaedic practices. The current use of Instagram may make it better suited for providing information and early exposure to medical students interested in the field. LEVELS OF EVIDENCE: III.

Social Media and Its Use in Orthopaedic Surgery Resident Education and Training.

¼: The use of social media by health-care professionals and medical educators has been increasing over the past decade. ¼: Online social networks, professional networks, blogs, microblogs, forums, podcasts, and video-sharing platforms can be used effectively to communicate and engage with, as well as learn from, other residents and attending physicians worldwide. ¼: Social media platforms and other web-based applications can serve as powerful educational tools to enhance orthopaedic resident learning, collaboration, teaching, and case discussion.

Sports Medicine Fellowship Training Significantly Increases Sports Case Volume: An Analysis of ACGME Case Log Data from 2006 to 2019.

PURPOSE: The purpose of this study was to determine the experiential benefit of completing a sports medicine fellowship for orthopaedic surgeons specializing in the treatment of sports injuries. METHODS: Accreditation Council for Graduate Medical Education case logs were examined for sports medicine cases performed by orthopaedic surgery residents from 2006 to 2019 and for orthopaedic sports medicine fellows from 2010 to 2019. The average number of arthroscopic cases was evaluated for residents and fellows according to each body group. Additional data based on subcategorization of arthroscopic cases was analyzed as well. A Student t-test was conducted to compare the means between the groups. RESULTS: Orthopaedic sports medicine fellows reported 274.9% more shoulder (260.6 ± 77.31 vs 94.8 ± 23.7, P < .0001), 685.6% more humerus/elbow (17.1 ± 6.14 vs 2.5 ± .508, P < .0001), 596.7% more pelvis/hip (41.4 ± 25.40 vs 6.9 ± 2.97, P < .0001), 188.1% more femur/knee (281.4 ± 57.85 vs 149.6 ± 34.09, P < .0001), and 264.1% more foot/ankle (16.9 ± 5.58 vs 6.4 ± .600, P < .0001) sports cases compared to orthopaedic surgery residents. Orthopaedic sports medicine fellows performed significantly more shoulder arthroscopy cases (126.8 ± 3.96 vs 86.0 ± 22.26, P = .032) and knee arthroscopy cases (179.4 ± 8.98 vs 101.75 ± 33.51, P = .015) than residents over a 5-year period. CONCLUSIONS: On average, orthopaedic sports medicine fellowships significantly increase sports case volume of orthopaedic trainees, especially in the upper extremity. Notable increases were in the shoulder, femur/knee, and pelvis/hip. We have demonstrated that orthopaedic sports medicine fellowships significantly increase exposure to sports medicine related cases. CLINICAL RELEVANCE: It is important for case volume to be evaluated across orthopaedic sports medicine fellowships because they must ensure that fellows receive adequate training in orthopaedic sports medicine.

Orthopaedic Sports Medicine Fellowship Websites: Information Considered Most Important to Fellowship Applicants.

INTRODUCTION: The purpose of this study was to determine which components of sports medicine fellowships are most important to applicants when reviewing fellowship websites during the application process. METHODS: An anonymous survey was distributed to 492 fellowship applicants from the 2017-2018 and 2018-2019 cycles. The survey included questions about the importance of including components of fellow education, recruitment, and experience on program websites. The weighted average of responses determined each component's rank, with 5 being "very important" and 1 being "not at all important." Responses were analyzed by application cycle, current position, and sex using the Wilcoxon rank-sum test. RESULTS: Sixty-five applicants participated in the survey and completed the demographics section, resulting in a 13.2% response rate. According to participants, the most important components to include on fellowship websites were exposure to advanced operative sports medicine techniques (weighted average, 4.62), complexity of cases performed (4.52), and number of cases performed (4.50). Analysis demonstrated statistically significant differences in opinion between application cycles for flexibility for conducting a remote interview (P = .0074), jobs obtained by previous fellows (P = .019), national rank of department (P = .021), program's geographic location (P = .026), protected academic time (P = .038), current positions for criteria for fellows' performance evaluations (P = .028), program's geographic location (P = .0097), and protected academic time (P = .0079). There were statistically significant differences in opinion between current positions regarding flexibility for conducting a remote interview (P = .0026), jobs obtained by previous fellows (P = .012), and national rank of department (P = .0013). CONCLUSIONS: Orthopaedic sports medicine fellowship applicants believe that it is most important to include information about the volume and complexity of fellows' cases and their day-to-day commitments on program websites. CLINICAL RELEVANCE: This information would enable applicants to identify programs that will support professional development and allow program directors to communicate expectations.

Musculoskeletal Injuries and Conditions Among Homeless Patients.

INTRODUCTION: The purpose of this study was to analyze existing literature on musculoskeletal diseases that homeless populations face and provide recommendations on improving musculoskeletal outcomes for homeless individuals. METHODS: A comprehensive search of the literature was performed in March 2020 using the PubMed/MEDLINE (1966 to March 2020), Embase (1975 to April 2020), and CINHAL (1982 to 2020) databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for accuracy of reporting, and the Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Twenty-nine articles met inclusion criteria. Seven studies observed an increased prevalence of musculoskeletal injuries among the homeless population, four observed increased susceptibility to bacterial soft-tissue infection, four observed increased fractures/traumatic injuries, three described increased chronic pain, and six focused on conditions specific to the foot and ankle region. DISCUSSION: Homeless individuals often have inadequate access to care and rely on the emergency department for traumatic injuries. These findings have important implications for surgeons and public health officials and highlight the need for evidence-based interventions and increased follow-up. Targeted efforts and better tracking of follow-up and emergency department usage could improve health outcomes for homeless individuals and reduce the need costly late-stage interventions by providing early and more consistent care.

Autograft Versus Allograft for Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

BACKGROUND: Patients with recurrent lateral patellar dislocations are often treated with reconstruction of the medial patellofemoral ligament (MPFL). PURPOSE: To perform a systematic review to evaluate clinical outcomes and the risk of recurrent patellar dislocation after MPFL reconstruction (MPFLR) with autograft versus allograft. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: The authors conducted a search of PubMed, the Cochrane Library, and Embase to identify studies comparing outcomes of MPFLR with autograft versus allograft. The inclusion criteria were full-text studies that directly compared clinical outcomes and/or risk of recurrent patellar instability between patients undergoing MPFLR with autograft versus allograft. A quality assessment was performed using the modified Coleman Methodology Score, and risk-of-bias assessment was performed using the Risk Of Bias In Non-randomized Studies-of Interventions and the Cochrane Collaboration tools. RESULTS: Seven studies (1 evidence level 2, 3 level 3, 3 level 4) that met inclusion criteria were identified and included a total of 150 patients who underwent MPFLR with autograft and 193 with MPFLR with allograft. One study found a significantly higher failure rate among patients with autograft, and another study found a trend toward a significantly higher failure rate among patients with autograft. One study demonstrated no significant difference between postoperative tibial tubercle-trochlear groove distance (measured on magnetic resonance imaging scans) in failed versus successful grafts. One study found that patellar tilt angle improved significantly from preoperatively to postoperatively (P < .001) but there was no difference between the groups. Kujala scores significantly improved for both autograft and allograft groups across studies. Two studies found significant differences in postoperative Kujala scores between the 2 groups, 1 of which found better scores in the allograft group (P = .0032) and another in which scores were better in the autograft group (P = .02). CONCLUSION: Patients undergoing MPFLR with either autograft or allograft can expect to experience improvement in clinical outcomes. Subjective outcomes improved to a similar degree in both groups. Graft failure was more frequently observed in patients with autograft. Allograft may be a better option for MPFLR owing to lower failure rate.

Patient Perspective on Post-Breast Reconstruction Exercise and Physical Therapy.

BACKGROUND: Breast reconstruction may result in significant functional compromise and pain. Postoperative exercise and physical therapy can mitigate these morbidities, but it is infrequently recommended by healthcare providers. This study asked how many breast reconstruction patients are instructed to perform postoperative at-home exercises or physical therapy, how many reported following through with these instructions, and what timeline they were given for these activities. METHODS: A 16-question multiple-choice anonymous online survey was distributed to a private breast cancer survivor Facebook group (Diep C. Foundation). RESULTS: A total of 150 breast reconstruction patients responded to our survey. The majority of respondents in our sample were not provided with specific instructions regarding postoperative at-home exercises (N = 70, 54.3%) or physical therapy (N = 77, 63.6%). Approximately 13 of 59 respondents (22%) who had been instructed to participate in postoperative at-home exercises were directed to begin at 2-3 weeks. Approximately 15 of 44 respondents (34.1%) who had been instructed to participate in physical therapy were directed to begin these at 4-5 weeks. CONCLUSIONS: To the best of our knowledge, this is the first study of how often postoperative at-home exercises and physical therapy are recommended to breast reconstruction patients. Despite robust evidence of these activities' benefits, most women are not instructed to participate in postoperative at-home exercises or physical therapy. This is likely to impede breast reconstruction patients' recovery and delay their return to activities of daily living. More studies are needed of how to actively engage breast reconstruction patients in postoperative at-home exercises and physical therapy.