Plantar Plating for Medial Naviculocuneiform Arthrodesis in Progressive Collapsing Foot Deformity.

Background: Medial column procedures are commonly used to treat progressive collapsing foot deformity (PCFD) reconstruction. The aim of this research is to present the clinical results of plantar plating for medial naviculocuneiform (NC) arthrodesis when NC joint pathology contributes to medial arch collapse. The authors hypothesized that lag screws with a plantar neutralization plate would result in a satisfactory NC joint fusion rate. Methods: A single-surgeon, retrospective case series was performed on patients with flexible PCFD who underwent NC arthrodesis using lag screws and a contoured neutralization plate applied plantarly across the medial NC joint as part of PCFD reconstruction. Thirteen patients (11 females, 2 males; mean age 53.1 [34-62] years) between 2016 and 2019 were identified for inclusion. Mean follow-up was 25.2 ± 12.7 months. Preoperative and postoperative anteroposterior talo-first metatarsal angle, lateral talo-first metatarsal angle, talonavicular coverage angle, and calcaneal pitch were measured. Union was evaluated radiologically. AOFAS midfoot scores were recorded at final follow-up. Results: All parameters demonstrated a significant improvement. Fusion was confirmed in 11 of 13 patients (85%) at a mean 5.7 ± 2.1 months. One patient required a revision of their NC fusion because of symptomatic nonunion. There were no cases of symptomatic plantar hardware. Conclusion: The results of this small cohort series suggest that lag screw with plantar plate NC arthrodesis yielded generally improved short-term radiographic and clinical outcomes in PCFD patients with medial arch collapse through the NC joint.Level of Evidence: Level IV, retrospective case series.

Factors Affecting Orthopedic Sports Medicine Surgeons' Online Reputation.

Physician rating websites (PRWs) rate physicians based on experiences of previous patients. Although a high rating is desirable, it may not correlate with quality of care, experience, or other physician-specific variables. This study examined the impact of physician-specific variables, such as American Board of Orthopaedic Surgery Sports Certificate of Added Qualification (CAQ) status, years in practice, sex, and geographic location, on the PRW patient satisfaction rating and number of ratings. A list of orthopedic sports medicine surgeons was obtained from the American Orthopaedic Society for Sports Medicine database. Demographic data were recorded. Surgeon profiles were gathered from the most commonly used PRWs (Healthgrades and Vitals), and a mean rating value was recorded on a 1- to 5-star scale. The t test and analysis of variance were used for comparisons. Multivariable linear regression was used to identify factors contributing to PRW ratings. Female sex had the biggest positive effect on PRW rating (R=0.04, P=.029). The PRW rating was positively affected by the number of ratings (R=0.04, P<.001) and negatively affected by an increase in years of practice (R=0.04, P<.001). Surgeons with fewer than 10 years in practice had higher PRW ratings than surgeons practicing longer than 10 years. The PRW ratings were not affected by sports CAQ status or geographic location. Fewer years in practice, female sex, and greater number of reviews were associated with higher PRW ratings. Number of reviews was the only modifiable factor. There was no observed association between sports medicine CAQ status and PRW rating. [Orthopedics. 2021;44(2):e281-e286.].

Is there a relationship between femoral neck-shaft angle and ischiofemoral impingement in patients with hip pain?

Ischiofemoral impingement (IFI) is a cause of deep gluteal space syndrome. The prevalence of radiographic findings in patients with hip pain is unknown. To assess if there is a correlation between femoral neck-shaft angle (NSA) and the distance of the ischiofemoral space (IFS) and quadratus femoris space (QFS) and to determine the prevalence of quadratus femoris (QF) edema in patients with hip pain. A retrospective case series was conducted involving 100 consecutive hip or pelvis magnetic resonance imaging scans on patients presenting with hip pain. NSA, IFS and QFS distances were measured and presence of QF edema was noted. Analysis of the groups (QF edema vs no edema) was performed using two-tailed t-test and Pearson correlation. There were 18 hips in the edema group (mean age 51.11 years ± 10.5) and 82 hips in the non-edema group (mean age 40.79 years ± 15.9). Within the edema group, there was a moderate positive correlation between NSA and QFS (r = 0.498, P = 0.036) and a weak positive correlation between NSA and IFI (0.312, P = 0.208). The prevalence of QF edema in this study was 18% with only 28% of those subjects having clinical symptoms of IFI. Patients with QF edema had significantly narrower QFS and IFS distances (P < 0.001). The prevalence of QF edema is 18% in a consecutive sample of adults with hip pain. In patients with QF edema, only 28% have symptoms of IFI. In patients with QF edema, there was a moderate positive correlation between NSA and QFS.

Which Subspecialties Do Female Orthopaedic Surgeons Choose and Why?: Identifying the Role of Mentorship and Additional Factors in Subspecialty Choice.

Limited data exist delineating the reasons women choose subspecialties within orthopaedics. Purpose: (1) To perform a survey that determines subspecialties female orthopaedic surgeons select and (2) to analyze the motivations behind their choices. Methods: A 10-question survey was distributed via e-mail to the Ruth Jackson Orthopaedic Society (RJOS), Texas Orthopaedic Association (TOA), and to a private internet page for women in Orthopaedics, which covered the area of subspecialty practice, motivations, and demographic data. Practicing female orthopaedic surgeons, fellows, or fellowship-matched residents were included. Respondents' ranked motivations when deciding for or against a subspecialty were analyzed and comparisons made. Results: Of the 304 survey responses, 288 met inclusion criteria. The most common subspecialties were hand (24.0%), pediatrics (22.6%), and sports medicine (16.3%). A higher proportion of younger surgeons are electing to subspecialize in sports medicine, whereas a lower proportion of younger surgeons are pursuing general orthopaedics. Top-ranked reasons for selecting a subspecialty were personal satisfaction (50.8%), intellectual stimulation (42.1%), and strong mentorship (37.4%). The most common reason for not selecting a subspecialty was lack of interest (60.6%). Conclusion: Strong mentorship was the largest extrinsic/modifiable factor that affected the decision-making process. A continued focus on mentorship will be necessary to encourage future female orthopaedic surgeons to enter this field and inspire them to explore a different set of subspecialties.

Application of three-dimensional printing for pre-operative planning in hip preservation surgery.

Three-dimensional printing is a valuable modality with broad clinical applications. Hip preservation surgery outcomes are dependent on correction of morphological abnormalities that may be optimally visualized with three-dimensional models. To assess the efficacy of three-dimensional models for patient and trainee education and to determine its benefits during pre-operative planning in hip preservation surgery. Sixteen patients with hip pathology were selected. Computed tomography was utilized to generate three-dimensional models. Customized Likert-style questionnaires were given to 10 hip preservation surgeons, 11 orthopedic surgery residents and 10 patients. All residents strongly agreed or agreed that the three-dimensional hip models helped them to understand patients' pathology. All but one patient agreed that the models assisted in their understanding of the treatment plan. Surgeons concurred that although they do not routinely order three-dimensional models, their use would improve trainee and patient education, especially when treating atypical osseous pathomorphologies. Three-dimensional models are tools that can help surgeon, trainee and patient understanding and participation in treatment of complex hip disorders. Patients and trainees agree that the prototypes enhanced their educational experience, as the surgeon can directly demonstrate complex morphological abnormalities. Trainees can therefore gain a better understanding of hip pathologies and treatment. As patients better understand their hip disorder, they can more fully participate in shared treatment decision-making. LEVEL OF EVIDENCE: Level IV, Retrospective Case Series.

Performance and Return to Sport After Achilles Tendon Repair in National Football League Players.

BACKGROUND: Achilles tendon injuries are common in sports, including football. The purpose of this study was to determine (1) return-to-sport rate in National Football League (NFL) players following Achilles tendon repair, (2) postoperative career length and games per season, (3) pre- and postoperative performance, and (4) postoperative performance compared with control players matched by position, age, years of experience, and performance. METHODS: Publicly available records were used to identify NFL players who underwent Achilles tendon repair and matched controls were identified. Ninety-five players (98 surgeries) were analyzed (mean age 28.2 ± 2.8 years; mean 5.5 ± 2 .8 years in NFL at time of surgery). Demographic and performance data were collected. Comparisons between case and control groups and preoperative and postoperative time points were made using paired-samples Student t tests. RESULTS: Seventy-one (72.4%) players were able to return to sport in the NFL at a mean of 339.8 ± 84.8 days following surgery. Thirty-one (32%) Achilles tendon repairs were performed during training camp or preseason. Controls (3.6 ± 2.1 years) had a significantly longer NFL career ( P < .05) than players who underwent Achilles tendon repair (2.7 ± 2.1 years). There was no significant difference in games per season in subsequent seasons following surgery compared with controls. Postoperative performance scores were significantly worse ( P < .05) for running backs (RBs) (n = 4) and linebackers (LBs) (n = 12) compared to preoperative scores. LBs had significantly worse postoperative performance scores when compared to matched controls ( P < .05). CONCLUSION: Following Achilles tendon repair, less than 75% of players returned to the NFL. Postoperative career length was 1 season shorter than matched controls. No difference was observed in the number of games per season played compared to matched controls. Postoperative performance scores were significantly worse for RBs and LBs compared to preoperative and LBs had significantly worse postoperative performance when compared to matched controls. LEVEL OF EVIDENCE: Level III, retrospective comparative series.