Fear of Re-Injury, Psychological Factors, and Sport Played Have Negative Impact on Return to Sport Following Medial Patellofemoral Ligament Reconstruction for Patellar Instability.

PURPOSE: To analyze factors that affect return to sport after medial patellofemoral ligament reconstruction (MPFLR), such as psychological factors, sport played, and a positive apprehension test following surgery, and to determine the average return to sport rates and time to return to sport. METHODS: A literature search was conducted according to PRISMA guidelines. Included studies met the following criteria: patients underwent MPFLR for patellar instability, return to sport was recorded, and a factor that affected return to sport was mentioned. Search terms included medial patellofemoral ligament, tibial tubercle osteotomy, tibial tubercle transfer, return to play, and return to sport. RESULTS: 18 of 632 identified studies met inclusion criteria. 1,072 patients that underwent MFPLR were recorded. Return to sport rates and mean/median time ranged from 60.0-100% and 3-10.4 months, respectively. 55.6-84.0% of patients returned to sport without decreasing level of competition. Six of 12 studies (50.0%) reported fear of re-injury as the top reason for patients not returning or returning at a lower level of sport. Volleyball/handball had the lowest return to the same level following surgery (18.2-50.0%). CONCLUSION: Athletes that underwent MPFLR following recurrent patellar instability returned to sport at a range of 60.0-100%. Return to sport at the same level or higher was found to have a lower maximum rate at 55.6-84.0%. Fear of re-injury and sport played were found to have a substantial impact on ability to return to sport. Surgeons can use this information to advise patients on expectations following surgery. LEVEL OF EVIDENCE: IV, systematic review of level III and IV studies.

Orthopaedic Surgery Residency Program Websites: Assessing Information Gaps and Opportunities for Attracting Applicants.

INTRODUCTION: The quality and volume of information on orthopaedic surgery residency program websites are helpful for informed decision making of prospective applicants. The purpose of this study was to evaluate the content on orthopaedic surgery residency program websites and identify areas for improvement. METHODS: In November 2023, 203 orthopaedic surgery residency programs were reviewed using the Association of American Medical Colleges Residency Explorer tool. Fourteen nonfunctional websites were excluded, leaving n = 189. Websites were assessed for 11 variables: resources for assisting resident research (eg, biomechanics laboratory, research assistant, and advisors), residents' past institutional affiliations, current resident profiles (including hometown and interests), alumni data, fellowship matches, American Board of Orthopedic Surgery I/II pass rates, Alpha Omega Alpha Society affiliation, target United States Medical Licensing Examination/ Comprehensive Osteopathic Medical Learning Exam Step 2 scores, educational activities (journal club, grand rounds, didactics), evaluation methods, and mentorship. RESULTS: Website variables differed markedly among identified program types, which included community programs, university programs (UPs), and affiliated programs (APs). Disparities were noted in the disclosure of residents' previous institutions (P = 0.001), the availability of alumni names (P = 0.001), research resources (P = 0.001), academic activities (P = 0.007), assigned mentorship programs (P = 0.006), and fellowship match information (P = 0.027). Notably, community programs shared statistically significantly less information in these areas compared with UPs and APs (P = 0.001). While there was a proportionate sharing of information between UPs and APs, UPs exhibited a slightly higher overall percentage of websites sharing more detailed information. CONCLUSION: The quality and comprehensiveness of information on orthopaedic surgery residency program websites vary markedly. Most of the orthopaedic surgery residency programs provided information on residents' past institutions and academic activities. However, very few provided information on designated mentorship programs or objective measures such as target Step 2 examination scores and ABOS pass rates. Improving the quality of information available on program websites will enhance transparency and consistency, enabling prospective applicants to make more informed decisions about where to apply and interview.

Bony Bankart Lesion: Diagnosis, Management, and Outcomes.

¼ Bony Bankart lesions are fractures of the anteroinferior glenoid rim, commonly associated with a traumatic anterior shoulder dislocation, and are diagnosed through radiological imaging and physical examination. Young male athletes playing contact sports are at highest risk of these injuries. Early diagnosis and treatment are crucial because, if left untreated, recurrent anterior shoulder instability and glenoid bone loss can occur. Both nonsurgical and surgical treatment options are available depending on the size of the lesion, with arthroscopic repair being the most common treatment method. After repair, patients typically have favorable outcomes with low rates of recurrent instability. This review aims to discuss the etiology, diagnosis, and treatment of bony Bankart lesions.¼ Bony Bankart lesions are fractures of the anteroinferior glenoid rim and occur in up to 22% of first-time anterior shoulder dislocations.¼ Young men involved in contact sports or combat training are at the highest risk of sustaining bony Bankart lesions.¼ Diagnosis and treatment of bony Bankart lesions are essential to prevent long-term shoulder instability.¼ Bony Bankart lesions can be treated either nonoperatively or operatively (arthroscopic vs open repair), with the size of the glenoid defect being the primary determinant of treatment.

AOA Critical Issues: Promoting Leadership Development Among Orthopaedic Faculty.

ABSTRACT: All orthopaedic surgeons are leaders in the operating room and clinic, and many orthopaedic surgeons choose to pursue other formal leadership roles. Effective leaders are proficient communicators, have high emotional intelligence, have a growth mindset, create structure, and facilitate teamwork. Participating in formal leadership training offered through the American Orthopaedic Association, the American Academy of Orthopaedic Surgeons, or advanced degree programs can facilitate the development of leadership skills. By setting goals, being aware of available leadership positions, and promoting diversity, senior leaders may help orthopaedic faculty to achieve senior leadership roles. Maxwell's leadership hierarchy, which consists of 5 levels of leadership (position, permission, production, people development, and pinnacle), provides a framework for the promotion and mentorship of junior partners by senior leaders. Seeking out and promoting leadership will encourage an environment of leaders and improve the field of orthopaedic surgery.

Venous Thromboembolism Chemical Prophylaxis in Patients Undergoing Shoulder Arthroscopy.

¼ Venous thromboembolism (VTE) after shoulder arthroscopy is rare (0.01%-0.38%) but impacts a significant number of patients because of the high procedure volume.¼ Studies found no significant benefit in reducing VTE risk with aspirin or low-molecular-weight heparins.¼ Current guidelines for thromboprophylaxis in shoulder arthroscopy lack consensus and need patient-specific considerations.¼ Further research is required to develop evidence-based thromboprophylaxis guidelines for shoulder arthroscopy.

Women in leadership in orthopaedic sports medicine societies throughout the world.

OBJECTIVES: The proportion of women in orthopaedic surgery is low compared to other specialties, despite equal numbers of male and female students entering the medical profession. This gender disparity persists across various aspects of orthopaedic sports medicine, such as academic leadership, medical education, and on the sidelines. The purpose of this study was to conduct a comprehensive and updated global analysis of female representation in leadership positions within orthopaedic sports medicine and arthroscopy societies throughout the world. METHODS: Publicly available websites for orthopaedic sports medicine societies throughout the world were evaluated. For societies that met inclusion criteria, the following data were collected: types of leadership positions available and breakdown of male and female orthopaedic surgeons in those positions. RESULTS: There were a total of 55 societies analyzed from North America (5, 9.1%), South America (8, 14.5%), Europe (18, 32.7%), Asia (13, 23.6%), Africa (2, 3.6%), the Middle East (3, 5.5%) and Australia (3, 5.5%), as well as 3 international societies (5.5%). North America had the highest percentage of women in leadership positions with 19 of 97 positions (19.6%), followed by international societies with 11 of 92 (12.0%) positions filled by women. The Middle East and Australia had the fewest number of women, with all-male leadership. Globally, female orthopaedic surgeons served in 11 of 181 (6.1%) board of directors positions, 16 of 192 (8.3%) executive committees positions, 17 of 143 (11.9%) committee chair positions, 2 of 18 (11.1%) officer positions, 1 of 12 (8.3%) council positions, and 2 of 7 (28.6%) spokesperson positions. CONCLUSION: While some countries have higher representation than others, the number of women in leadership positions in orthopaedic sports medicine societies throughout the world is significantly less than their male counterparts. While this is a preliminary analysis, future studies should aim to evaluate these trends over time. Providing equitable opportunities for women to rise into high-ranking positions in orthopaedic sports medicine may contribute to the interest of women and other minorities in the field of sports medicine and help improve diversity. LEVEL OF EVIDENCE: Level V.

Lateral Extra-articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Is Most Commonly Indicated for Pivot Shift of Grade 2 or Greater and for Revision Anterior Cruciate Ligament Reconstruction.

PURPOSE: To determine the most common indications for lateral extra-articular tenodesis (LET) augmentation of anterior cruciate ligament reconstruction (ACLR). METHODS: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 2000 to the present (June 2022). Studies that met the following criteria were included: patients of any age who underwent LET in addition to ACLR, studies reporting at least 1 indication for LET, and observational/randomized controlled trial study designs including prevalence of indications. Publications had to be reported in English and peer reviewed and to have originated in the United States or countries offering identical protocols and procedures. RESULTS: A total of 463 studies were identified from the initial search, 23 of which met inclusion criteria and were included in the review. Eight of the 23 studies (34.8%) used a modified Lemaire technique, seven (30.4%) used a MacIntosh modified by Arnold-Coker, and eight (34.8%) used other techniques to perform LET. A total of 2,125 patients (53% female, 47% male [3 studies did not report sex]) underwent ACLR augmented with LET. The indications along with prevalence were as follows: positive pivot shift test (grade ≥2) (19 of 23, 82.6%), revision ACLR (12 of 23, 52.2%), ligamentous laxity (11 of 23, 47.8%), general sports participation (11 of 23, 47.8%), age less than 25 years (8 of 23, 34.8%), high risk of graft failure (5 of 23, 21.7%), and positive Lachman test (4 of 23, 17.4%). CONCLUSIONS: Pivot shift grade ≥2 was the most common reason orthopaedic surgeons chose to add LET to ACLR, with revision ACLR, patient age <25, and general sports participation following closely behind. LEVEL OF EVIDENCE: Level I to IV, systematic review of studies.

Analysis of Graft Types Augmented With an Internal Brace for ACL Reconstruction: A Systematic Review.

BACKGROUND: New techniques are being developed to decrease the failure rate of anterior cruciate ligament (ACL) grafts and prevent revision surgery. One such technique involves high-strength suture tape (ST), also referred to as internal bracing. Recent literature has highlighted the use of ST for ACL reconstruction, but no study has compared ST augmentation between graft types. PURPOSE: To compare the use of ST augmentation for ACL reconstruction based on the type of graft used (ie, bone-patellar tendon-bone [BPTB], quadriceps, hamstring). STUDY DESIGN: Systematic review; Level of evidence, 5. METHODS: An online search of multiple databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was completed April 2022 to identify studies related to ST augmentation of ACL grafts. RESULTS: Of 926 studies identified, 10 met inclusion criteria. Five studies (50%) used hamstring tendon (HT), 3 (30%) used quadriceps tendon (QT), 1 (10%) used BPTB, and 1 (10%) used both HT and QT grafts. HT autografts augmented with ST had decreased dynamic and peak elongation (15%-56%), increased load to failure, and increased initial and final dynamic stiffness compared with controls. There was no significant difference in postoperative physical examination findings (range of motion, Lachman, pivot shift), except that ST-augmented grafts had significantly less laxity after surgery compared with HT alone (0.8 vs 1.9 mm; P < .05). QT allografts with ST augmentation showed increased graft strength. Human QT autograft studies showed higher Knee injury and Osteoarthritis Outcome Score scores compared with controls. BPTB allografts with ST augmentation had decreased cyclic displacement by 31% (P = .015) and increased load (758 ± 128 N; P < .001) and stiffness (156 ± 23 N/mm; P = .003) compared with nonaugmented groups. The complication rate was low or showed no increase in the ST augmentation groups compared with control groups. CONCLUSION: HT, QT, and BPTB grafts augmented with ST demonstrate an effective method for ACL reconstruction. All graft types with ST augmentation showed no evidence of clinical disadvantage, with some studies indicating significant biomechanical or clinical advantages compared with conventional ACL reconstruction.

Hip Range of Motion During Passive and 1-Leg Exercises Is Greater in Women: A Meta-analysis and Systematic Review.

PURPOSE: To summarize sex-related differences in hip range of motion (ROM), including flexion, extension, abduction, adduction, internal rotation, and external rotation. METHODS: We performed a systematic search of 3 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Embase). The search terms were as follows: hip, pelvis, range of motion, kinematic, men, and women. Included studies reported sex-specific data on hip ROM in healthy, uninjured adults. To generate hip ROM mean differences, a DerSimonian-Laird random-effects model was used. Effect sizes were pooled for each exercise. Subgroup analyses compared hip ROM by physical activity group: passive ROM, 1-leg hop or jump, 2-leg hop or jump, 2-leg drop or landing, 1-leg squat, 2-leg squat, walking, and jogging/running. Positive effect sizes represent greater ROM in women. RESULTS: Thirty-eight studies with 3,234 total subjects were included; of these subjects, 1,639 were women (50.1%). The mean age was 25.3 years. An effect difference was considered statistically significant if P < .05 and clinically significant if the mean difference was greater than 4.0°. Women showed statistically and clinically significantly greater hip flexion in passive ROM (mean difference, 6.4°) and during the 1-leg hop or jump exercise (mean difference, 6.5°). Women also showed statistically and clinically significantly greater hip adduction during the 1-leg hop or jump (mean difference, 4.5°) and 1-leg squat (mean difference, 4.4°) exercises, as well as statistically and clinically significantly greater hip internal rotation in passive ROM (mean difference, 8.2°). In contrast, men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise (mean difference, -9.1°). No clinically significant differences in extension, abduction, or external rotation were found between women and men. CONCLUSIONS: On average, women showed statistically and clinically significantly greater flexion, adduction, and internal rotation during passive and 1-leg exercises whereas men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise. LEVEL OF EVIDENCE: Level IV, meta-analysis and systematic review of Level II-IV studies.

Misinformation About Orthopaedic Conditions on Social Media: Analysis of TikTok and Instagram.

Introduction Social media outlets such as TikTok (TT) and Instagram (IG) have surged as a method to disseminate information. More recently, healthcare professionals have targeted this space as a means to provide medical education and advice. With the ever-growing content on these applications, there is significant variability and quality of material available, which can lead to the dissemination of misinformation. This study aims to evaluate the accuracy and popularity of content on common orthopaedic pathology on TT and IG. Methods Content on TT and IG related to six common orthopaedic conditions - achilles tendon tear, ACL tear, meniscus tear, tennis elbow, rotator cuff tear, and ankle sprains - was evaluated between April and June 2022. The top ten posts for the top two associated hashtags for each condition were reviewed. The quality of each post was analyzed using the DISCERN instrument, rating each on a scale of 1 to 5. Each post was characterized by the author's profession (physician, physical therapist, chiropractor, etc.) and content type (educational, testimonial, personal, promotional, and entertainment). Popularity and engagement metrics such as "comments," "likes," and "shares" were also collected. Results There were 165,666,490 views on TT and 9,631,015 views on IG amongst the six common aforementioned orthopaedic conditions. Content created by physicians had less overall engagement (16.1%) compared to content created by non-physicians (83.9%). The quality of content on average was low (mean misinformation index 2.04 ± 1.08 (1-5)1. Physician-created posts in comparison to non-physician posts were significantly more accurate (mean misinformation index score 3.38 ± 1.12 vs 1.89 ± 0.94, p<0.0001). Conclusions Common orthopaedic conditions such as Achilles tendon tears, ACL tears, and meniscus tears are frequently the focus of content posted on TT and IG; however, this information is often not medically accurate. Increased physician engagement may help to rectify this misinformation.

Perception and Usage of Social Media Among Women in Orthopaedics.

INTRODUCTION: The use of social media for marketing, education, and networking has increased among orthopaedic surgeons. Social media has played an important role in supporting women physicians and trainees, by allowing connections to be made across stages of training and geographic borders. The purpose of this study was to determine the perceptions of female orthopaedic surgeons, fellows, residents, and medical students regarding their usage of social media. METHODS: A 22-question anonymous survey regarding the perceptions of social media usage was distributed to 1,189 female members of Ruth Jackson Orthopaedic Society via e-mail in July 2022. Data collection lasted a total of 4 weeks, from July to August 2022. Data analysis was performed using descriptive statistics. RESULTS: A total of 207 responses were received (17% response rate). The respondents comprised 90 orthopaedic surgeons (43%), 60 medical students (29%), 49 residents (24%), and eight fellows (4%). Ninety one percent of participants (189 of 207) reported having a social media account, with 23% (43 of 189) having separate 'personal' and 'professional' accounts. Less than half of all participants reported altering (51 of 189; 27%) or deleting (20 of 189; 11%) profiles for interviews. Fifty three percent of participants (109 of 207) 'agreed' that social media is a good way to network. Twenty eight percent of participants (58 of 207) feared gaining attention to their profile when engaging with professional accounts. Forty percent of participants (62 of 207) agreed that personal life events on social media can be considered unprofessional and should be kept on a private profile. CONCLUSION: Social media can be used to network professionally within orthopaedic surgery, connecting women at different levels of training. Although concerns about professionalism of social media accounts exist, this may be mitigated by maintaining a separate private account from a public, professional profile. Future guidelines regarding social media usage and how to maintain professionalism while being active on social media may be beneficial.

Females Are More Likely Than Males to Fill an Opioid Prescription in the Year After Anterior Cruciate Ligament Reconstruction.

Purpose: To report rates of preoperative and postoperative opioid use between male and female patients and to identify risk factors for extended opioid use following anterior cruciate ligament reconstruction (ACLR). Methods: Patients undergoing ACLR between 2011 and 2018 were identified from the PearlDiver database. The opioid refill rates for males vs females were compared at monthly intervals for 1 year after ACLR. Patients who filled an opioid prescription <3 months before surgery were classified as opioid users, while those who had never filled one were classified as nonopioid users. Results: Of 106,995 ACLR patients, 37,890 (35.4%) were opioid users <3 months before surgery, and 37,554 (35.1%) had never filled an opioid prescription. Of the preoperative opioid users, 20,413 (53.9%) were female and 17,477 (46.1%) were male (P < .001). Postoperatively, females were at higher risk of filling an opioid prescription at each monthly interval, except for the first month after surgery. The refill rate for opioid users was also higher than that for nonopioid users at each monthly interval after ACLR. In addition to patient sex, a preoperative diagnosis of anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use increased a patient's risk of filling an opioid prescription postoperatively. Conclusions: This study demonstrated that females are significantly more likely to be opioid users than males prior to ACLR and are more likely to continue to refill an opioid prescription in the year following surgery. Multiple risk factors were associated with prolonged postoperative opioid utilization, including female sex, anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use. Level of Evidence: Level III, retrospective cohort study.

Persistent Lack of Female Orthopaedic Sports Medicine Fellows.

Purpose: To evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete description of gender diversity within this subspecialty. Methods: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last 5 years. Results: Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021 to 2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (P < .001). Within the past 5 years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (P < .001). There was no significant difference in the gender composition of current fellows compared with the composition of fellows within the last 5 years (P = .74). When we examined gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (P < .001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared with 83 men in such positions (85.6%) (P < .001). Conclusions: Orthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared with those who graduated in the last 5 years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine. Level of Evidence: IV, descriptive study.

Diversity-Related Positions in Orthopaedic Surgery Residency Programs.

Background: The Association of American Medical Colleges and the American Academy of Orthopaedic Surgeons have incorporated diversity and inclusion as one of their primary goals. Orthopaedic surgery remains the least diverse medical specialty when measured for practicing physicians and trainees. The purpose of this study was to determine the number and distinct types of diversity, equity, and inclusion (DEI) positions within orthopaedic surgery residency programs in the United States. Methods: The Fellowship and Residency Electronic Interactive Database was used to obtain a list of all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs. The following was collected from 193 residency program websites between June 6, 2022, and June 26, 2022: program location, university or community based, allopathic or osteopathic recognition, number of faculty in the orthopaedic department, number of residents per year, diversity-related statements, and diversity-focused faculty positions. Results: Of the 193 programs evaluated, 74 (38.9%) included DEI statements on their website while only 42 (21.8%) had at least one DEI-specific faculty role (e.g., diversity committee, diversity liaison, vice chair for DEI). For 16 (8.3%) programs, the faculty role was nonspecific to the orthopaedic residency program. Nonspecific roles were primarily created by the affiliated school of medicine, but in 4 (2.1%) outlier cases, faculty members assumed DEI roles through a medical center, a graduate medical education program, or a department of surgery. Conclusions: Less than half of orthopaedic surgery residency programs currently advocate for DEI on their associated websites while fewer than 25% have a DEI faculty position. Previous studies have called for a greater number of DEI positions and committees among orthopaedic residencies because of the lower admittance rate of qualified Under Represented in Medicine (URiM) applicants. A role dedicated to DEI may increase the number of women and URiM applicants pursuing a career in orthopaedic surgery.

Orthopaedic Surgeons Should Consider Online and E-publication Resources for the Most Current Evidence-Based Medicine Following the COVID-19 Pandemic.

Purpose: To compare the time to publication of accepted manuscripts and content in orthopaedic sports medicine journals during the first 2 years of the COVID-19 pandemic. Methods: A convenience sample of articles published in January, May, and September during the years 2019-2021 was taken from Arthroscopy, American Journal of Sports Medicine (AJSM), and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). The duration between the aspects of the article publication process was compared between journals and years. Results: Overall, 826 journal articles were included. Arthroscopy demonstrated no significant differences in the time from manuscript submission to journal publication from 2019 to 2021, a significant decrease in time from acceptance to e-Pub (140 vs 74 vs 16 days; P < .001), but an increase from e-Pub to journal publication (23 vs 74 vs 130 days; P < .001). In AJSM, there was an overall increase in time from submission to journal publication significant between 2019 and 2021 (P = .05) and 2020 and 2021 (P = .001). KSSTA demonstrated the longest timelines in 2020. There was a trend toward a greater number of systematic reviews and meta-analyses. Conclusion: Changes in various aspects of the time to publication and journal content occurred in orthopaedic sports medicine journals in the years surrounding the peak of the COVID-19 pandemic in 2020. Although it is not possible to know whether these delays are caused by journal or author-related factors, orthopaedic surgeons should be aware of the possible delay in time to publication and consider online and e-publication resources for the most current evidence-based medicine, while journals may take this information into account to consider ways of improving the publication process and when determining journal content. Clinical Relevance: It is important to understand the impact the COVID-19 pandemic had on the publications which orthopaedic sports medicine surgeons rely on for clinical knowledge and the practice of evidence-based medicine.

A Comparison of Match Rates to Orthopaedic Surgery Residency Programs Between First-Time Versus Repeat Applicants: An Analysis of the National Resident Matching Program Data from 2018 to 2022.

Orthopaedic surgery has become one of the most competitive specialties to match into among medical students applying to residency. The purpose of this study was to compare match rates to orthopaedic surgery residency programs among first-time vs. repeat applicants. Methods: Data were obtained from the National Resident Matching Program from 2018 to 2022. For each year, the total number of applicants to orthopaedic surgery residency programs was obtained, as well as the number of applicants who successfully matched into orthopaedics. The match rate was compared between first-time vs repeat applicants. A subanalysis was performed on allopathic graduates (MDs) and osteopathic graduates (DOs)/international medical graduates (IMGs). In addition, the match rate for first-time applicants and reapplicants was compared between MD and DO/IMG applicants. Results: Overall, there was a significantly higher match rate among first-time applicants (89.8%) vs. repeat applicants (22.5%, p < 0.0001). When substratified by MD and DO/IMG applicants, first-time applicants still matched at a significantly higher rate than reapplicants within each group (p < 0.0001 for each). Among first-time applicants, MDs (93.1%) matched at a significantly higher rate than DOs/IMGs (68.6%, p < 0.0001). Among reapplicants, DOs/IMGs (25.3%) matched at a significantly higher rate than MDs (20.1%, p < 0.01). Conclusion: First-time applicants to orthopaedic surgery residency programs have a significantly higher rate of matching compared with reapplicants, irrespective of degree. In recent years, first-time MD applicants have matched at a significantly higher rate than first-time DO/IMG applicants.

Most Faculty Members at the Top Orthopaedic Sports Medicine Fellowship Programs Trained at Many of the Same Programs.

Purpose: To determine the proportion of faculty members at the top orthopaedic sports medicine fellowship programs who completed a fellowship at one of these programs themselves, how many remained at their fellowship training programs as an attending (institutional loyalty), where they most commonly completed residency and medical school, and to characterize their research productivity. Methods: The fellowship programs of current orthopaedic sports medicine fellowship faculty members at each of the top 10 orthopaedic sports medicine fellowship programs (based on a recent study) were determined by searching program websites or contacting program coordinators. For each program, we determined the proportion of faculty members who completed fellowship at one of these top 10 programs and the proportion who remained at their fellowship program as an attending. Residency and medical school information was found for faculty members on their professional websites. To determine research output, each faculty member's name was searched within the Scopus database and the number of publications was recorded. Results: Data were obtained from each of the top 10 sports medicine fellowship programs. Fifty-eight of 82 (70.7%) fellowship faculty members completed fellowship at a top 10 program. Regarding institutional loyalty, 36 of 82 (43.9%) fellowship faculty members remained at the program where they trained, with one program led entirely by alumni. The average number of publications per faculty member was 130.6, with a range among the 10 programs of 23-355.8. Conclusions: Most orthopaedic sports medicine fellowship faculty at the top perceived training programs completed a fellowship at one of these same programs and maintain high research productivity. Clinical Relevance: Orthopaedic surgery trainees who wish to become faculty members at one of the top orthopaedic sports medicine training programs should aim to match into one of these top programs when applying for fellowship.

Exponential Growth in Female Residency Applicants in Orthopaedic Surgery Over the Past 15 Years.

Orthopaedic surgery is recognized as one of the most popular but least diverse medical subspecialties. Although significant efforts have been made in recent years to improve gender diversity, orthopaedic surgery continues to lag behind other surgical subspecialties. A recent study predicted that it would take 217 years for orthopaedic surgery to reach gender parity matching the 36.3% of practicing female physicians in the United States. The purpose of our study was to evaluate the annual percentages of female medical student applicants in orthopaedic surgery over the past 15 years and to determine when this gender parity percentage may be reached among residency applicants. Methods: The Electronic Residency Application Service was queried for orthopaedic residency applicant data from 2007 to 2022. The annual percentage of female applicants as well as the annual change in percentage of female applicants was recorded. A best-fit trendline was calculated and extrapolated to predict future rates of female applicants. Results: The percent of female applicants has increased from 11.8% in 2007 to 23.0% in 2022. Between 2007 and 2022, there were 9 years with annual increases in percentage of females applying into orthopaedic surgery with a statistically significant increase in 4 of those years (2008, 2014, 2019, and 2022). There were 6 years with annual decreases in percentage of females applying to orthopaedic surgery, none of which were statistically significant. The best-fit curve is exponential with a correlation coefficient of 0.8 (p < 0.001). This predicts reaching the predetermined gender parity percentage of 36.3% in 16 years. Conclusion: In the past 15 years, there has been a near-doubling in the percentage of female medical students applying to orthopaedic surgery residency. Although orthopaedic surgery remains the least gender-diverse field of medicine, these trends are encouraging and support the initiatives currently in place including early education and increased mentorship to help close the gender gap in orthopaedic surgery.

Bullying in Orthopaedic Surgery: A Survey of US Orthopaedic Trainees and Attending Surgeons.

INTRODUCTION: Bullying is a notable problem in surgery, creating a hostile environment for surgeons and trainees, and may negatively affect patient care. However, specific details regarding bullying in orthopaedic surgery are lacking. The primary aim of this study was to determine the prevalence and nature of bullying within orthopaedic surgery in the United States. METHODS: A deidentified survey was developed using the survey created by the Royal College of Australasian Surgeons and the validated Negative Acts Questionnaire-Revised survey tool. This survey was distributed to orthopaedic trainees and attending surgeons in April 2021. RESULTS: Of the 105 survey respondents, 60 (60.6%) were trainees and 39 (39.4%) were attending surgeons. Although 21 respondents (24.7%) stated they had been bullied, 16 victims (28.1%) did not seek to address this behavior. Perpetrators of bullying were most commonly male (49/71, 67.2%) and the victims' superior (36/82, 43.9%). Five bullying victims (8.8%) reported the behavior, despite 46 respondents (92.0%) stating that their institution has a specific policy against bullying. CONCLUSION: Bullying behavior occurs in orthopaedic surgery, with perpetrators being most commonly male and the victims' superiors. Despite the fact that an overwhelming majority of institutions have policies against bullying, the reporting of such behavior is lacking.