Female Orthopaedic Surgeons Are Less Represented as Head Team Physicians in Collegiate Athletic Programs.

PURPOSE: The purpose of this study was to evaluate National Collegiate Athletic Association (NCAA) head team physicians (HTP), focusing on gender as it relates to divisional variability, medical specialty, and research productivity. METHODS: In December 2022, the NCAA member directory was utilized to obtain HTP information from the top 5 conferences within Divisions I, II, and III (DI, DII, DIII, respectively). Division I schools were selected from the previously established "Power 5" conferences. Divisions II and III used NCAA rankings. HTP data was collected from publicly available verifiable data sources. Data for gender, Scopus H-index, residency programs, and fellowship programs were collected. Mean, median, skewness, p-values, and odds ratio were calculated for analysis. RESULTS: One hundred and eighty six NCAA institutions were evaluated: 69 DI (37%), 65 DII (35%), and 52 DIII (28%). DIII had the highest female representation (8; 16%). Out of the 67 orthopaedic surgery HTPs, 5 (7.5%) were female and 62 male (92.5%). There is a statistically significant difference in female orthopedic surgeon representation in the HTP field compared to males (p-value = 0.038, alpha = 0.05). Female orthopaedic surgeons have 38% lower odds of being represented as HTPs compared to males (p-value = 0.046, alpha = 0.05). Female HTPs in Divisions I and III had higher H-indexes than the overall average and median values for their respective divisons. CONCLUSION: Female HTPs are significantly less represented compared to males in the NCAA. Furthermore, female orthopaedic surgeons were found to have lower odds of being represented as HTPs compared to their male counterparts. For research productivity, female HTPs impacted the distribution as outliers in Divisions I and III.

Demographics and Characteristics of Vice Chairs in Academic Orthopaedic Surgery Programs: A Descriptive Study.

INTRODUCTION: The Vice-chair (VC) position is gaining popularity in academic orthopaedic surgery departments; however, there is a paucity of information regarding qualifications and career advancements associated with this role. The purpose of this study was to define the characteristics of current orthopaedic surgery department VCs. DESIGN: Descriptive study following a retrospective web-based search utilizing the Fellowship and Residency Electronic Interactive Database (FREIDA) database and orthopaedic surgery residency program websites. SETTING: 200 ACGME-accredited orthopaedic surgery residency programs across the United States. PARTICIPANTS: Program name and hospital affiliations were collected from the FREIDA database to account for all ACGME-accredited programs. The following information was derived from publicly available program websites: title, role description, previously trained institutions, academic rank, and concurrent roles of VCs. Research productivity was measured using the H-index. The previous roles of current Department Chairs (DC) were also evaluated. RESULTS: Of the 178 VCs identified, VC of Research (n = 36; 20%), Education (n = 25; 14%), and Clinical Operations/Affairs (n = 21; 12%) were the most common titles. Women made up 17% (n = 30) of the VCs. Trauma (n = 36; 20%) was the most common fellowship subspecialty among VCs. The average H-index for VCs was 25. Among VCs, 94 (53%) were professors, 78 were also Chiefs/Heads/Directors (44%), 7 (4%) were Fellowship Directors, and 18 (10%) were Residency Directors. Twenty-six of 95 (27%) current DC had VC experience. CONCLUSION: The findings can facilitate effective leadership development, promotion of diversity and inclusion in these roles, and guidance for those who seek such leadership positions.

Trends in Orthopaedic Surgery Fellowship Match Among Female Residents: Discrepancies in Sex Diversity by Subspecialty.

Introduction: There is a historic sex imbalance in the field of orthopaedic surgery in the United States, with female physicians being vastly underrepresented. In addition, this sex imbalance is particularly pronounced in certain subspecialties. As such, we sought to analyze the distribution of graduating female residents and their fellowship match trends from 2017 to 2022. Methods: The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States during the 2016 to 2017 and the 2021 to 2022 academic years. The data were supplemented with the Accreditation Council for Graduate Medical Education (ACGME) Data Book to include data on all ACGME-accredited programs in 2017 and 2022. The percentage of female orthopaedic surgery residents matching into each subspecialty was calculated. Continuous data were analyzed with independent t test, and significance was set at p < 0.05. Results: From 2017 to 2022, there has been a significant increase in the percentage of female residents matching in orthopaedic surgery fellowships (14.6% vs. 19.5%, p < 0.001). In the orthopaedic hand subspecialty, 24 (15.8%) female residents matched into a hand fellowship in 2017 vs. 56 (35.2%) in 2022 (p < 0.001). Spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine fellowships have not seen a significant change in the distribution of female residents matching over the past 5 years. Conclusion: Between 2017 and 2022, the total number of female orthopaedic surgery fellows increased, and there was significant growth in the percentage of matched female fellows in the subspecialty of hand. Other orthopaedic subspecialties including spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine have seen no significant change in the distribution of women fellows over the past 5 years. Further investigation is warranted to determine factors leading to growth in certain fellowships among female residents to encourage sex diversity among all subspecialties in orthopaedic surgery.

Sex, Race, and Ethnicity of Faculty and Department Chairs in Orthopaedic Surgery and Comparable Fields: 2015 to 2022.

INTRODUCTION: The field of orthopaedic surgery has disproportionately low numbers of women and underrepresented in medicine (URM) groups. Although the representation of women and URM in orthopaedics has increased over the past several years, the growth has not kept up with other surgical specialties. METHODS: This is a retrospective review of data presented by the Association of American Medical Colleges (AAMC) regarding US medical school faculty and department chair makeup in 2018 to 2022 and 2015 data from the AAMC Group on Women in Medicine and Sciences reports. Data regarding the sex and race/ethnicity of faculty and department chairs in orthopaedic surgery, a comparable surgical specialty (otolaryngology), surgery, and all medical fields were assessed. Otolaryngology was chosen as a comparable specialty because orthopaedic surgery and otolaryngology are the only two surgical specialties classified within the AAMC faculty report, separate from any medical counterpart. RESULTS: Among orthopaedic surgery, otolaryngology, surgery, and all clinical sciences, the representation of women and individuals from URM groups increased between 2015 and 2022. During this time, orthopaedic surgery had the lowest growth rate of the four groups in female faculty (+0.63%/year), URM faculty (+0.32%/year), and URM department chairs (+0.11%/year). However, orthopaedic surgery did have an increase in female department chairs (0.96%/year to 7% in 2022), similar to increases seen in surgery and all clinical sciences. DISCUSSION: The increase in representation in female and URM faculty and department chairs in orthopaedic surgery lags behind comparable fields and medicine as a whole. In addition, orthopaedic surgery had the lowest representation of female and URM faculty in 2015 and 2022. Improving the representation of female and URM orthopaedic faculty and department chairs is critical because this may encourage more diverse medical students to consider pursuing a career in the field.

Gender Disparity in Authorship Among Orthopaedic Surgery Residents.

Background: Gender disparity remains pervasive in orthopaedic surgery, which affects the research pursuits of orthopaedic surgeons. The purpose of this study was to characterize gender-related authorship trends of orthopaedic surgery residents, including evaluation of gender-concordant publication rates. Methods: An observational cross-sectional analysis of US orthopaedic surgery residency programs was performed. Information on residency programs and demographics of each cohort was collected. Publication metrics consisting of number of first and non-first author publications and H-indices were manually obtained for PGY-3 to PGY-5 residents attending the 25 programs ranked the highest for research output by Doximity. Gender of each resident and senior author was determined from institutional websites using photos, biographies, and preferred pronouns when available. Results: A total of 532 residents, 169 (31.8%) female and 363 (68.2%) male, were included for authorship analysis. Of them, 415 (78%) had at least one first author publication, which did not vary significantly by gender. Female residents had disproportionately fewer first author publications compared with their representation (22% vs. 31.8%, p < 0.00001). Female residents averaged fewer first and non-first author publications compared with male residents (2.8 vs. 4.6, p = 0.0003; 6.4 vs. 10, p = 0.0001 respectively). Despite fewer publications overall, a greater subset of publications by female residents were written in collaboration with a female senior author compared with publications by male residents (p < 0.0001). Male residents had a higher average H-index of 5.4 vs. 3.9 among female residents (p = 0.00007). Conclusion: Despite similar rates of first author publication among male and female residents, female residents had fewer publications overall, lower H-indices, and disproportionately fewer first author publications than would be expected given their representation. Findings from this study suggest that gender disparity in orthopaedic surgery extends to differences in research productivity as early as in residency. This may have negative implications on the career advancement of female orthopaedic surgeons. Additional work is needed to identify and understand biases in research productivity and career advancement, to promote more equitable strategies for academic achievement. Level of Evidence: IV.

Effective Use of Twitter by Orthopaedic Sports Medicine Journals Can Result in Increased Impact Factor.

Purpose: To determine whether activity on Twitter was correlated with increasing impact factor (IF) among 6 orthopaedic sports medicine journals. Methods: Twitonomy software was used to collect account activity for the American Journal of Sports Medicine; Arthroscopy: The Journal of Arthroscopic and Related Surgery; Knee Surgery, Sports Traumatology, Arthroscopy; Journal of Shoulder and Elbow Surgery; Orthopaedic Journal of Sports Medicine; and Sports Health. Data from 2000 to 2020 were collected. Each journal's annual IF score was collected via scijournal.org. A multivariate regression model was used to predict the influence of different Twitter metrics on IF from 2012 to 2019. The journal name, number of tweets, and interaction of the two were used to predict IF. Additionally, Pearson correlation was used to assess correlations between Twitter account metrics and IF. Results: Over the study period, all IFs increased, with the exception of that for American Journal of Sports Medicine. The effect size between number of tweets and IF was not the same for each journal. For every additional tweet, American Journal of Sports Medicine increased its IF by 0.001 (P = .18). Sports Health and Orthopaedic Journal of Sports Medicine increased their IF by 0.01 (P = .002) and 0.022 (P < .001), respectively. Knee Surgery, Sports Traumatology, Arthroscopy would expect a decrease in its IF by 0.004 (P = .55) and Journal of Shoulder and Elbow Surgery and Arthroscopy would increase its IF by 0.002 (P = .71) and 0.001 (P = .99), but this was not significant. There was a statistically significant positive correlation between annual tweets and IF across all journals. Conclusions: Markers of Twitter account activity, specifically the number of annual tweets, were predictive of an increase in IF among the orthopedic sports medicine journals included in this study. Clinical Relevance: The findings of this study may allow orthopaedic sports medicine journals to make more effective, targeted, and productive use of their social media accounts to reach a broader audience, increase their influence, and increase the IF of their journal.

Fear of Reinjury, 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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 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: Eighteen of 632 identified studies met inclusion criteria, and 1,072 patients who underwent MFPLR were recorded. Return-to-sport rates and mean/median time ranged from 60.0% to 100% and 3 to 10.4 months, respectively. Of the patients, 55.6% to 84.0% returned to sport without decreasing the level of competition. Six of 12 studies (50.0%) reported fear of reinjury 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%). CONCLUSIONS: Athletes who underwent MPFLR following recurrent patellar instability returned to sport at a range of 60.0% to 100%. Return to sport at the same level or higher was found to have a lower maximum rate at 55.6% to 84.0%. Fear of reinjury 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: Level 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.

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.

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.

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.

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.

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.