Analysis of patient-directed search content and online resource quality for ulnar collateral ligament injury and surgery.

Background: Patients use the Internet to learn information about injuries, yet online content remains largely unstudied. This study analyzed patient questions posed online regarding ulnar collateral ligament (UCL) tears or UCL surgical management. Methods: Three separate search strings about UCL tear and UCL surgery were queried on the Google search engine. The 300 most commonly asked questions were compiled for each topic and associated webpage information was collected from the "People also ask" section. Questions were categorized using the Rothwell classification and webpages by Journal of the American Medical Association (JAMA) benchmark criteria. Results: The most frequent UCL tear questions were "how long does it take to heal a torn UCL?" and "what is nonsurgical treatment for the UCL?" The most frequent UCL surgery question was "can you retear your UCL after surgery?" The Rothwell classification of questions for UCL tear/UCL surgery was 55%/32% policy, 38%/57% fact, and 7%/11% value with highest subcategories being indications/management (46%/25%) and technical details (24%/25%). The most common webpages were academic (39%/29%) and medical practice (24%/26%). Mean JAMA score for all 600 webpages was low (1.2), with journals (mean = 3.4) having the highest score. Medical practice (mean = 0.5) and legal websites (mean = 0.0) had the lowest JAMA scores. Only 30% of webpages provided UCL-specific information. Conclusion: Online UCL patient questions commonly pertain to technical details and injury management. Webpages suggested by search engines contain information specific to UCL tears and surgery only one-third of the time. The quality of most webpages provided to patients is poor, with minimal source transparency.

Infection in Shoulder Arthroplasty: Prevention, Diagnosis, and Treatment.

Prosthetic joint infection is a devastating complication following shoulder arthroplasty that can lead to pain, poor function, and poor quality of life. With the increasing number of shoulder arthroplasties performed annually, recognition of prosthetic infection and treatment is necessary. The skin surrounding the shoulder has a unique microbiome, and Cutibacterium acnes is the most commonly encountered bacteria causing prosthetic joint infection. C acnes is a low-virulence organism that resides in the subcutaneous layer of the skin. As a result, the clinical presentation is typically less obvious than prosthetic infections seen in other joints such as the hip and knee. Therefore, diagnosis is not always straightforward, and optimal treatment strategy is unclear. Guidance on prevention, diagnosis, and treatment of shoulder prosthetic joint infection with special emphasis on the consensus definition established at the 2018 International Consensus Meeting is provided.

Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction restores joint mechanics to the intact state and improves clinical function: a systematic review of biomechanical and clinical outcomes.

PURPOSE: To perform a systematic review of biomechanical and clinical outcomes following lateral meniscus posterior root (LMPR) repair with concomitant anterior cruciate ligament reconstruction (ACLR). METHODS: A literature search was performed systematically using PubMed, Embase, and Medline databases in April 2022. The search included the following terms combined with Boolean operators: 'Meniscus repairs', 'Meniscal Repair', 'Posterior Horn', 'Root', 'Radial'. Inclusion criteria consisted of level I-IV human clinical and biomechanical studies reporting biomechanical data and/or outcomes following LMPR repair in the setting of ACLR. RESULTS: Three biomechanical studies, all utilizing a transtibial pullout technique, were identified, all of which reported significant improvement in joint contact pressures and mechanics and 3/4 of which reported significant improvement in anterior or rotational stability with LMPR repair. Five clinical studies, consisting of 146 patients (mean age 28.5 ± 1.1 years) undergoing LMPR repair, were identified with an average follow-up of 19.1 months (range 6.2-46 months). Across all clinical studies, Lysholm and International Knee Documentation Committee (IKDC) scores were found to improve postoperatively, with 3/4 reporting significant improvement in Lysholm (all, p ≤ 0.001) scores and 3/5 reporting significant improvement in IKDC scores when compared to preoperative values (all, p ≥ 0.004). Meniscal extrusion decreased significantly following repair in 2/4 studies (all, p ≤ 0.001). CONCLUSIONS: Biomechanically, transtibial pullout repair of the LMPR restored joint contact pressures and joint mechanics to intact levels when performed with concomitant ACLR. Clinically, LMPR repair with concurrent ACLR resulted in improved Lysholm and IKDC scores. These findings enable surgeons to determine optimal treatment plans and discuss realistic outcomes with patients when encountering LMPR injuries. LEVEL OF EVIDENCE: IV.

Social Media Use Among Arthroscopic and Orthopaedic Sports Medicine Specialists Varies by Subspeciality.

Purpose: To evaluate active social media use among members of the Arthroscopy Association of North America (AANA) and investigate differences in social media use based on joint-specific subspecialization. Methods: The AANA membership directory was queried to identify all active, residency-trained orthopaedic surgeons within the United States. Sex, practice location, and academic degrees earned were recorded. Google searches were conducted to find professional Facebook, Twitter, Instagram, LinkedIn, and YouTube accounts along with institutional and personal websites. The primary outcome was the Social Media Index (SMI) score, an aggregate measure of social media use across key platforms. A Poisson regression model was constructed to compare SMI scores across joint-specific subspecializations: knee, hip, shoulder, elbow, foot & ankle, and wrist. Specialization in the treatment of each joint was collected using binary indicator variables. Since surgeons were specialized in multiple groups, comparisons were made between those who do and do not treat each joint. Results: In total, 2,573 surgeons within the United States met the inclusion criteria. 64.7% had ownership of at least 1 active account, with an average SMI score of 2.29 ± 1.59. Western practicing surgeons had a significantly greater presence on at least 1 website than those in the Northeast (P = .003, P < .001) and South (P = .005, P = .002). Social media use by knee, hip, shoulder, and elbow surgeons was greater relative to those who did not treat those respective joints (P < .001 for all). Poisson regression analysis demonstrated that knee, shoulder, or wrist specialization was a significant positive predictor of a greater SMI score (P ≤ .001 for all). Foot & ankle specialization was a negative predictor (P < .001), whereas hip (P = .125) and elbow (P = .077) were not significant predictors. Conclusions: Social media use widely varies across joint subspecialties within orthopaedic sports medicine. Knee and shoulder surgeons had a greater social media use than their counterparts, whereas foot & ankle surgeons had the lowest social media use. Clinical Relevance: Social media is a vital source of information for both patients and surgeons, providing a means for marketing, networking, and education. It is important to identify variations in social media use by orthopaedic surgeons by subspecialty and explore the differences.

Patients With Femoroacetabular Impingement Obtain Information From Low-Quality Sources Online and Are Most Interested in Conservative Treatment and Expected Recovery.

Purpose: To investigate the type of questions patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) are searching online and determine the type and quality of the online sources from the top results to each query by the "people also ask" Google algorithm. Methods: Three search strings pertaining to FAI were carried out through Google. The webpage information was manually collected from the "People also ask" Google algorithm. Questions were categorized using Rothwell's classification method. Each website was assessed using Journal of the American Medical Association Benchmark Criteria for source quality. Results: A total of 286 unique questions were collected with their associated webpages. The most common questions included: "How do you treat femoroacetabular impingement and labral tears without surgery?" "What is the recovery process after hip arthroscopy and are there limitations after surgery?" and "How do you diagnose hip impingement and differentiate from other causes of hip pain?" The Rothwell Classification of questions were fact (43.4%), policy (34.3%), and value (20.6%). The most common webpage categories were Medical Practice (30.4%), Academic (25.8%), and Commercial (20.6%). The most common subcategories were Indications/Management (29.7%) and Pain (13.6%). Government websites had the highest average Journal of the American Medical Association score (3.42), whereas Single Surgeon Practice websites had the lowest (1.35). Conclusions: Commonly asked questions on Google regarding FAI and labral tears pertain to the indications and management of pathology as well as pain control and restrictions in activity. The majority of information is provided by medical practice, academic, and commercial sources, which have highly variable academic transparency. Clinical Relevance: By better understanding which questions patients ask online, surgeons can personalize patient education and enhance patient satisfaction and treatment outcomes after hip arthroscopy.

Rotator cuff repair: what questions are patients asking online and where are they getting their answers?

BACKGROUND: This study analyzed questions searched by rotator cuff patients and determined types and quality of websites providing information. METHODS: Three strings related to rotator cuff repair were explored by Google Search. Result pages were collected under the "People also ask" function for frequent questions and associated webpages. Questions were categorized using Rothwell classification and topical subcategorization. Webpages were evaluated by Journal of the American Medical Association (JAMA) benchmark criteria for source quality. RESULTS: One hundred twenty "People also ask" questions were collected with associated webpages. Using the Rothwell classification of questions, queries were organized into fact (41.7%), value (31.7%), and policy (26.7%). The most common webpage categories were academic (28.3%) and medical practice (27.5%). The most common question subcategories were timeline of recovery (21.7%), indications/ management (21.7%), and pain (18.3%). Average JAMA score for all 120 webpages was 1.50. Journal articles had the highest average JAMA score (3.77), while commercial websites had the lowest JAMA score (0.91). The most commonly suggested question for rotator cuff repair/ surgery was, "Is rotator cuff surgery worth having?," while the most commonly suggested question for rotator cuff repair pain was, "What happens if a rotator cuff is not repaired?" CONCLUSIONS: The most commonly asked questions pertaining to rotator cuff repair evaluate management options and relate to timeline of recovery and pain management. Most information is provided by medical practice, academic, and medical information websites, which have highly variable reliability. By understanding questions their patients search online, surgeons can tailor preoperative education to patient concerns and improve postoperative outcomes.

Superior Capsule Reconstruction and Lower Trapezius Transfer for Irreparable Posterior-Superior Rotator Cuff Tear: A Case Report.

CASE: A 49-year-old right-hand-dominant male weightlifter was referred with persistent left shoulder pain, weakness, and range of motion limitations after failed arthroscopic rotator cuff repair and subsequent arthroscopic debridement for a massive posterior-superior supraspinatus and infraspinatus tear. The patient underwent a superior capsular reconstruction (SCR) with lower trapezius (LT) transfer to re-establish rotator cuff function. CONCLUSION: LT transfer in addition to SCR may be a promising modality to treat massive, irreparable posterior-superior rotator cuff tears in young adults. LT transfer can optimize external rotation, whereas SCR may more adequately address pain and forward elevation.

An evidence-based approach to managing unexpected positive cultures in shoulder arthroplasty.

BACKGROUND: Unexpected positive cultures (UPCs) are very commonly found during shoulder arthroplasty when surgeons send intraoperative cultures to rule out periprosthetic joint infection (PJI) without clinical or radiographic signs of infection. Cutibacterium acnes is thought to be the most common bacteria cultured in this setting; however, the implications of an unexpected positive result are neither well defined nor agreed upon within the literature. The current review evaluates the incidence of UPCs and C acnes in reverse total arthroplasty; the clinical significance, if any, of these cultures; and various prognostic factors that may affect UPC incidence or recovery following PJI. METHODS: A systematic review was performed with PRISMA guidelines using PubMed, CINAHL, and Scopus databases. Inclusion criteria included studies published from January 1, 2000, to May 20, 2021, that specifically reported on UPCs, native or revision shoulder surgery, and any study that directly addressed one of our 6 proposed clinical questions. Two independent investigators initially screened 267 articles for further evaluation. Data on study design, UPC rate/speciation, UPC risk factors, and UPC outcomes were analyzed and described. RESULTS: A total of 22 studies met the inclusion criteria for this study. There was a pooled rate of 27.5% (653/2373) deep UPC specimen positivity, and C acnes represented 76.4% (499/653) of these positive specimens. Inanimate specimen positivity was reported at a pooled rate of 20.1% (29/144) across 3 studies. Male patients were more likely to have a UPC; however, the significance of prior surgery, surgical approach, and type of surgery conflicted across multiple articles. Patient-reported outcomes and reoperation rates did not differ between positive-UPC and negative-UPC patients. The utilization of antibiotics and treatment regimen varied across studies; however, the reinfection rates following surgery did not statistically differ based on the inclusion of antibiotics. CONCLUSION: UPCs are a frequent finding during shoulder surgery and C acnes represents the highest percentage of cultured bacteria. Various preoperative risk factors, surgical techniques, and postoperative treatment regimens did not significantly affect the incidence of UPCs as well as the clinical outcomes for UPC vs. non-UPC patients. A standardized protocol for treatment and follow-up would decrease physician uncertainty when faced with a UPC from shoulder surgery. Given the results of this review, shoulder surgeons can consider not drastically altering the postoperative clinical course in the setting of UPC with no other evidence of PJI.

Social Media in Hip Arthroscopy Is an Underused Resource That Enhances Physician Online Reputation.

Purpose: To analyze the impact of professional social media (SM) presence, activity level, and physician practice-specific variables on online ratings and rating frequency for hip arthroscopists across 3 leading physician review websites (PRWs). Methods: The Arthroscopy Association of North America and American Orthopaedic Society of Sports Medicine directories were queried to identify practicing hip arthroscopists. Physicians included were residency-trained surgeons practicing within the United States. Surgeon ratings, comments, and reviews were compiled from 3 PRWs (Google, Healthgrades, Vitals). Google searches assessed for professional Facebook, Twitter, and Instagram accounts and demographic information. Surgeons were considered active if they posted the month before data collection. Logistical regression and a univariate model analyzed effects of demographic factors and other variables on SM use and PRW statistics. Results: In total, 555 surgeons met inclusion criteria (93.2% male, 6.8% female); 41% had a professional SM account (27.4% Facebook, 24.3% Twitter, 12.1% Instagram). Few surgeons with SM actively posted (30.5% Facebook, 43.7% Twitter, 37.3% Instagram). Surgeons with any SM had significantly greater number of ratings on all review websites (P < .001). Linear regression revealed academic physicians had lower number of ratings (P = .002) and average ratings (P < .001). Instagram users had an average 12.4 more ratings. Surgeons more likely to use SM resided in greater population cities (990 vs 490 [per 1,000]) with higher surgeon density (3.3 vs 2.2). Conclusions: Most hip arthroscopists have no professional SM, and fewer frequently post content. SM presence significantly increases the number of ratings on PRWs but does not affect overall rating. Surgeons using SM practice in more populous cities with more competition. Academic surgeons had fewer ratings and lower average ratings. A professional Instagram account can increase the number of online ratings. Clinical Relevance: Understanding how SM presence affects an orthopaedic surgeon's practice may provide information on how surgeons best connect with patients.

Social media use by shoulder and elbow surgeons increases the number of ratings on physician review websites.

BACKGROUND: The use of physician review websites by patients is increasingly frequent. One potential way for shoulder and elbow surgeons to enhance their online reputation and attract patients is via social media, yet its impact is unknown. This study sought to analyze the effect of social media use on the number of online ratings and overall rating of shoulder and elbow surgeons. We secondarily studied variables affecting social media use. METHODS: The American Shoulder and Elbow Surgeons directory was probed to identify practicing surgeons. Surgeon evaluation data, including ratings, comments, and reviews, were compiled from 3 physician review websites (Google, Healthgrades, and Vitals). Google was queried to assess for a professional Facebook, Twitter, or Instagram account, as well as obtain information on surgeon training, practice location, and other demographic variables. RESULTS: A total of 646 surgeons met the inclusion criteria (93.8% male and 6.2% female surgeons). Overall, 37% had a professional social media account (Facebook, 23.1%; Twitter, 24.1%; and Instagram, 9.4%). Linear regression analysis showed that Facebook use correlated with an average increase of 48.6 in the number of ratings. No social media platform correlated with physician rating. The surgeons more likely to use social media were those who graduated residency in 2000 or later (40.8% vs. 29.2%), those who practiced in cities with higher populations (mean, 1188.9 vs. 708.4 [per 1000]), and those with more surgeons practicing in the same city (mean, 7.0 vs. 5.0). CONCLUSION: The majority of shoulder and elbow surgeons do not have a professional social media account. Those using this platform are younger and located in more populous cities with more competition. Having a professional social media profile was not correlated with ratings, but there was a positive association with the number of online ratings, and Facebook had the strongest association. Surgeon ratings are overwhelmingly positive with minimal variability; therefore, a high number of ratings confirms a surgeon's exceptional reputation. The residency graduation year, city population, and number of nearby surgeons affected ratings, although the absolute differences were minimal. For shoulder and elbow surgeons, a professional social media account correlates with an increase in the number of online physician ratings. Recent graduates practicing in competitive locations may feel increased pressure to leverage this in an attempt to build their practices.