Publication rates of abstracts presented at American Shoulder and Elbow Surgeons annual open and closed conferences: 2015-2019.

Background: The annual meetings hosted by the American Shoulder and Elbow Surgeons (ASES) present the latest prepublication literature in shoulder and elbow surgery, facilitating early dissemination of novel findings that impact clinical decision-making. Evaluating the publication rate of presented abstracts at ASES conferences becomes crucial in assessing the quality of research showcased, as these presentations often precede the peer-review process. Methods: The ASES conference programs from 2015-2019 were reviewed to identify presented abstracts. For each abstract, the title, author(s), conference year, and meeting type (open vs. closed) were recorded. The names of the author(s) of each abstract were searched in the PubMed and Google Scholar databases to determine if there was an associated published manuscript. For each identified manuscript, the title, author(s), date of publication, publishing journal, impact factor of the publishing journal, level of evidence, and number of citations were recorded. Results: A total of 316 abstracts were presented as podium lectures at ASES open and closed meetings between 2015 and 2019. Within 3 years of presentation, 240 (75.9%) of the presented abstracts resulted in publication. There was an increase in the proportion of abstracts resulting in publication within 3 years of the presentation from 2015-2019 (R = 0.8733, P = .053). Overall, the proportion of presented abstracts that went on to publication in peer-reviewed journals also increased (R = 0.8907, P = .043). Manuscripts of abstracts presented at open meetings had a shorter time to publication (8.78 vs. 11.82 months; P = .0160) and were cited more often (40.89 vs. 30.11, P = .0099) than those presented at closed meetings. Conclusion: There has been an increase in the publication rate of abstracts presented at ASES annual meetings in the study period. Published manuscripts of abstracts presented at ASES open conferences were published faster, and were cited more often, than closed conferences. ASES conferences allow for the presentation of high-quality prepublication literature in shoulder and elbow surgery.

Academic Degree Bias Among Speaking and Leadership Roles at the American Academy of Orthopaedic Surgeons Annual Meetings, 2016-2021.

OBJECTIVE: This study examined the proportion of Doctors of Osteopathic Medicine (DOs) across various speaking and leadership roles at recent American Academy of Orthopaedic Surgeons (AAOS) annual meetings.  Design: Meeting programs from the AAOS were publicly accessed and compiled between 2016 and 2021. Two categories of AAOS meeting participants were created. Invited speaker and faculty roles included moderators of symposia and program committee members while authors of presented papers were classified into academic roles. The proportion of DOs in each role type (invited speaker, academic) was recorded for each meeting program. The representation of DOs in these roles was then examined longitudinally across our analysis period using Pearson's Correlation.  Results: Overall, 1.1% (119/10,636) of all roles were held by DOs. Across our analysis period, DOs were disproportionately underrepresented as invited faculty or speakers (0.1%, 4/2791) compared with academic roles (0.1% vs 1.5%, p<0.001). Specifically, DOs were underrepresented as program committee members (0.08% vs 1.5%, p<0.001), symposia lecturers (0.1% vs 1.5%, p=0.004), and moderators of paper presentations (0.3% vs 1.5%, p=0.01).  Conclusion: Between 2016-2021, DOs were disproportionately represented as invited speakers or faculty at AAOS annual meetings. Our definition of diverse perspectives may need to expand to include osteopathic physicians.

Risk Factors for Unexpected Admission Following Lumbar Spine Laminectomy: A National Database Study.

Introduction Laminectomy is one of the most common orthopedic spine surgeries performed in the United States. Compared to other spine operations such as fusions, laminectomies in isolation are of lower morbidity. However, complications may arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission following a laminectomy. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent a laminectomy procedure from 2015 to 2019 using CPT code 63030. This query yielded 61,708 cases. Demographic, lifestyle, comorbidity, and peri-operative factors were recorded. Independent samples Student's t-tests, chi-squared, and, where appropriate, Fisher's exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following a laminectomy procedure. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. Results Of the 61,708 patients included in our sample, 2,359 were readmitted within 30 days of surgery, corresponding to a readmission rate of 3.82%. Results of the univariate analysis revealed statistically significant relationships between readmission status and the following patient variables: patient age, sex, BMI, ASA classification, race, bleeding disorder, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, congestive heart failure (CHF), chronic steroid use, total operative time, and tobacco use (p < 0.05). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age greater than 65 (p < 0.05), female sex (p = 0.013), bleeding disorder (p = 0.011), diabetes (p = 0.006), current smoker (p = 0.010), COPD (p < 0.001), steroid use (p = 0.006), ASA Class II or above (p < 0.05), and total operative time (p < 0.001). Conclusion Unplanned 30-day readmission after laminectomy is infrequent. However, increasing age, female sex, steroid use, current smokers, bleeding disorders, diabetes, COPD, CHF, a higher ASA classification, and longer operative times are independent risk factors for readmission following laminectomy.

Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures.

BACKGROUND: Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient's values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures. METHODS: We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms GOC discussions and hip fracture, with additional descriptors including arthroplasty and geriatric. RESULTS: There were 11 articles that met the selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining 6 articles were published in non-orthopaedic fields. There was one systematic review, 2 narrative reviews, 6 observational studies, and 2 descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions. CONCLUSIONS: Goals of care discussions provide a framework for treatment decisions based on an individual patient's values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient health care literacy, and physicians' misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as Outcome Prioritization Tool, and the incorporation of GOC discussions into institutional hip fracture pathways.

Orthopedic Surgery Matched Applicants Are Publishing More: A Bibliometric Analysis of Research Output.

Introduction This study analyzed the number of peer-reviewed publications submitted by matriculants prior to applying for the orthopedic surgery residency. The graduating residency classes of 2023 and 2027 were included in the study to understand the trend of publications, to inform aspiring orthopedic surgeons. Methods The top, middle, and bottom 10 orthopedic surgery residency programs were identified on the Doximity online website. Matriculants were searched on PubMed and Google Scholar for publication contributions. Variables including number of publications, orthopedic publications, first-author authorship, and H-index were analyzed. A logistic regression model was created, and a t-test was conducted to statistically compare the 2027 and 2023 graduating classes. Results Matriculants of the 2023 match had higher numbers of publications, orthopedic surgery-specific publications, first authorships, and h-indices than the matriculants of the 2018 match. Conclusion The average number of publications has been observed to increase over four years, indicating an increase in competition to match into orthopedic surgery residency. Publishing in higher numbers may be a good indicator of an applicant's success in not only matching but also matching into a higher-tier program.

Analysis of Changing Practice Trends in Anterior Cruciate Ligament Reconstruction: A Multicenter, Single-Institution Database Analysis.

PURPOSE: To identify trends in anterior cruciate ligament reconstruction (ACLR), including graft choice, femoral tunnel drilling techniques, and augmentation techniques, and to assess how various surgeon factors impact these trends. METHODS: A retrospective review of primary ACLRs performed between 2014 and 2022 was completed using a multicenter institutional database. Patient demographic characteristics, graft type, femoral drilling technique, use of extra-articular tenodesis, and use of suture augmentation were recorded from the medical record. Surgeon fellowship training (sports trained vs non-sports trained), experience (high [minimum of 15 years in practice] vs low), and volume (high [minimum of 15 ACLRs/year] vs low) were used to stratify technique utilization. The z test for proportions was used to compare categorical variables. Pearson correlation analyses identified trends and assessed statistical significance, defined as P < .05. RESULTS: Our cohort consisted of 2,032 ACLRs performed in 2,006 patients. The average patient age was 28.3 ± 11.6 years, with more procedures performed in male patients (67.3%). The average length of surgeon experience was 19.7 ± 11.4 years, with an average annual procedural volume of 4.0 ± 5.4 ACLRs. Most surgeons were sports trained (n = 55, 64.7%), high experience (n = 44, 57.1%), and low volume (n = 80, 94.1%). There was an increasing annual proportion of ACLRs performed by sports-trained surgeons (R = 0.748, P = .020) and low-experience surgeons (R = 0.940, P < .001). Autograft reconstructions were most often performed by sports-trained (71.2%), low-experience (66.1%), and high-volume (76.9%) surgeons. There was an increasing proportion of autograft ACLRs that used quadriceps tendon among sports-trained (R = 0.739, P = .023), high-experience (R = 0.768, P = .016), and low-volume (R = 0.785, P = .012) surgeons. Independent drilling techniques were used in an increasing proportion of ACLRs performed by non-sports-trained (R = 0.860, P = .003) and high-volume (R = 0.864, P = .003) surgeons. Augmentation of ACLR with concomitant suture augmentation (n = 24, 1.2%) or extra-articular tenodesis (n = 6, 0.3%) was rarely performed. CONCLUSIONS: In our multicenter institution, the quadriceps tendon autograft has been increasingly used in ACLR by sports-trained, low-volume, and high-experience surgeons. Independent drilling techniques have been increasingly used by non-sports-trained and high-volume surgeons. CLINICAL RELEVANCE: Surgeons must stay current with the literature that affects their procedures to ensure that evidence-based medicine is being practiced.

Capsular Repair, Labral Repair, and Femoroplasty are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome.

PURPOSE: To provide an updated assessment of hip arthroscopy use by using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS). METHODS: All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology coding in a multi-institutional, single health system database. A longitudinal analysis was performed to identify trends in the use of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up. RESULTS: During the study, 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1,490% (R2 = 0.87, P = .001). Capsular repair (R2 = 0.92, P < .001), labral repair (R2 = 0.75, P = .002), and femoroplasty (R2 = 0.70, P = .004) were performed in an increasing proportion of cases over our study period whereas labral debridement (R2 = -0.84, P < .001) became less used. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in use (R2 = 0.02, P = .73). CONCLUSIONS: Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS whereas the use of labral debridement decreased significantly over our study period. Postless traction systems were used in the majority of cases each year. CLINICAL RELEVANCE: As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.

Testosterone Replacement Therapy in Orthopaedic Surgery.

Testosterone replacement therapy (TRT) is an indicated treatment of several medical conditions including late-onset hypogonadism, congenital syndromes, and gender affirmation hormonal therapy. Increasing population age, medical benefits, and public awareness of TRT have resulted in increased prevalence of its utilization. However, TRT is not without concern for adverse risks including venous thromboembolic complications, cardiovascular events, and prostate issues. In the field of orthopaedic surgery, research is beginning to delineate the complex relationship between TRT and the development of orthopaedic conditions and potential effects on surgical interventions and outcomes. In this review, we discuss current literature surrounding TRT and subsequent development of osteoarthritis, incidence of total joint arthroplasty, musculotendinous pathology, postoperative infection risk, improvements in postoperative rehabilitation metrics, enhancement of osseous healing, and increased bone-implant integration. The authors suggest future areas of investigation that may provide guidance on how surgeons can mitigate adverse risks while optimizing benefits of TRT in the orthopaedic patient.

Do ChatGPT and Google Differ in Answers to Commonly Asked Patient Questions Regarding Total Shoulder and Total Elbow Arthroplasty?

BACKGROUND: Artificial intelligence (AI) and large language models (LLM) offer a new potential resource for patient education. The answers by ChatGPT, a LLM AI text bot, to frequently asked questions (FAQs) were compared to answers provided by a contemporary Google search to determine the reliability of information provided by these sources for patient education in upper extremity arthroplasty. METHODS: "Total shoulder arthroplasty" (TSA) and "total elbow arthroplasty" (TEA) were entered into Google Search and ChatGPT 3.0 to determine the ten most frequently asked questions (FAQs). On Google, the FAQs were obtained through the "people also ask" section, while ChatGPT was asked to provide the ten most FAQs. Each question, answer, and reference(s) cited were recorded. A modified version of the Rothwell system was used to categorize questions into 10 subtopics: special activities, timeline of recovery, restrictions, technical details, cost, indications/management, risks and complications, pain, longevity, and evaluation of surgery. Each reference was categorized into the following groups: commercial, academic, medical practice, single surgeon personal, or social media. Questions for TSA and TEA were combined for analysis and compared between Google and ChatGPT with a two sample Z-test for proportions. RESULTS: Overall, most questions were related to procedural indications or management (17.5%). There were no significant differences between Google and ChatGPT between question categories. The majority of references were from academic websites (65%). ChatGPT produced a greater number of academic references compared to Google (80% vs 50%; p=0.047), while Google more commonly provided medical practice references (25% vs 0%; p=0.017). CONCLUSION: In conjunction with patient-physician discussions, AI LLMs may provide a reliable resource for patients. By providing information based on academic references, these tools have the potential to improve health literacy and improved shared decision making for patients searching for information about TSA and TEA. CLINICAL SIGNIFICANCE: With the rising prevalence of AI programs, it is essential to understand how these applications affect patient education in medicine.

Seventy Percent of Abstracts Presented at the AANA Annual Meeting Are Later Published.

Purpose: To assess the future publication rates of abstracts presented at AANA annual meetings between 2015 and 2019. Methods: Abstracts presented at the 2015-2019 AANA annual meetings were identified. The PubMed and Google Scholar databases were searched for a corresponding manuscript for each abstract using the name of the first author, abstract title, and keywords. A level of evidence and anatomic category were assigned to each abstract. For each corresponding manuscript identified, the authors, journal of publication, journal impact factor (IF), time to publication, and number of citations were recorded. Results: Overall, 70.5% of abstracts presented at the 2015-2019 AANA annual meetings (275 of 390) went on to future publication, with 63.6% (248 of 390) achieving publication within 3 years. The median time to publication from presentation was 12.8 months. Arthroscopy (29.8%) was the most frequent journal of publication. The average IF of publishing journals was 4.92 ± 3.41, with 61.8% of manuscripts (170 of 275) published in journals with an IF of at least 4.00. Published manuscripts received an average of 36.30 ± 47.6 citations per manuscript. A stronger level of evidence was associated with an increased likelihood of future publication (P = .008). Conclusions: Pre-publication literature presented at the AANA annual meetings has continued to be associated with a strong likelihood of future publication in Arthroscopy and Arthroscopy, Sports Medicine, and Rehabilitation, as well as other respected peer-reviewed journals. Clinical Relevance: Exposure to pre-publication literature may have an impact on clinical management. It is important to understand the quality of research presented in abstracts from AANA annual meetings. Knowing how many abstracts are ultimately published in peer-reviewed journals provides an indicator of the quality and reliability of the research.

Publication Rates of Abstracts Presented at American Orthopaedic Society for Sports Medicine Annual Meetings From 2016 to 2019.

Background: Research in the form of poster and podium abstracts is disseminated at subspecialty society meetings. The quality of this research can be defined by exploring the ultimate publication rate of the presented abstracts. Purpose: To investigate (1) the manuscript publication rate of abstracts presented at the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting; (2) whether abstract format (poster vs podium) influences overall or 2-year publication rates and time to publication; (3) the abstract factors that are associated with increased publication rate; and (4) whether publication quality as measured by journal of publication, level of evidence (LOE), and number of citations differs between posters and podiums. Study Design: Cross-sectional study. Methods: Poster and podium abstracts that were presented at the AOSSM annual meetings between January 1, 2016, and December 31, 2019, were included. The PubMed and GoogleScholar databases were searched by abstract title and authors to determine whether the related manuscript had been published. For published manuscripts, the journal, journal impact factor (IF), time to publication, authors, and LOE were recorded. Results: The manuscripts of 664 abstracts (341 poster, 323 podium presentations) were published during the study period. The overall publication rate was 52.4%. Publication within 2 years of the meeting was found to be higher in podium abstracts (45.8%) compared with poster abstracts (37.8%) (P = .0366). Podium abstracts had a shorter time to publication (P < .001), higher LOE (P = .0166), more citations (P < .0001), and were published in higher IF journals (P = .0028). Poster presentations were more likely to undergo a change in first author between the time of the conference and future publication (P = .0300). The most common journal of publication was the American Journal of Sports Medicine (36.8%). Conclusion: Abstracts presented at the AOSSM annual meeting had a high rate of publication within 2 years. There was no difference in publication rates between podium and poster abstracts, but podium abstracts had a shorter time to publication and more future citations and were published in journals with higher IFs.

A Review of Federal and Statewide Guidelines and Their Effects on Orthopedics.

In the past three decades, the use of opioids has risen tremendously. Pain was named the "fifth patient vital sign" in the 1990s, and from that point, opioid usage has continued to grow throughout the 2010s leading to its recognition as a crisis. The United States is responsible for 80% of the global opioid usage while only accounting for less than 5% of the global population. Previously opioids were mostly used to treat acute pain, however, opioids have been most recently used to manage chronic pain as well. The opioid crisis has presented new challenges in treating pain while preventing the abuse of these medications in a system that lacks standardization of treatment guidelines across the United States. Therefore, the authors of this review examine the current national recommendations to help manage the ongoing opioid crisis and explore how they may impact orthopedic patient care.

Risk factors for unexpected readmission and reoperation following open procedures for shoulder instability: a national database study of 1,942 cases.

BACKGROUND: The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. RESULTS: In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). CONCLUSIONS: Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure. Level of evidence: III.

A review of chronic pectoralis major tears: what options are available?

Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be challenging. Tendon retraction, poor tendinous substance and quality of tissue, muscle atrophy, scar formation, and altered anatomy make direct repairs complicated, often necessitating auto- or allograft use. We review the various graft options and fixation methods that can be used when treating patients with chronic pectoralis major tears.

Risk Factors for Unexpected Admission Following Outpatient Rotator Cuff Repair: A National Database Study.

Introduction  Rotator cuff repair (RCR) procedures are some of the most common orthopaedic surgeries performed in the United States. Compared to other orthopaedic procedures, RCRs are of relatively low morbidity. However, complications may arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission after RCR. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent elective RCR from 2015-2019. Univariate and multivariate analyses were utilized to assess patient demographics, comorbidities, and peri-operative variables predicting unplanned 30-day readmission. Results Of the identified 45,548 patients that underwent RCR, 597 (1.3%) required readmission within 30 days of the procedure. Multivariate analysis identified male sex (OR 1.36, 95% CI: 1.10, 1.67), hypertension (OR 1.29, 95% CI:1.03, 1.62), chronic obstructive pulmonary disease (COPD) (OR 2.07, 95% CI: 1.46, 2.93), American Society of Anesthesiologists (ASA) Class III (OR 1.85, 95% CI: 1.07, 3.18), ASA Class IV (OR 5.38, 95% CI: 2.70, 10.72), and total operative time (OR 1.002, 95% CI: 1.000, 1.004) as independent risk factors for unplanned readmission. Conclusion Unplanned 30-day readmission after RCR is infrequent. However, certain patients may be at increased risk for unplanned 30-day admission to an inpatient facility. This study confirmed male sex, COPD, hypertension, ASA Class III, ASA Class IV, and total operative time to be independent risk factors for readmission following outpatient RCR.

Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature.

¼ Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.¼ In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.¼ Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.

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.

Update on Educational Resources and Evaluation Tools for Orthopaedic Surgery Residents.

Innovations in orthopaedic resident educational resources and evaluation tools are essential to ensuring appropriate training and ultimately the graduation of competent orthopaedic surgeons. In recent years, there have been several advancements in comprehensive educational platforms within orthopaedic surgery. Orthobullets PASS, Journal of Bone and Joint Surgery Clinical Classroom, and American Academy of Orthopaedic Surgery Resident Orthopaedic Core Knowledge each have their own unique advantages in preparation for the Orthopaedic In-Training Examination and American Board of Orthopaedic Surgery board certification examinations. In addition, the Accreditation Council for Graduate Medical Education Milestones 2.0 and the American Board of Orthopaedic Surgery Knowledge Skills Behavior program each provide objective assessment of resident core competencies. Understanding and using these new platforms will help orthopaedic residents, faculty, residency programs, and program leadership to best train and evaluate their residents.

Comparison of Sports Medicine Questions on the Orthopaedic In-Training Examination Between 2009 and 2012 and 2017 and 2020 Reveals an Increasing Number of References.

Purpose: To provide an updated analysis of the sports medicine section of the Orthopedic In-Training Examination (OITE). Methods: A cross-sectional review of OITE sports medicine questions from 2009 to 2012 and 2017-2020 was performed. Subtopics, taxonomy, references, and use of imaging modalities were recorded and changes between the time periods were analyzed. Results: The most tested sports medicine subtopics included ACL (12.6%), rotator cuff (10.5%), and throwing injuries to the shoulder (7.4%) in the early subset, while ACL (10%), rotator cuff (6.25%), shoulder instability (6.25%), and throwing injuries to the elbow (6.25%) were the most common in the later subset. The American Journal of Sports Medicine (28.3%) was the most cited journal referenced from 2009 to 2012, while The Journal of the American Academy of Orthopaedic Surgeons (17.5%) was most referenced in questions from 2017 to 2020. The number of references per question increased from the early to the late subset (P < .001). There was a trend toward an increased taxonomy type one questions (P = .114), while type 2 questions had a decreased trend (P = .263) when comparing the new subset to the early group. Conclusion: When comparing sports medicine OITE questions from 2009 to 2012 and 2017 to 2020, there was an increase in the number of references per question. Subtopics, taxonomy, lag time, and use of imaging modalities did not show statistically significant changes. Clinical Relevance: This study provides a detailed analysis of the sports medicine section of the OITE, which can be used by residents and program directors to direct their preparation for the annual examination. The results of this study may help examining boards align their examinations and provide a benchmark for future studies.

Residency Match Rates in Orthopaedic Surgery Based on Sex, Under-Represented in Medicine Status, and Degree Type.

Orthopaedic surgery is well recognized as one of the most competitive and least diverse medical specialties. Despite efforts toward improving diversity, studies have shown that gender and racial/ethnic disparities continue to persist in orthopaedic graduate medical education. Therefore, we sought to identify the match rates of traditionally under-represented groups within orthopaedic surgery-female candidates, racial and ethnic minorities under-represented in medicine (URiM), and osteopathic physicians-compared with their application rates. Methods: A retrospective review of the Electronic Residency Application Service (ERAS) application data from the 2017 to 2021 application cycles was performed, and the total number of applicants, sex, race/ethnicity, and degree type of all students applying for orthopaedic surgery were recorded. A separate database, the Orthopaedic Residency Information Network (ORIN), which is a database self-reported by residency programs to provide information to applicants, was also queried to identify the total number of residents, sex, race/ethnicity, and degree type of all current residents in June 2022, corresponding to those residents who matched in 2017 to 2021. Results: From the ERAS application data, a total of 7,903 applicants applied to orthopaedic surgery during the study period. A total of 1,448 applicants (18%) were female, 1,307 (18%) were URiM, and 1,022 (15%) were from an osteopathic medical school. Based on the ORIN database, 688 of 3,574 residents (19%) were female, 1,131 of 7,374 (19%) were URiM, and 1,022 of US medical school graduates (12%) had a DO degree. The application and match rates were not significantly different for female (p = 0.249) and URiM (0.187) applicants; however, there was a significant difference in the application and match rates (15% vs 12%; p = 0.035) for US medical graduates with a DO degree. Conclusion: In recent years, there has been a significant and necessary push to increase diversity in the field of orthopaedic surgery. From 2017 to 2021, match rates of female and URiM candidates are reflective of their application rates. Osteopathic applicants in orthopaedic surgery have a lower match rate than their allopathic counterparts. Level of Evidence: III.