Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior Instability of the Shoulder: A Systematic Review.

BACKGROUND: Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair. PURPOSE: To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated. RESULTS: In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290). CONCLUSION: Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.

Psychological Factors Associated With Return to Play After Ulnar Collateral Ligament Reconstruction: A Systematic Review.

Background: The role of psychological factors in return to play (RTP) after ulnar collateral ligament (UCL) reconstruction remains unclear. Purpose: To perform a systematic review of the literature to (1) identify the specific psychological factors that affect RTP after UCL reconstruction and (2) determine the proportion of failures to RTP after UCL reconstruction because of psychological factors. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. We queried the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science databases to identify studies examining psychological factors and RTP after UCL reconstruction. Data pertaining to study characteristics and design, clinical and demographic characteristics, and psychological factors were collected. Patients were pooled across included studies, weighted means were calculated, and descriptive statistical analysis was performed. Results: A total of 8 studies consisting of 378 patients were included for analysis. The mean time to RTP was 12.2 months, and the overall RTP rate was 89.4%. Psychological factors affecting RTP included loss of interest, fear of reinjury, individual personality traits, personal reasons, and psychological concerns. While clinical factors accounted for 46.2% (n = 24) of failures to RTP, psychological factors comprised 40.4% (n = 21) of the reasons for failure to RTP. The most commonly cited psychological factors affecting RTP were loss of interest (n = 15 [28.8%]) and fear of reinjury (n = 3 [5.8%]). Conclusion: Psychological factors represented a substantial proportion of failures to RTP after UCL reconstruction, especially in adolescent athletes. Future prospective studies and multicenter initiatives are needed to more thoroughly evaluate the psychological concerns of patients before and after UCL reconstruction.

The Role of Advanced Academic Degrees in Orthopaedic Sports Medicine Faculty.

BACKGROUND: Limited knowledge exists on the role of advanced academic degrees within faculty positions in orthopaedic sports medicine. PURPOSE: To 1) provide an assessment of the baseline demographics of advanced degrees among orthopaedic sports medicine faculty and 2) examine the impact of advanced degrees on research productivity and career attainment of orthopaedic sports medicine faculty. STUDY DESIGN: Cross-sectional study; Level of evidence, 4. METHODS: Orthopaedic sports medicine academics were identified using faculty listings on websites of the 200 orthopaedic surgery residency programs during the 2020-2021 academic year. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures included timing of advanced degree obtainment, residency program rankings, research productivity, and current academic rank and leadership roles. Statistical analysis was performed using chi-square and Mann-Whitney U tests to determine the association of advanced degrees on outcome measures. RESULTS: In total, 911 orthopaedic sports medicine faculty members were identified, of whom 100 had an advanced degree. The most common advanced degrees were Master of Science (MS/MSc; 38%), Doctor of Philosophy (PhD; 23%), and Master of Business Administration (MBA; 13%). The presence of an advanced degree was associated with greater research productivity, including higher h-index and number of publications, as well as more editorial board positions on orthopaedics journals (P < .001). Advanced degrees were not significantly associated with attending a higher ranked orthopaedic surgery residency program, current academic rank, or leadership roles. At the institutional level, orthopaedic sports medicine programs that employed faculty with an advanced degree had a higher residency program ranking and the presence of a sports medicine fellowship was more likely (P < .05). CONCLUSION: Advanced degrees in orthopaedic sports medicine were associated with greater faculty research engagement and employment at a higher ranked institution; they were not associated with matching to a highly ranked orthopaedic surgery residency program, higher faculty rank, or academic leadership roles.

Academic Influence as Reflected by h Index Is Not Associated With Total Industry Payments but Rather With National Institutes of Health Funding Among Academic Orthopaedic Sports Medicine Surgeons.

PURPOSE: (1) To compare the total number and dollar amount of industry funding and National Institutes of Health (NIH) funding to academic orthopaedic sports medicine surgeons and (2) to examine the impact of academic influence on industry funding and NIH funding to academic orthopaedic sports medicine surgeons. METHODS: Academic orthopaedic sports medicine surgeons were identified using faculty web pages. Academic influence was approximated by a physician's Hirsch index (h index) and number of publications and obtained from the Scopus database. Total industry payments were acquired through the Open Payments Database, and NIH funding was determined from the NIH website. Statistical analysis was performed using Mann-Whitney U test and Spearman correlations with significance set at P < .05. RESULTS: Physicians who received industry research payments and NIH funding had a significantly higher mean h index and more mean total publications than physicians who did not receive industry research payments and NIH funding. There were no significant differences in h index (P = .374) or number of publications (P = .126) between surgeons receiving industry nonresearch funding and those who did not. h Index and number of publications were both weakly correlated with the amount of industry research and nonresearch funding. CONCLUSION: Although academic influence is associated with industry research funding and NIH funding, there is no association between measures of academic influence and total industry and industry nonresearch payments. Combined with the weak associations between academic influence and the amount of industry payments, academic influence does not appear to be a major determinant of industry funding to academic orthopaedic sports medicine surgeons. CLINICAL RELEVANCE: Surgeons should be cognizant of potential conflicts with industry, but the relationship between academic sports medicine surgeons and industry may be less subject to bias than previously believed.