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.

Following Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies.

Purpose: To (1) perform a systematic review of level I randomized controlled trials (RCTs) detailing the incidence of anterior knee pain and kneeling pain following anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft and (2) investigate the effect of bone grafting the patellar harvest site on anterior knee and kneeling pain. Methods: A systematic review of level I studies from 1980 to 2023 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome evaluated was the presence of donor site morbidity in the form of anterior knee pain or kneeling pain. A secondary subanalysis was performed to assess for differences in the incidence of postoperative pain between patient groups undergoing ACLR with BPTB receiving harvest site bone grafting and those in whom the defect was left untreated. Results: Following full-text review, 15 studies reporting on a total of 696 patients met final inclusion criteria. Patients were followed for an average of 4.78 years (range, 2.0-15.3), and the mean age ranged from 21.7 to 38 years old. The incidence of anterior knee pain, calculated from 354 patients across 10 studies, ranged from 5.4% to 48.4%. The incidence of postoperative pain with kneeling was determined to range from 4.0% to 75.6% in 490 patients from 9 studies. Patients treated with bone grafting of the BPTB harvest site had no significant difference in incidence of any knee pain compared with those who were not grafted, with incidences of 43.3% and 40.2%, respectively. Conclusions: Based on the current level I RCT data, the incidences of anterior knee pain and kneeling pain following ACLR with BPTB autograft range from 5.4% to 48.4% and 4.0% to 75.6%, respectively. Level of Evidence: Level I, systematic review of RCTs.

Manipulation Under Anesthesia and Lysis of Adhesions Are the Most Commonly Reported Treatments for Arthrofibrosis of the Knee After Arthroscopy or Anterior Cruciate Ligament Reconstruction in Both Pediatric and Adult Patients.

Purpose: To systematically review the literature and provide a detailed summary of the current treatments and outcomes for arthrofibrosis following knee arthroscopy and anterior cruciate ligament reconstruction (ACLR) and to compare the treatment strategies in pediatric and adult populations. Methods: A systematic review was performed in March 2022 using PubMed, EMBASE, and Cochrane Library Databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Search terms consisted of variations of the following: ("arthrofibrosis" OR "stiffness" OR "stiff" OR "complications") AND ("arthroscopy" OR "arthroscop" OR "ACL" OR "anterior cruciate") AND ("treat" OR "care" OR "management" AND "knee"). The inclusion criteria were studies that were written in English, were published since 2000, and that reported outcomes of knee arthroscopy or ACLR for treatment of arthrofibrosis of the knee. The study quality was assessed, and data about the patients and treatments were recorded. Treatments were compared between pediatric and adult patients. Results: A total of 1,208 articles were identified in the initial search, 42 (3.48%) of which met eligibility criteria, involving treatment regimens for arthrofibrosis following knee arthroscopy or ACLR. Of the 42 studies included, 29 (69.0%) were reported data for adults and 13 (31.0%) reported data for pediatric patients. Thirty-nine studies (92.8%) discussed manipulation under anesthesia and/or lysis of adhesions (LOA) as treatment for arthrofibrosis of the knee, whereas 2 (4.8%) described the use of medications. Conclusions: Within orthopaedic sports medicine literature, there is variability in the reported treatment options for arthrofibrosis of the knee. Most studies identified manipulation under anesthesia and/or LOA as the treatment among both adult and pediatric patients. Other variants include notchplasty, open posterior arthrolysis, total graft resection, removal of hardware with LOA, dynamic splinting, casting in extension, bracing, and medications. Level of Evidence: Level IV, systematic review of Level I-IV studies.

Medial Collateral Ligament Reconstruction With Autograft Versus Allograft: A Systematic Review.

BACKGROUND: Medial collateral ligament (MCL) reconstruction (MCLR) is performed after failed nonoperative treatment or high-grade MCL injury with associated valgus instability. PURPOSE: To evaluate clinical outcomes after MCLR with autograft versus allograft. STUDY DESIGN: Systematic review, Level of evidence, 4. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors conducted a search of the PubMed, CINAHL, EMBASE, and Cochrane databases to identify studies comparing outcomes of MCLR with autograft versus allograft. Studies were included if they evaluated clinical outcomes after MCLR using autograft and/or allograft. Any study that included concomitant knee ligament injury other than the anterior cruciate ligament injury was excluded. A quality assessment was performed using the modified Coleman Methodology Score. RESULTS: The initial search identified 746 studies, 17 of which met the inclusion criteria and were included in this review. The studies included 307 patients: 151 (49.2%) patients received autografts, and 156 (50.8%) received allografts. The most used autograft was the semitendinosus tendon (136 grafts; 90.1% of specified allografts), and the only allograft used was the Achilles tendon (110 grafts; 100% of specified autografts). The mean follow-up of the studies was 25.6 months. Postoperative pain (Lysholm scores) ranged from 82.9 to 94.8 in patients receiving autografts and 87.5 to 93 in patients receiving allografts. Postoperative range of motion was full in 8 of 15 (53.3%) patients receiving autografts compared with 82 of 93 (88.2%) patients receiving allografts. Five of the 151 (3.3%) patients who had MCLR with autografts had complications such as infection, instability, and prominent screws. Two of the 156 (1.3%) MCLRs with allografts developed complications of prominent screws and nonhealing incisions. CONCLUSION: MCLR with either autografts or allografts leads to improved patient-reported, radiographic, and clinical outcomes. Patient-reported postoperative pain was similar in patients receiving either graft type. Other outcomes were difficult to compare between graft types because of nonstandardized reporting and a lack of pre- and postoperative measurements. Therefore, there is no evidence of significantly improved outcomes in the use of either autograft or allograft with MCLR.

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.

Operative Treatment of Ulnar Collateral Ligament Injury in Female Athletes.

Background: Ulnar collateral ligament (UCL) reconstruction has been the standard surgical intervention for elite male athletes with UCL insufficiency. Recently, UCL repair and augmentation with an internal brace has been increasingly performed. Purpose: To evaluate the clinical and functional outcomes as well as return-to-sport rate after UCL repair in female athletes. Study Design: Case series; Level of evidence, 4. Methods: Included were 15 female athletes (mean age, 16.5 ± 3.5 years) who underwent UCL repair between 2011 and 2021 at a single institution. Data collected included age, sport played, competition level, symptom onset, previous surgeries, mechanism of injury, surgical intervention, and return to sport. Patients were contacted via phone at minimum 24-month follow-up, and postoperative outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Results: Of the 15 female athletes, there were 4 cheerleaders, 3 softball players, 2 volleyball players, 2 soccer players, 1 gymnast, 1 tennis player, 1 dancer, and 1 javelin thrower. Ten of the 15 athletes (67%) competed at the high school level, 4 (26%) at the collegiate level, and 1 patient (7%) was a recreational volleyball player. In all patients, there was an acute onset of symptoms after injury. Ten patients underwent UCL repair with an internal brace (67% of athletes), while 5 underwent standard UCL repair. The median MEPS for athletes with and without an internal brace was 100 (range, 80-100). There was no significant difference of MEPS (P = .826) or SANE scores (P = .189) between the patients who received an internal brace and those who did not. Thirteen of the 15 athletes (86.7%) returned to sport. Conclusion: The UCL injuries in the female athletes in this study were the result of acute trauma. Primary UCL repair, both with and without internal bracing, was an effective surgical treatment for returning these athletes to sport.

Both Quadriceps and Bone-Patellar Tendon-Bone Autografts Improve Postoperative Stability and Functional Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Purpose: To compare postoperative knee stability, functional outcomes, and complications after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) versus quadriceps tendon autograft. Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, the PubMed, Embase, and Cochrane Library databases were searched for studies published in 2002 or later. Studies were included if they met the following criteria: randomized controlled trials that included patients who underwent ACL reconstruction with BPTB or quadriceps tendon autograft including all soft tissue and bone-quadriceps tendon and in which measures of postoperative stability and functional outcomes were reported. Studies that were not written in English and those that analyzed animals or cadavers, were not randomized controlled trials, or used other grafts (e.g., hamstring) were excluded. Results: The initial search identified 348 studies, 6 of which were included in this systematic review. Two of the six studies found no significant difference in performance outcomes or complications between quadriceps and BPTB autografts. One study found that patients receiving quadriceps autograft self-reported improved knee functional status compared with those receiving BPTB autograft. Another study found that quadriceps autograft resulted in a significantly reduced Quadriceps Index postoperatively compared with BPTB autograft (69.5 vs 82.8, P = .01) but found no difference in postoperative quadriceps strength. An additional study found that the outcomes of quadriceps tendon and BPTB autografts were equivalent per the International Knee Documentation Committee scale, but anterior knee pain was less severe in patients with quadriceps tendon autograft. Furthermore, one study revealed the overall International Knee Documentation Committee score was reported as normal significantly more often in patients who underwent ACL reconstruction with BPTB autograft (85% vs 50%, P < .001) and that donor-site morbidity was greater in patients with quadriceps autograft. No significant difference was found in complications requiring reoperation across studies. Conclusions: Patients undergoing ACL reconstruction with either BPTB or quadriceps tendon autograft reported improved postoperative knee stability and functional outcomes. There is no significant difference in complications between quadriceps autograft use and BPTB autograft use. Level of Evidence: Level III, systematic review of Level III retrospective 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.

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.

Instagram Outperforms Twitter in Driving Social Media Engagement Among Sports Medicine Orthopaedic Surgeons.

Purpose: To determine the content posted by sports medicine orthopaedic surgeons on Instagram and Twitter and to evaluate the associated engagement. Methods: Data were collected from sports medicine orthopaedic surgeons' Instagram profiles and Twitter profiles between December 2020 and June 2022. The median number of total number of likes, comments, and retweets was calculated. The content of posts from both platforms was divided into the following categories: personal life, research, patient testimony, day in the life, pathway to becoming a physician, clinical cases, medical facts, and team coverage. Results: Data from 71 Instagram profiles and 39 Twitter profiles were used in this study. A total of 1,193 posts were identified on Instagram and 1,284 posts were identified on Twitter. The personal life category had the greatest number of posts on Instagram (303, 25.4%), whereas the medical facts category had the greatest number of posts on Twitter (251, 19.5%). Pathway to becoming a physician had the greatest median number of likes on both Instagram (97.5, range 48-2,467) and Twitter (19, range 0-50) and the greatest median number of comments on Instagram at 16 (range 1-203). The team coverage category on Instagram had the greatest percentage of likes per follower at 9.9%. A significantly greater percentage of orthopaedic surgeons posted about day in the life content, medical facts, and research on Twitter in comparison with Instagram. Instagram resulted in significantly more social media engagement than Twitter in all 8 categories (P < .05). Conclusions: Instagram resulted in significantly more social media engagement across all categories in comparison with Twitter with team coverage, personal life, and pathway to becoming a physician being the most popular categories. Clinical Relevance: The information learned in this study may help sports surgeons understand how they may best utilize social media to engage with others and enhance their clinical practice.

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.

Virtual Interviews Are Not Adequate Replacements for In-Person Interviews for Orthopaedic Sports Medicine Fellowship Program Directors and Applicants.

Purpose: To understand the opinions of both orthopaedic sports medicine fellowship program directors (PDs) and applicants regarding the utility of virtual interviews in comparison to in-person interviews following the 2022-2023 application cycle. Methods: An anonymous online survey was distributed through the American Orthopaedic Society for Sports Medicine to applicants and PDs of orthopaedic sports medicine fellowship programs. Questions in the survey included how the virtual format affected the applicants' personal connection to the program, the interview day structure, and costs associated with the interview process. Results: Responses were received from 69 of 93 PDs (74%) and 97 of 266 applicants (36%). Ninety-five percent of PDs (59 of 62) preferred in-person interviews, compared to 79% of applicants (70 of 89). Ninety-eight percent of PDs (60 of 61) and 82% of applicants (72 of 88) thought it was important/very important to interview in-person. Sixty-one percent of PDs (35 of 57) and 49% of applicants agreed/strongly agreed that conducting virtual interviews negatively affected their personal connection with the fellowship interviewee/program. The presence of virtual interviews allowed 50% (43 of 86) of applicants to go on more interviews. Thirty-two percent (18 of 57) of fellowship programs saved up to $5,000 conducting virtual interviews, and 85% (69 of 81) of applicants saved up to $5,000 on travel expenses by attending virtual interviews. Conclusions: Virtual interviews allow fellowship applicants to complete more interviews and presented financial savings for both programs and applicants. However, both PDs and applicants stated that interviewing in-person is essential for applicants to meet faculty and tour the facilities. Clinical Relevance: This study may be valuable to fellowship programs considering continued use of virtual interviews.

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.

A modified Delphi consensus statement on patellar instability: part I.

Aims: The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach. Methods: A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous. Results: Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus. Conclusion: The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed.

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.

Review of Intra-Articular Use of Antibiotics and Antiseptic Irrigation and Their Systematic Association with Chondrolysis.

Introduction: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration. Methods: A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for chondrotoxicity following antibiotic exposure. Results: The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported. Conclusions: This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use.

Management of Acromioclavicular Joint Injuries: A Historic Account.

There has been a rapid evolution in best practice management of acromioclavicular (AC) joint injuries. AP, Zanca, scapular Y, and dynamic axillary radiographic views provide optimal visualization of the joint and may assess for the presence of horizontal AC instability. Severity of AC joint pathology is classified according to the 6-tier Rockwood scoring system. Over 160 surgical techniques have been described for AC joint repair and reconstruction in the last decade; as a result, determining the optimal treatment algorithm has become increasingly challenging secondary to the lack of consistently excellent clinical outcomes.

Psychological Readiness to Return to Sport After Shoulder Instability.

¼ The shoulder is the most commonly dislocated joint in the body, representing 50% of all major joint dislocations. This injury occurs most commonly in contact sports and may be treated either nonoperatively (rest, immobilization, and physical therapy) or surgically.¼ Several factors contribute to an athlete's recovery after shoulder injury, including psychological readiness that has been identified as having a significant impact on athlete's rate of return to sport. The psychological readiness of athletes can be quantified using patient-reported outcome measures and psychological assessment tools.¼ Managing priorities and expectations, mood, social support, and confidence have all been identified as factors that affect readiness to return to play. Kinesiophobia was the most common factor reported in patients interviewed after arthroscopic Bankart repair.¼ Psychological interventions including cognitive behavioral therapy and mindfulness are aimed at reducing the effects of psychological factors and mood states by decreasing stress, anxiety, and kinesiophobia. These interventions may also increase the rates of return to sport after shoulder instability.