American Orthopaedic Society For Sports Medicine Research Articles

Academic Productivity at Orthopedic Surgery Sports Medicine Fellowship Programs in the United States Has a Weak Positive Correlation with Non-Research Life-Time Industry Earnings

PurposeTo characterize the relationship between academic productivity, as defined by H-index, and industry payments for fellowship-trained sports medicine surgeons in faculty positions at sports medicine fellowships. MethodsThe American Orthopaedic Society for Sports Medicine (AOSSM) fellowship directory was used to create a comprehensive list of all fellowship programs nationwide. Fellowship websites were then reviewed to generate a list of the teaching faculty associated with each program. Total non-research life-time earnings was obtained from the Centers for Medicare and Medicaid Services website. Academic productivity of each fellowship faculty was assessed via H-index. Frequency counts and other descriptive statistic measures were used to describe the data for this study. Correlation was performed for continuous data using Spearman’s rho. Results90 orthopedic surgery sports medicine fellowships were identified with a combined total of 574 orthopedic surgery sports medicine fellowship faculty. There was a weak positive correlation between individual physician H-index and individual physician life-time earnings at orthopedic surgery sports medicine fellowships (p<0.001; Spearman’s rho = 0.329). There was a statistically significant difference between individual faculty H-index by quartile and individual faculty life-time earnings (test statistic: 47.3; p<0.001). There was no significant regional difference in payments but there is remarkable heterogeneity in the distribution of payments to individual physicians, with the top 10% of physicians receiving over 80% of industry dollars. ConclusionThere is a positive correlation between academic productivity and industry payments at both the individual and institutional level in orthopedic sports medicine departments, although this relationship was greater at the fellowship level. Furthermore, the majority of non-research industry funding goes to a minority of physicians. Clinical RelevanceEvaluating the impact that non-research industry payments have on a sports medicine orthopedic surgeon's research productivity can offer valuable insights into the relationship between industry compensation and scholarly output in this field.

Medical advisability of softball youth pitching recommendations on the internet

ABSTRACT Objective Developing softball pitchers are prone to injury due to the repetitive throwing motion. Many children and parents use the internet as a source of medical advice, but this information may not always be aligned with medical guidelines. The purpose of this study was to assess the medical advisability of injury prevention guidelines for developing softball pitchers on websites using Google as the primary search engine. Methods The first 100 websites populated from a Google search using the term softball youth pitching recommendations were evaluated. Each website was categorized as discussing baseball, softball, or both, and as athletic, commercial, or educational. For every website, 16 recommendations described by the American Orthopaedic Society for Sports Medicine (AOSSM) Stop Sports Injuries softball injury prevention guidelines (Table 1) were scored as in agreement (+1), different guideline mentioned (0.5), no mention (0), or discordant (−1). Table 1. Websites with guidelines identical to AOSSM by type of website, by sport, and by order of appearance in google search, AOSSM = American orthopaedic society for sports medicine. ‘*’ indicates p value < 0.05. Results Of the 98 qualifying websites, 57 advised only about softball, while 19 advised about both baseball and softball. Fifty websites had no mention of any recommendation outlined by AOSSM. Websites that were mostly in agreement with AOSSM were educational websites (mean score = 3.9, p = 0.02), websites discussing only softball (mean score = 2.0, p = 0.02), and the first 50 websites (mean score = 2.2, p = 0.04). The most common discordant guideline was differing opinions in pitch count (13 websites). Conclusion The most common category in disagreement with AOSSM was different pitch count guidelines, highlighting a need for websites to provide more consistent information using high-quality resources. Educational websites, websites discussing only softball, and the first 50 websites had the highest scores, indicating that these types of websites are most likely to have the highest amount of medically advisable information. We recommend users conduct targeted Google searches on reliable websites for information on pitching softball recommendations to maximize the validity of Google search results.

Paper 44: In-Person Versus Virtual Interviews for Orthopaedic Surgery Sports Medicine Fellowship: Applicant Perspectives

Objectives: Virtual fellowship interviews were widely utilized during the COVID-19 pandemic. Little is published at this time about the preferences of applicants of orthopaedic surgery sports medicine fellowship positions regarding in-person versus virtual interviews. The purpose of this study is to determine the applicant cost-benefit willingness for both in-person and virtual interviews, assess the ability to learn about a program in a virtual setting, and to gauge the opinions of applicants on their preferences for in-person or virtual interviews. Methods: An online survey was distributed to all orthopaedic sports medicine applicants for the 2022-2023 match cycle through the American Orthopaedic Society for Sports Medicine (AOSSM). Statistical analysis was performed using descriptive statistics. Results: Forty-five surveys were completed. Respondents had a mean age of 31.49 years (±2.49) with 38 (84.4%) identifying as male and 7 (15.6%) as female. Most applicants applied to between 31-40 (26.7%) or 21-30 programs (22.2%), while attending between 11-15 interviews (44.4%). 51.1% of applicants stated that ~25% of their interviews were virtual format, with 15.6% of all applicants attending over 50% of interviews in the virtual format. Most applicants spent between $2,500-$5,000 (35.7%) or $5,000-$7,500 (26.7%) on interviews. Applicants stated they would feel most comfortable spending between $2,500-$5,000 (46.7%) or $5,000-$7,500 (26.7%). 36.4% of applicants stated they completed less in-person interviews due to cost, and 52.3% said they would have completed less interviews overall if there was no virtual option. 68.2% of applicants stated distance traveled was irrelevant when electing to attend an interview virtually. When comparing in-person vs virtual interviews, applicants either strongly agreed or agreed that in-person interviews allowed them to better represent themselves (95.6% vs 44.4%), assess right “fit” (95.6% vs 28.9%) and sufficiently formulate a rank list (93.2% vs 40%) compared to virtual interviews. Conclusions: Fellowship applicants had strong preferences for in-person interviews in the orthopaedic surgery sports medicine fellowship match. Cost was a limiting factor in declining in-person interviews and most applicants attended more interviews due to virtual formats. Applicants did not feel that virtual interviews were sufficient for creating accurate rank lists.

Publication History and Associated Academic Metrics of Selected Content Speakers at Arthroscopy Association of North America and American Orthopaedic Society for Sports MedicineAnnual Meetings

Background Annual meetings held by the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM) are important platforms for showcasing relevant sports medicine innovation and research. While meeting planning committees likely consider multiple factors when selecting content speakers, it may be assumed that these speakers are well-published or have an academic reputation on their topic of presentation. Hypothesis/Purpose To assess the peer-reviewed publication history and associated academic metrics of selected content speakers of prominent sports medicine society meetings and to identify content areas that lack speakers with previous peer-reviewed publications on their topic of presentation. Study Design Cross-Sectional Review Methods The 2016-2019 conference programs of AANA and AOSSM annual meetings were screened for selected content speakers. Each selected content speaker was searched in the Scopus database to identify prior peer-reviewed publications that were relevant to their presentation topic. Each selected content speaker, presentation, and content category was analyzed to determine the speakers’ Hirsch index (H-index), number of speakers’ previous topic-specific publications, manuscripts’ weighted citation count (WCC), and number of speakers using means and proportions. Comparisons were performed with two-sample T-tests for continuous variables and two-sample Z-tests for proportions for categorical variables, with p-values less than 0.05 indicating statistical significance. Results Of 432 total lectures, 371 (86%) were given by speakers who were previously published on their topic, leaving only 61 lectures (14%) by speakers without previous topic-specific publication (p=0.0005). Nonoperative sports medicine had the highest proportion (34%, 24/71) of lectures delivered by speakers without prior topic-specific publications. Speakers presenting on the hip had the highest H-index (41.67); speakers presenting on the elbow held the highest average number of prior topic-specific publications (12.17); and speakers presenting on biologics held the highest average WCC (8.56). There were no differences between conferences in regard to the proportion of speakers without previous topic-specific publications, the total average number of prior topic-specific publications per speaker, or the total average WCC. Conclusion The AANA and AOSSM annual meetings largely include selected content speakers with prior peer-reviewed literature. While publication history and associated academic metrics may be factors in speaker selection, each organization likely has its own individual selection criteria for delivering high-quality programs.

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

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. 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. Cross-sectional study. 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. 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%). 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.

Poster 281: Current practice for meniscus repair rehabilitation amongst AOSSM members

Objectives: Meniscus repair has correspondingly become more popular, with promise of preservation of joint mechanics and hopes of preventing secondary arthritis. However, it is not clear the optimal rehabilitation protocol, with regards to the duration of limitation of range of motion and weight bearing, following repair of various meniscal tear types. The purpose of this study is to understand the current contextual landscape of how practitioners recommend rehabilitating patients that undergo meniscal repair. Methods: This is a cross-section observational survey study. A de-identified survey was designed using arthroscopic images from six cases of meniscal repair (Fig 1): Radial tear at popliteal hiatus, medial meniscus posterior root repair, lateral meniscus radial tear, lateral meniscus horizontal tear, medial meniscus red-white zone bucket-handle repair, and medial meniscus red-red zone longitudinal peripheral tear. This survey was distributed to American Orthopaedic Society for Sports Medicine (AOSSM) members by e-mail. Questions were designed to elicit, from the surveyed surgeons, their recommendations for duration of limitation of: 1. range of motion, and 2. weight bearing status, for each case. Additionally, use of meniscal repair adjuncts, including bracing and use of biologics, was elicited from the same cohort. Results: 451 completed surveys were obtained from 2973 AOSSM members (15.2%). A majority of AOSSM members recommend bracing after repair of tears that lost hoop integrity (83.3%) and that had intact hoop integrity (76.0%). A majority of members report routine use of synovial rasping/trephination (86.0%) and notch microfracture (66.5%), while a minority report use of more involved biologic supplementations including classic fibrin clot (4.9%), platelet-rich plasma (8.9%), and bone marrow aspirate concentrate (2.9%). Timing of return to weight-bearing and range of motion appear to depend on hoop stress integrity; tears with intact hoop integrity were, on average, permitted to return to weight bearing more quickly (1.4 weeks for partial weight bearing, 3.6 weeks for full weight bearing), versus tears that demonstrated loss of hoop integrity (3.9 weeks for partial weight bearing, 6.2 weeks for full weight bearing). Hoop integrity also appears to affect return to full range of motion, with tears that had a loss of hoop integrity demonstrating a longer period of post-operative restriction of range of motion. Full flexion was permitted at an average of 5.0 weeks for tears with intact hoop stress, versus 5.8 weeks for tears with loss of hoop stress. Out of the six cases presented, the most cautious tear types for post- repair rehabilitation were a radial tear at the popliteal hiatus, followed by a medial meniscus posterior root tear. Conclusions: Although there is no consensus on how each tear type should be rehabilitated following repair, initial tear hoop stress integrity appears to substantially affect rehabilitation decision-making, with loss of hoop stresses triggering a more conservative approach to rehabilitation, both with regards to permissive return to range of motion and weight bearing. A majority of AOSSM practitioners brace after meniscal repair. A majority of practitioners perform in situ adjuncts for biological healing, while a minority adds extrinsic biologics. [Table: see text]

Poster 378: The Availability and Price of Orthobiologic Injections in the Chicagoland Area: A Market Assessment Study

Objectives: Orthobiologic therapies have recently gained popularity in orthopaedic surgery as potential treatment options that can be used to manage the symptoms of musculoskeletal conditions. However, the market for these products remains unregulated by the Food and Drug Administration (FDA), giving rise to a wide range of available yet untested products. There are growing concerns related to patient safety and product efficacy, but also in regard to the amount of money being charged by providers for these treatments Thus, the purpose of this study was to investigate the current market for orthobiologic injections for knee osteoarthritis in a large, metropolitan city and determine 1) the willingness of providers to disclose the cost of an injection prior to an appointment; 2) the cost of injections if disclosed; 3) the cellular source of injections being advertised as “stem cell” products; and 4) whether there are differences in the market for orthobiologics within and outside of orthopaedic sports medicine practices. Methods: Orthopaedic sports medicine providers in the Chicagoland area were identified through the American Orthopaedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA) registries of sports medicine physicians seeing patients in at least one location within the Chicagoland area. Non orthopaedic clinics (including chiropractors, pain management physicians, and self-advertised “regenerative medicine” clinics) offering orthobiologic injections were compiled using Yelp! and Google search for listings and reviews containing the following key words: “PRP” or “platelet-rich plasma” or “platelet rich plasma,” “SCT” or “stem cells” or “amniotic tissue injections” or “adipose stem cell injections,” and “BMAC” or “bone marrow aspirate concentrate.” A single author [BLINDED] contacted every clinic via a common telephone script, which was modified from an existing study. Data was collected for each site on the types of injections offered, whether price was disclosed over the phone, the price of injections offered, and the source of alternative “stem cell” injections if they were provided. Prices were explicitly specified as being for one injection of one joint. Results: A total of 25 orthopaedic sports medicine practices (comprising 80 AOSSM/AANA surgeons) and 40 non orthopaedic clinics offered at least one of either PRP, “stem cell,” and/or BMAC injections over the phone (Table 1). There was no difference in the likelihood of providing PRP injections (p = 0.698) or BMAC injections (p = 0.340). However, non orthopaedic clinics were significantly more likely to offer “stem cell” injections (p &lt; 0.001). There was no difference in the willingness to disclose the price of PRP without an appointment (p = 0.269), willingness to disclose the price of “stem cell” injections (p = 0.302), willingness to disclose price of BMAC (p = 0.528), or willingness to disclose the source of what each clinic advertised as “stem cell” injections (p = 0.302). While the average price of a BMAC injection was not different between provider types (p = 0.238), the average price of a single PRP injection was significantly higher (p = 0.011) and significantly more variable (F statistic = 0.139; p &lt; 0.001) at non orthopaedic clinics (Figure 1). Similarly, the average price of a single “stem cell” injection was significantly higher (p &lt; 0.001) and significantly more variable (F statistic = 0.080; p = 0.025) at non orthopaedic clinics. Most commonly, alternative “stem cell” products included amniotic-based injections, which are currently discouraged for distribution or use based upon the most recent FDA guidance document. Conclusions: When compared to orthopaedic sports medicine providers, non orthopaedic clinics providing orthobiologic treatments in the Chicagoland area are more likely to offer alternative “stem cell” injections and charge a significantly greater and more variable amount per PRP and “stem cell” injection. Unfortunately, there was liberal use of the terms “regenerative medicine” and “stem cell” therapies in the face of increased scrutiny related to the FDA’s current position on cell-based therapies. Future studies should examine these trends on a national scale to assess compliance with FDA regulations on orthobiologics, as well as establish standards of price for these treatments. [Table: see text]

Gender Disparities Among Professional Team Sports Medicine Physicians.

Although recent trends from the Accreditation Council for Graduate Medical Education (ACGME) present encouraging growth of female representation in sports medicine, the field is still lagging behind other specialties. This study investigates gender disparities among physicians providing care for professional sports teams in male and female sports leagues. Information regarding physicians providing sports medicine care to professional teams obtained by database queries (May 2021). Chi-square analysis compared gender data of orthopaedic team physicians with American Orthopaedic Society for Sports Medicine (AOSSM) and American Academy of Orthopaedic Surgeons (AAOS) membership, residency, and fellowship census data. Primary care sports medicine physicians were compared with American Medical Society for Sports Medicine (AMSSM) and primary-care sports medicine fellowship census data. Professional sports health care. Professional league physicians. None. Gender, residency, and fellowship training of professional league physicians. Among a total of 608 team physicians, 572 (93.5%) were male and 40 (6.5%) were female. Orthopedic surgeons comprised 64.7% of the physicians. Fourteen (3.6%) team orthopedic surgeons were female. Thirty-five percent of team physicians were primary care sports medicine physicians. Twenty-six primary care sports medicine physicians (11.6%) were female. Orthopaedic female team physician representation overall was comparable with AOSSM and AAOS membership but significantly less than orthopaedic surgery residents and sports medicine fellows ( P < 0.01). Women's National Basketball Association orthopaedic team physicians were more represented than female membership among AOSSM, AAOS, and orthopaedic sports medicine fellows ( P < 0.01). Except for the WNBA, Premiere Hockey Federation, National Women's Soccer League, and United States Football League, female primary care sports medicine physicians were underrepresented in professional sports compared with AMSSM membership and primary care sports fellows ( P < 0.01). Overall, female representation is poor among orthopaedic surgeons and primary care physicians providing sports medicine care to professional teams. Leagues encompassing female athletes tend to have better representation of female physicians. IV.

Return to Sport After Primary Anterior Cruciate Ligament (ACL) Reconstruction: A Survey of The American Orthopaedic Society for Sports Medicine.

Anterior cruciate ligament (ACL) tears are a common sports injury, and typically require a prolonged post-operative rehabilitation. The purpose of this study was to survey members of the American Orthopaedic Society for Sports Medicine (AOSSM) to determine their return to sport (RTS) criteria after primary ACL reconstruction (ACLR). A 23-question, anonymous survey hosted through Google® Docs was distributed electronically to AOSSM members. This survey included questions regarding the timing, as well as any functional tests or other metrics used to determine when an athlete is ready to RTS. A total of 863 surgeons responded over four months. The most popular graft choice was bone patellar tendon bone autograft (63%). For non-pivoting sports, 43% of respondents allowed RTS at five to six months, while 31% allowed RTS at seven to eight months. For pivoting sports, 34% of respondents allowed RTS at seven to eight months, while 36% allowed RTS at nine to ten months. The most common criteria for return to non-pivoting sports include full knee motion (89%) and time after ACLR (76%). The most common criteria for return to pivoting sports include full knee motion (87%) and passing a hop test (80%). Only 21% of respondents assessed for psychological readiness to RTS. RTS occurred sooner in non-pivoting than pivoting sports, with similar RTS criteria in both groups. Most respondents did not assess for psychological readiness to RTS.

Evaluation of Social Media and Online Utilization Among Members of the American Orthopaedic Society for Sports Medicine: Implications in Practice.

Social media has the potential to act as an avenue for patient recruitment, patient and surgeon education, and expansion of the physician-patient relationship. To evaluate the existing social media presence among members of the American Orthopaedic Society for Sports Medicine (AOSSM) to describe trends in different subgroups within the membership. Cross-sectional study. The AOSSM database was queried for a complete membership list. Members were excluded from analysis if they were not orthopaedic sports medicine surgeons practicing in the United States. Demographic characteristics, online media profiles, and levels of online presence were evaluated, and an online media presence score was calculated. Bivariate analysis was performed to compare demographic variables and levels of online presence. A total of 2870 surgeons were included in the analysis. LinkedIn was the most used platform (56%), while YouTube was the least used (10%). Surgeons in academic practice had a significantly greater overall social media presence than their private practice counterparts. Female surgeons had a more significant active online presence on Twitter, Instagram, and Facebook than male surgeons. Surgeons practicing in the Northeast had a greater social media presence than those in any other United States region, and surgeons in the earlier stages of practice (0-14 years) were more likely to utilize social media than their more senior colleagues (≥15 years of practice). On multivariate analysis, surgeons in the earlier stages of practice were more likely to have active Twitter, Instagram, and Facebook accounts, and female surgeons were more likely to have an active Facebook account. Additionally, multivariate analysis revealed that a greater number of ResearchGate publications were associated with male sex and having an academic practice. Comparatively, active Twitter and Instagram use was associated with having an academic practice. The most used platform in this surgeon population was LinkedIn. Orthopaedic surgeons in academic practice, female surgeons, those early in their career, and those practicing in the Northeast highlighted a subset of the sports medicine community who were more likely to have an active online presence compared to the rest of the AOSSM.

Prospective evaluation of sport activity and the development of femoroacetabular impingement in the adolescent hip (PREVIEW): results of the pilot study

BackgroundThe purpose of this pilot study was to validate the feasibility of a definitive study aimed at determining if high-intensity physical activity during adolescence impacts the development of femoroacetabular impingement (FAI).MethodsThis prospective cohort pilot study had a sample size target of 50 volunteers between 12 and 14 years old at sites in Canada, South Korea, and the Netherlands. Participants were evaluated clinically and radiographically at baseline and at 2 years. The participants’ sport and physical activity were evaluated using the Habitual Activity Estimation Scale (HAES) and the American Orthopaedic Society for Sports Medicine (AOSSM) criteria for sport specialization. The primary outcome was feasibility and secondary outcomes included the incidence of radiographic FAI and hip range of motion, function (Hip Outcome Score, HOS), and quality of life (Pediatric Quality of Life questionnaire, PedsQL) at 24 months. Study groups were defined at the completion of follow-up, given the changes in participant activity levels over time.ResultsOf the 54 participants enrolled, there were 36 (33% female) included in the final analysis. At baseline, those classified as highly active and played at least one organized sport had a higher incidence of asymptomatic radiographic FAI markers (from 6/32, 18.8% at baseline to 19/32, 59.4% at 24 months) compared to those classified as low activity (1/4, 25% maintained at baseline and 24 months). The incidence of radiographic FAI markers was higher among sport specialists (12/19, 63.2%) compared to non-sport specialists (8/17, 47.1%) at 24 months. The HOS and PedsQL scores were slightly higher (better) among those that were highly active and played a sport compared to those who did not at 2 years (mean difference (95% confidence interval): HOS-ADL subscale 4.56 (− 7.57, 16.70); HOS-Sport subscale 5.97 (− 6.91, 18.84); PedsQL Physical Function 7.42 (− 0.79, 15.64); PedsQL Psychosocial Health Summary 6.51 (− 5.75, 18.77)).ConclusionOur pilot study demonstrated some feasibility for a larger scale, definitive cohort study. The preliminary descriptive data suggest that adolescents engaged in higher levels of activity in sports may have a higher risk of developing asymptomatic hip deformities related to FAI but also better quality of life over the 2-year study period.

There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopaedic Surgeons

To identify the clinical practice preferences of orthopaedic surgeons regarding anterior cruciate ligament reconstruction (ACLR) rehabilitation through a survey of members of the Arthroscopy Association of North American (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM). An online survey was distributed to members of AANA and AOSSM between November 2020 and September 2021. Participants reported on their clinical preferences for ACLR protocol development and patient selection, use of technology in ACLR recovery and rehabilitation, and preferences for advancing through multiple phases of the rehabilitative process. Responses from 46 orthopaedic surgeons were analyzed. Patient-reported outcome measures were not found to be utilized often at various phases of the perioperative period. Thirty-eight (82.6%) participants reported utilization of postoperative bracing. There was no consensus on when participants allow their patients to advance through rehabilitation, but most report waiting 3 to 4 months for advancement to jogging/lateral movement, 6 to 8 months for return to noncontact sport, and 9 months of more for return to unrestricted sport. Many participants utilize functional and strength testing with associated limb symmetry indices to determine patient readiness to return to sport, with 18, 26, and 25 participants reporting use of functional testing and 28, 26, and 27 participants reporting use of strength testing at the return to jogging/lateral movements, noncontact return to sport, and unrestricted return-to-sport phases, respectively. This study provides an insight into the rehabilitative protocols and modalities utilized for ACLR by orthopaedic surgeons in practice across the United States. There is notably substantial variation in rehabilitative patterns and preferences, particularly with regards to what constitutes criteria for progressing patients through the phases of returning to unrestricted sport. Additionally, our findings show that while many surgeons believe that quantitative assessment technology could be beneficial in decision-making for returning patients to sport, there are still many barriers that stand in the way of its implementation into clinical practice. Postoperative rehabilitative protocols after ACLR vary by surgeon.

Virtual Interviews for Sports Medicine Fellowship Positions Save Time and Money but Don’t Replace In-Person Meetings

PurposeTo understand the perceptions of program directors (PDs) and fellowship applicants regarding the virtual interview process for orthopaedic surgery sports medicine fellowship programs.MethodsAn anonymous online survey was distributed through the American Orthopaedic Society for Sports Medicine (AOSSM) to applicants and PDs of orthopaedic surgery sports medicine fellowship programs following the 2020-2021 fellowship application cycle.ResultsA total of 40 responses were received from PDs for a response rate of 47% (40 of 85) and 72 responses were received from applicants for a response rate of 27% (72 of 271). All of the surveyed PDs (40/40, 100%) agreed/strongly agreed that the applicant’s interview carries significant weight in determining where an applicant is ranked on the match list. Fifty-eight percent (23 of 40) of PDs agreed/strongly agreed that virtual interviews negatively affected their personal connection with the fellowship interviewee. The presence of virtual interviews allowed 80% (57 of 71) of applicants to go on more interviews. Seventy-three percent (51 of 70) of applicants were able to save greater than $5,000 on travel expenses and 63% (25 of 40) of fellowship programs were able to save greater than $2,500 by conducting virtual interviews.ConclusionsVirtual interviews allowed fellowship programs and applicants to complete more interviews, but both PDs and applicants stated that interviewing in-person was important for applicants to meet faculty and tour the institution where they may be spending a year. In contrast, significant financial savings resulted due to the transition to virtual interviews. Finally, both PDs and applicants were in favor of having the option of interviewing virtually, suggesting that virtual interviews may continue to play a role in future application cycles.Clinical RelevanceThis study may be valuable to fellowship programs that will continue to implement virtual interviews into future application cycles.

How Are Orthopaedic Sports Medicine Physicians Triaging Cases and Using Telehealth in Response to COVID-19? A Survey of AOSSM Membership.

Background:The COVID-19 pandemic has changed the practice of orthopaedic sports medicine. The threat of COVID-19 persists, and future restrictions to elective procedures are possible. It is important to understand how sports surgeons are prioritizing surgical cases during elective case restrictions and how telehealth is being incorporated into practice.Purpose:To understand how orthopaedic sports surgeons have triaged surgical sports cases and how telehealth is being utilized in response to COVID-19.Study Design:Cross-sectional study.Methods:A survey was presented to participants of the American Orthopaedic Society for Sports Medicine (AOSSM) webinar “Handling Sports and COVID-19” and distributed through email to all members of the AOSSM. The survey consisted of 25 questions with 3 sections: demographics, clinical practice, and telehealth. Descriptive statistics were performed.Results:Overall, 104 respondents participated. Respondents varied with respect to their location, type of clinical practice, and years in practice. The cases with the highest priority during triage included infections, fractures, and traumatic tendon ruptures (eg, quadriceps tendon). Before COVID-19, <14.0% of surgeons used telehealth, and 76.7% had never used telehealth. Now, however, 81.4% of respondents plan to use telehealth at least once a week in their practice. Respondents indicated postoperative visits and return patients as the most appropriate for telehealth. The majority felt that telehealth was not appropriate for new shoulder (65.9%) or knee (55.6%) evaluation. The leading barriers to telehealth use that were identified included, in decreasing order, concerns about clinical appropriateness, accuracy of physical examination, billing/reimbursement, and medicolegal concerns.Conclusion:Telehealth has seen rapid adoption during the COVID-19 pandemic, and the majority of respondents plan to continue using it. It is being used more for established patients rather than new patient visits. For surgical cases, there was a clear triage priority of sports medicine cases, including infections, fractures, and traumatic tendon ruptures. Lower extremity cases had higher priority than upper extremity.

Sex-Specific Analysis Is Lacking in Abstracts Presented at Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Annual Meetings From 2016 to 2019

PurposeTo evaluate the presence of sex-specific analysis (SSA) in abstracts accepted for podium presentation at the Arthroscopy Association of North America (AANA) and American Orthopaedic Society for Sports Medicine (AOSSM) annual meetings from 2016 to 2019.Methodss accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019 were selected for review. Studies that included sex as a variable in a multifactorial statistical model were considered to have performed adequate SSA. Secondary data collected included whether the abstract had a female lead or senior author, the degrees of the female authors, and the anatomic focuses of studies with SSA.ResultsOf the 891 total abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019, 90 (10%) included SSA. There were 284 AANA abstracts, 24 (8%) of which reported SSA. Of the 607 AOSSM abstracts, 66 (11%) reported SSA. There were 43 female first authors (15%) and 33 female senior authors (12%) of the AANA abstracts compared with 92 female first authors (15%) and 39 female senior authors (6%) of the AOSSM abstracts. Of the 891 total abstracts, 135 (15%) listed a female lead author and 72 (8%) had a female senior author. Of the 135 female first authors, 92 (68%) had an M.D., whereas 40 of the 72 female senior authors (56%) had an M.D. Analysis of all abstracts combined showed a positive correlation between SSA and a female first author (Pearson correlation coefficient = 0.035, P = .147), as well as between SSA and a female senior author (Pearson correlation coefficient = 0.052, P = .059).ConclusionsFrom 2016 to 2019, only 10% of abstracts accepted for podium presentation at the AANA and AOSSM annual meetings included SSA. Altogether, women represented 15% of first authors and 8% of senior authors.Clinical RelevanceThis study highlights the low percentage of SSA in abstracts presented at the AANA and AOSSM annual meetings from 2016 to 2019. Future studies should attempt to perform SSA when relevant to better evaluate differences in outcomes between male and female patients.

An update on graft-tunnel mismatch in anterior cruciate ligament reconstruction: A survey of the experts in the field of orthopedic sports medicine demonstrates no clear consensus in management

BackgroundThe purpose of this study was to identify and report on the rate at which leaders in orthopaedic surgery are encountering GTM, their treatment methods and to identify whether these clinicians’ demographics or techniques correlate with their GTM incidence and/or treatment algorithms. MethodsA survey was sent to identify the rate at which member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM), the National Football League Physicians Society (NFLPS), and the Herodicus Society are encountering GTM in ACL reconstruction with BTB graft and to establish what methods are most commonly utilized. ResultsIn total, 260 orthopaedic surgeons completed the survey. Respondents most frequently reported GTM in 1–5% of cases, with GTM most often between 5 and 10 mm. For lower levels of GTM, surgeons are most frequently recessing the femoral bone plug and adding a cortical suspensory device or outside–in fixation. Higher degrees of GTM are most commonly supplemented with a screw/post on the tibia. Those with >15 years of experience were more commonly using a transtibial femoral drilling with lower tibial tunnel angulation, and lower incidences of GTM than their less experienced counterparts. ConclusionThere is tremendous variability in the incidence and management of GTM in ACL reconstruction with BTB graft with no clear consensus among experts. Differences are seen in ACL reconstruction techniques and means of correcting GTM when evaluating based on years of surgical experience and Sports Medicine Fellowship completion.

Female Team Physician Representation in Professional and Collegiate Athletics

Background: Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized. Purpose: To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM). Study Design: Cross-sectional study. Methods: Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally. Results: Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons (P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women’s National Basketball Association (31.3%). Conclusion: Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.

Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process

Objectives: Treatment algorithms for the arthroscopic management of femoroacetabular impingement syndrome (FAI) remain controversial due to a paucity of evidence-based guidance. Consequently, significant variability in clinical practice exists between different practitioners, necessitating expert consensus. The purpose of this study is to establish Best Practice Guidelines (BPG) using formal techniques of consensus building among a group of experienced hip arthroscopists driven by the results of a systematic review and meta-analysis. The scope of these guidelines includes preoperative recommendations, intraoperative practices, and postoperative protocols. Methods: The validated Delphi process and nominal group technique (NGT), utilized by the Centers for Disease Control and peer-reviewed orthopedic literature, were used to formally derive consensus among 15 surgeons in North America. Participants were surveyed for current practices, presented with the results of a meta-analysis and systematic literature review, and asked to vote for or against inclusion of non-leading, impartially-phrased items during three iterative rounds while preserving the anonymity of participants’ opinions. Agreement greater than 80% was considered consensus, and items near consensus (70%-80% agreement) were further queried using the NGT in a moderated group session at the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting. Results: Participants had a mean of 12.3 years of practice (range: 1-29 years) and performed an annual mean of 249 (range 100 to 500+) hip arthroscopies, with a combined total of approximately 52,580 procedures. Consensus was reached for the creation of BPG consisting of 27 preoperative recommendations, 15 intraoperative practices, and 10 postoperative protocols. The final checklist was supported by 100% of participants. Conclusion: We developed the first national consensus-based Best Practice Guidelines for the surgical and nonsurgical management of FAI. The resulting consensus items can serve as a tool to reduce the variability in pre-, intra-, and postoperative practices and guide further research for arthroscopic management of FAI.

Defining the Critical Elements of the Most Common Arthroscopic Procedures: A Consensus of Orthopaedic Sports Medicine Surgeons.

ObjectiveTo define the critical elements of common procedures in arthroscopic surgery.MethodsA survey was administered to surgeons associated with the American Orthopaedic Society for Sports Medicine (AOSSM) to determine the critical elements for four common arthroscopic procedures: anterior cruciate ligament (ACL) reconstruction, knee arthroscopy with meniscal debridement or repair, rotator cuff repair (RCR), and capsulorrhaphy for anterior glenohumeral instability (Bankart repair). Respondents were asked which steps necessitated their direct supervision. The level of experience and practice demographics were also recorded.ResultsFor all applicable procedures, patient positioning and closure were not considered critical steps. Establishing arthroscopic portals was critical for all procedures, except knee arthroscopy. Diagnostic arthroscopy was only critical in ACL reconstruction. Private practice surgeons considered every step of these common procedures to be critical elements. Less experienced surgeons were more likely to regard certain aspects of a procedure critical. Surgeons with >15 years of experience considered diagnostic arthroscopy critical to all procedures, whereas those with <15 years of experience did not. Unlike surgeons with a resident as first assist, surgeons with a physician assistant (PA) or nurse practitioner (NP) found every step of each procedure to be critical except closure and positioning.ConclusionAcross all procedures, only patient positioning and closure were consistently regarded as non-critical elements. There were significant differences in responses according to experience and practice setting. Future research is necessary to determine the implications of these findings and guide the definition of the “critical portions” of surgery.

A Closer Look at the Relationship Between Industry and Orthopaedic Sports Medicine Surgeons

Background:A recent study demonstrated that discrepancies exist between disclosures reported by authors publishing in The American Journal of Sports Medicine and disclosures listed in the Physician Payments Sunshine Act–initiated Open Payments database, managed by the Centers for Medicare & Medicaid Services (CMS). However, no study to date has explored the relationship between the biopharmaceutical and device industry (industry) and the membership base of the American Orthopaedic Society for Sports Medicine (AOSSM).Purpose:To critically examine the relationship between orthopaedic sports medicine surgeons and industry.Study Design:Cross-sectional study.Methods:The publicly available CMS Open Payments database website was accessed to search for sports medicine orthopaedic surgeons in the United States who were members of the AOSSM. Financial data, specifically general, research, and ownership payments for 2015, were recorded for each surgeon. The American Academy of Orthopaedic Surgeons (AAOS) disclosures of each surgeon were then obtained. Descriptive statistics and simple proportions were calculated to summarize the collected data, including years in practice and amount of payment. Median values for general payments were compared to provide a more accurate reflection of payments transferred to a “typical” sports medicine surgeon.Results:A total of $58,113,561 in general payments, $3,996,051 in research payments, $72,481,814 in money invested, and $144,552,383 in interest earned from money invested were identified as being paid to 2274 surgeons (all amounts in US$). The distribution of total general payments received was skewed: 10% of surgeons received 95.4% ($55,463,183) of the total general payments. A total of 1433 surgeons had completed, up-to-date AAOS disclosures. Although 44% (635 surgeons) self-reported no financial conflict to the AAOS, the Open Payments database indicated some level of industry support to these surgeons. Unreported general payments totaled $1,393,212, or a median of $561 per surgeon (interquartile range, $10-$200,048).Conclusion:Although orthopaedic sports medicine surgeons received substantial payments from industry, most of the total general payments were given to a small proportion of people. The regional distribution of these payments did not differ significantly. Summary reports of data are largely skewed by outliers and should be interpreted with caution. However, a large percentage of these surgeons failed to reveal industry support of any kind in their AAOS disclosures, including meals and educational funding, demonstrating the importance of transparency and accuracy when completing financial disclosures.