Arthroscopy Association Of North America Research Articles

Capsular Management at the Time of Hip Arthroscopy for Femoroacetabular Impingement Syndrome Varies With Geography and Surgeon Subspecialty Training: A Cross-Sectional, Multinational Surgeon Survey

PurposeTo perform a multi-national survey and identify patterns in capsular management at the time of hip arthroscopy. MethodsAn anonymous, non-validated survey was distributed by the American Orthopedic Society for Sports Medicine, Arthroscopy Association of North America, European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, International Society for Hip Arthroscopy, and Turkish Society of Sports Traumatology, Arthroscopy, and Knee Surgery. Questions were broken down into 6 categories: demographics, capsulotomy preference, traction stitches, capsular closure, postoperative rehabilitation, and postoperative complications. ResultsThe survey was completed by 157 surgeons. Surgeons who used a half or full T-type capsulotomy had 2.4 higher odds of using traction sutures for managing both the peripheral and central compartment during hip arthroscopy for femoroacetabular impingement (FAIS) (p=0.024). Surgeons who felt that there was sufficient literature regarding the importance of hip capsule closure had 1.9 higher odds of routinely performing complete closure of the capsule (p=0.044). Additionally, surgeons who practiced in the United States had 8.1 higher odds of routinely closing the capsule relative to international surgeons (p<0.001). Moreover, those who received hip arthroscopy training in residency or fellowship had 2.4 higher odds of closing the capsule completely compared to surgeons who did not have exposure to hip arthroscopy during their training (p=0.009). ConclusionGeographic and surgeon-related variables correlate to capsular management preferences during hip arthroscopy. Surgeons who utilized a half or full T-capsulotomy more often utilized traction stitches for managing both the peripheral and central compartment. Surgeons performing routine capsular closure are more likely to believe that sufficient evidence is available to support the practice, with surgeons in the United States more likely to perform routine capsular closure in comparison to their international colleagues.

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.

Perceptions and Opinions on Cannabidiol in the Orthopaedic Sports Medicine Community.

Cannabidiol (CBD) is a known pain modulator that is garnering increased attention in the orthopaedic world. There may be a considerable knowledge gap among orthopaedic sports medicine providers and their perception of its therapeutic value. To (1) examine the knowledge and beliefs of sports medicine orthopaedic providers with respect to CBD, (2) deliver an educational component, and (3) elucidate potential barriers to its widespread application. Cross-sectional study. A 3-component, 25-question online survey was distributed to members of the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America between July and October 2022. The first 20 questions assessed baseline knowledge and opinions regarding CBD, followed by an educational component, and then 5 questions assessing whether the respondents' opinions had changed after learning more about CBD. Responses were compared according to age, practice setting, and state's cannabinoid legalization status using the chi-square test, and changes in opinions from before to after the educational component were compared using the paired t test. There were 101 survey responses, for a response rate of approximately 1%. Most respondents believed that there is a role for CBD in postoperative pain management (76%), acute pain and inflammation after an injury (62%), and chronic pain (94%). Most respondents admitted that they were not knowledgeable about the mechanism of action (89%) or their state's laws (66%) concerning CBD. A minority (25%) believed that CBD has psychoactive properties. While most respondents (76%) did not believe that they would be stigmatized if they were to suggest CBD to a patient, only 48% had ever suggested CBD. Notably, 94% of respondents had encountered patients who reported trying CBD to treat pain. After reading the fact sheet, 51% of respondents stated that their opinion on CBD had changed, and 63% felt inclined to investigate the topic further. Most survey respondents believed that CBD has a role in postoperative and chronic pain management. Although there was a relative familiarity with CBD, there was a knowledge gap, suggesting that increased attention, education, and research are necessary.

Poster 388: Gender Diversity of Orthopaedic Sports Medicine Fellowship Trainees, Faculty and Leadership

Objectives: Orthopaedic surgery has remained the most male-dominated field in medicine, despite recent efforts to recruit and retain more women. The objective of this study was to determine the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete analysis of gender diversity within this subspecialty. Methods: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America (AANA) fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows and fellows who graduated within the last five years. Results: In the academic year 2021-2022, 132 sports medicine fellows were in fellowship training in the United States within 97 programs. Of these, 113 (85.6%) were men and 19 (14.4%) were women (p&lt;0.001). Within the past five years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (p&lt;0.001). There is no significant difference in the gender composition of current fellows compared to the composition of fellows within the last 5 years (p=0.74). When examining gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (p&lt;0.001). There are 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program directors or assistant program directors) compared to 83 men in such positions (85.6%) (p&lt;0.001). Conclusions: Orthopaedic sports medicine fellowships remain heavily male-dominated in their trainees, faculty, and leadership. There was no significant difference in the gender composition of current fellows when compared to those who graduated in the last five years, suggesting further and novel initiatives are needed to enhance gender diversity in sports medicine. [Table: see text][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]

Poster 193: Glenoid Bone Loss Evaluation: Utilization of Current Methods

Objectives: Preoperative evaluation of glenoid bone loss is essential in surgical planning and for patients’ expectations of their surgical outcome. The four literature backed methods for measuring glenoid bone loss include the chord method, percent diameter method, the intraoperative probe method, and Pico method. Using the intraoperative probe method, it has been suggested that 25% bone loss of the inferior glenoid may be the threshold of significant bone loss. In contrast, other studies show bone loss using percent diameter above 13.5-17.3% has been associated with significantly worse clinical outcomes. Differences in bone loss measurements method utilization can lead orthopedic surgeons to proceeding with soft-tissue stabilization in a high-risk patient or alternatively to an unnecessary osseous augmentation procedure. Therefore, it is important to understand how orthopedic surgeons measure bone loss. While 3D CT and the Pico method have been previously described as the gold standard in bone loss evaluation for their highest accuracy and interobserver reliability, it is unclear how most orthopedic surgeons evaluate for bone loss in their practice. The purpose of this study is to investigate how orthopedic surgeons measure glenoid bone loss. Methods: Based on existing literature, a 16-question survey was created by the senior author. This survey included questions investigating participants’ demographic information, typical surgical practice and volume, and glenoid bone loss identification method. The survey was sent out to members of the American Orthopedic Society for Sports Medicine (AOSSM) and Arthroscopy Association of North America (AANA). Results: One-hundred-seventy-two orthopedic surgeons responded to the survey with an average of 13.4 years in practice and average number of instability surgeries performed each year of 31.2 +/- 35. In regard to subspecialty, 137 participants completed a sports medicine fellowship, 18 completed a shoulder and elbow fellowship, 10 completed both a sports medicine and shoulder and elbow fellowship, 1 completed a sports medicine and pediatric sports medicine fellowship, and 1 completed a sports medicine and trauma fellowship (97% response rate). Responders were from a variety of geographic locations: 26% were from the Northeast, 30% were from the Midwest, 21% were from the South, 10% were from Mountain States, 10% were from the West Coast, 1 was from Hawaii, 1 was from Alaska, 1 was from Columbia, and 1 practiced in Italy (98% response rate). 46% of responders belong to a private practice, while 34% practice at an academic institution. An additional 16% reported a hospital- based practice, 2% reported military affiliation, and 2% work in a private practice with academic affiliations (99% response rate). 91.3% of responders said that they routinely measure glenoid bone loss. 3D CT was the imaging modality most commonly used for bone loss evaluation (125), followed by 2D MRI (86), X-rays (68), 2D CT (60), and 3D MRI (11) (Figure 1). The frequency of four common bone loss evaluation methods were analyzed: percent diameter loss was the most commonly used and was used routinely, the intraoperative probe length method was used occasionally, Pico method was used rarely, and the chord length method was used never (Figure 2). There was no significant effect of time in practice, practice location, and fellowship training on bone loss methods. Those in private practice or a medical group setting had a higher frequency of using the intraoperative probe length method. Conclusions: The result of this study suggests that there is significant inconsistency in how orthopedic surgeons evaluate and measure glenoid bone loss in the setting of shoulder instability. While physicians commonly use the most reliable imaging modality (3D CT), the most accurate literature backed method for evaluating bone loss (Pico method) is seldom used. Future research is necessary to understand the limiting factor for orthopedic surgeons to incorporate validated glenoid bone loss measurements into their practice and develop new automated methods to improve overall utilization.

Diversity in Orthopaedic Sports Medicine Societies

The purpose of this study was to report demographic trends in terms of ethnicity/race and gender among the membership and leadership positions of the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society of Sports Medicine (AOSSM). Over the years both AANA and AOSSM will increase in diversity through their committee membership and leadership positions. AANA and AOSSM membership and leadership were reviewed for the years 2010, 2015, and 2020. Race/ethnicity was divided into Caucasian, Asian, African American (AA), Hispanic/Latin/South American (HLSA), and Middle Eastern (ME). Gender was limited to male or female, based on name and photographic depiction. Diversity in AANA and AOSSM committee and leadership positions is summarized in Table1 and Table2, respectively. In 2010, 166/191 (87%) AANA committee members were Caucasian, as compared with 125/186 (67%) in 2020. Asian committee members were similar in 2010 (13/191, 7%) and 2015 (13/216, 6%) but increased to 17/186 (10%) in 2020. HLSA committee members increased from 5/191 (3%) 2010 to 11/186 (6%) in 2020. AA committee membership increased from 2/191 (1%) in 2010 to 5/186 (3%) in 2020. The diversity of AANA Board of Director leadership positions increased, with Caucasian representation decreasing from 14/14 (100%) 2010 to 11/12 (92%) in 2020 and Asian representation increasing from 0% in 2010 to 1/12 (8%) in 2020, with HLSA, AA and ME remaining the same with 0/12 (0%). In AANA, men comprised 181/191 (95%) committee members in 2010 and 166/186 (89%) in 2020. The percentage of female committee members increased from 10/191 (5%) in 2010 to 20/186 (11%) in 2020. In 2010, 73/79 (92%) AOSSM committee members were Caucasian compared to 62/81 (77%) in 2020 with AA having the largest increase in committee members from 0% in 2010 to 6/81 (7%) in 2020 (Table2). Within AOSSM, men comprised 73/79 (92%) committee members in 2010 and 70/81 (86%) in 2020. The percentage of female committee members in AOSSM increased from 6/79 (8%) in 2010 to 11/81 (14%) in2020. There has been a progressive trend toward increasing diversity in both committee membership and leadership positions in AANA and AOSSM from 2010 to 2020. Within AANA, there has been a decrease in the Caucasian representation from 87% in 2010 to 67% in 2020 and an increase in the female representation from 5% in 2010 to 11% in 2020. AOSSM demonstrated a similar trend, with Caucasian representation decreasing from 92% in 2010 to 77% in 2020, in addition to female percentage increasing from 8% in 2010 to 14% in 2020. Although there has been an increase in representation of minority and female orthopaedic surgeons within both societies, there is still room for more diversity and inclusion within committee membership and leadership. It is important to progress toward the understanding of the changes that need to be made and work to implement opening the field of orthopaedic sports medicine.

Persistent Lack of Female Orthopaedic Sports Medicine Fellows

PurposeThe purpose of this study was to evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete analysis of gender diversity within this subspecialty. MethodsOfficial program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America (AANA) fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last five years. ResultsOf the 132 orthopaedic sports medicine fellows in training in the United States in the 2021-2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (p<0.001). Within the past five years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (p<0.001). There was no significant difference in the gender composition of current fellows compared to the composition of fellows within the last 5 years (p=0.74). When examining gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (p<0.001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared to 83 men in such positions (85.6%) (p<0.001) ConclusionsOrthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared to those who graduated in the last five years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine.

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

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

Increasing Patient Age, Ambulatory Surgery Center Setting, and Surgeon Experience Are Associated With Shorter Operative Duration for Anterior Cruciate Ligament Reconstruction

PurposeTo identify variables associated with operative duration and intraoperative or perioperative complications after primary anterior cruciate ligament reconstruction (ACLR).MethodsSurgeons who performed a minimum of 20 arthroscopic cases per month were recruited for participation through the Arthroscopy Association of North America from 2011 through 2013. All participants agreed to voluntarily submit data for 6 months of consecutive knee and shoulder arthroscopy cases. Only subjects coded for ACLR were analyzed, whereas revision cases were excluded. ACLRs were subdivided into isolated ACLR, ACLR with minor concomitant procedures, and ACLR with major concomitant procedures. Patient, surgeon, and surgical variables were analyzed for their effect on operative duration and complications.ResultsOne hundred thirty-five orthopaedic surgeons participated, providing 1,180 primary ACLRs (399 isolated ACLRs, 441 ACLRs plus minor procedures, and 340 ACLRs plus major procedures). Most surgeons were in private practice (72.8%). Most patients were male patients (58.8%), and the mean body mass index (BMI) was 26.2 ± 5.1. The overall mean operative duration was 95.9 ± 42.0 minutes (isolated ACLRs, 88.4 ± 36.8 minutes; ACLRs plus minor concomitant procedures, 90.1 ± 37.6 minutes; and ACLRs plus major concomitant procedures, 118.5 ± 112.4 minutes; P < .001). Patient age was inversely correlated with operative duration (ρ = –0.221, P < .001). Surgical procedures performed in an ambulatory surgery center had a shorter mean operative duration (91.5 ± 40.4 minutes) compared with those performed in a hospital setting (105.0 ± 43.8 minutes, P < .001). There were 22 intraoperative and 47 early postoperative complications, with the most common being deep vein thrombosis (n = 15). Surgical volume (knee arthroscopy cases per month) correlated inversely with operative time (ρ = –0.200, P = .001) and complication rate (ρ = –0.112, P < .001). Patient BMI was associated with increased odds of early postoperative complications on multivariate analysis (odds ratio, 1.060; P = .044; 95% confidence interval, 1.002-1.121).ConclusionsIncreasing patient age, private practice, ambulatory surgery center setting, and surgeon experience are associated with a shorter operative duration for ACLR. Although an increasing number of arthroscopic knee procedures performed by surgeons correlated with fewer complications, only increasing patient BMI significantly predicted odds of complications.Level of EvidenceLevel IV, prognostic case series.

Regarding Arthroscopy: Can Orthopedists and Rheumatologists Be Friends?

Rheumatologists' interest in arthroscopy began before the 1980s, when many era practitioners began to take up the procedure in earnest. Some of the important players in pre-World War II explorations of arthroscopy were rheumatologists, and the father of modern arthroscopy Makei Watanabe counted many rheumatologists among his postwar students, who were publishing about arthroscopic insights into rheumatic conditions in the 1960s and 1970s. We chose to review this evolution to demonstrate the diverging interests of rheumatologists and orthopedists in arthroscopy and emphasize the chances for reconciliation and cooperation. Methods involve our personal recollection and review of the literature. Guidelines for the practice of arthroscopy were published by the American Rheumatism Association (now the American College of Rheumatology) 7 years before similar guidelines appeared from the Arthroscopy Association of North America. American rheumatologists ceased arthroscopy when controlled trials showed no effect in osteoarthritis beyond placebo and biologics for synovitis virtually eliminated situations in which synovectomy might be considered. The research potential of arthroscopy has been realized mainly by European rheumatologists, although the ultrasound-guided biopsy is supplanting arthroscopy as means to secure synovium for investigation, despite the advantages of the latter, such as the ability to obtain larger amounts of tissue, select tissue based on macroscopic appearance, sample multiple area in the same joint, and deliver the potentially therapeutic effect of washout. New miniscopes suitable for office use could restore some of the lagging interest in arthroscopy for investigation. Orthopedists have generally been resistant to rheumatologists doing arthroscopy but would not be sharing any turf with rheumatologists using the miniscope. We hope that we orthopedists and rheumatologists could be friends as we enter this new phase of arthroscopy as we use the technique for different purposes.

Wit, Wisdom, and Whitewater: A Journey With the 2021 AANA Traveling Fellows

It was an incredible honor to be selected as the 15th class of the Arthroscopy Association of North America (AANA) Traveling Fellowship. This fellowship was made even more special given the significant restrictions on travel and meetings throughout 2020 and into 2021 due to the COVID-19 (coronavirus disease 2019) pandemic. After a late cancelation of the 2020 AANA Traveling Fellowship, the class expanded to a total of 6 Traveling Fellows, the largest Traveling Fellowship to date. The Traveling Fellows included Kostas J.

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

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

The Forum, Society for Women Sports Medicine Orthopaedic Surgeons

The Forum is a private, not-for-profit organization for board-certified, fellowship-trained, female orthopaedic surgeons. Founded in 1999, The Forum was conceived as a partnership with women in industry, designed to support women orthopaedic surgeons by providing a place to share research and practice ideas and to stimulate interest and research in arthroscopic surgery. Membership has grown from a handful of founding members to nearly 100 strong in 2021. An annual meeting is held over Martin Luther King, Jr., weekend each year, combining scientific and social programs and highlighted by the Sandy Kirkley Memorial Lecture. The Forum has recently gained notoriety through the work of some of its members in advocating for the protection of athletes from sexual abuse and the publication of the first position statement on the topic, subsequently endorsed by the American Academy of Orthopaedic Surgeons. A recent partnership with the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America to provide concurrent sessions at the 2021 combined annual meeting has increased the visibility of the society and its members.

The FAST Workstation Shows Construct Validity and Participant Endorsement

PurposeTo determine in what way the proposed simulation-based intervention (SBI) is an effective intervention for use in basic arthroscopic skills training.MethodsTwenty candidates were recruited and grouped according to experience. Performance metrics included the time to activity completion, errors made, and Global Rating Scale score. Qualitative data were collected using a structured questionnaire.ResultsPerformance on the SBI differed depending on previous arthroscopic training received. Performance on the simulator differed between groups to a statistically significant level regarding time to completion. A difference was also present between participants with no previous training and those with previous training when assessed using the Global Rating Scale. The SBI was deemed acceptable, user-friendly, and realistic. Participants practicing at the expert level believe that such an SBI would be beneficial in developing basic arthroscopic skills.ConclusionsThe results of this study provide evidence that the use of an SBI consisting of a benchtop workstation, laptop viewing platform, 30° arthroscope, and defined performance metrics can detect differences in the level of arthroscopic experience. This format of SBI has been deemed acceptable and useful to the intended user, increasing the feasibility of introducing it into surgical training.Clinical RelevanceThis study adds to the existing body of evidence supporting the potential benefits of benchtop SBIs in arthroscopic skills training. Improved performance on such an SBI may be beneficial for the purpose of basic arthroscopic skills training, and we would support the inclusion of this system in surgical training programs such as those developed by the Arthroscopy Association of North America and American Board of Orthopaedic Surgery.

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.

Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons

BackgroundManagement of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. MethodsAn online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. ResultsA total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. ConclusionsConsistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.

Arthroscopic Rotator Cuff Repair Metrics: Establishing Face, Content, and Construct Validity in a Cadaveric Model

To create and determine face validity and content validity of arthroscopic rotator cuff repair (ARCR) performance metrics, to confirm construct validity of the metrics coupled with a cadaveric shoulder, and to establish a performance benchmark for the procedure on a cadaveric shoulder. Five experienced arthroscopic shoulder surgeons created step, error, and sentinel error metrics for an ARCR. Fourteen shoulder arthroscopy faculty members from the Arthroscopy Association of North America formed the modified Delphi panel to assess face and content validity. Eight Arthroscopy Association of North America shoulder arthroscopy faculty members (experienced group) were compared with 9 postgraduate year 4 or 5 orthopaedic residents (novice group) in their ability to perform an ARCR. Instructions were given to perform a diagnostic arthroscopy and a 2-anchor, 4-simple suture repair of a 2-cm supraspinatus tear. The procedure was videotaped in its entirety and independently scored in blinded fashion by trained, paired reviewers. Delphi panel consensus for 42 steps and 66 potential errors was obtained. Overall performance assessment showed a mean inter-rater reliability of 0.93. Novice surgeons completed 17% fewer steps (32.1 vs 37.5, P= .001) and enacted 2.5 times more errors than the experienced group (6.21 vs 2.5, P= .012). Fifty percent of the experienced group members and none of the novice group members achieved the proficiency benchmark of a minimum of 37 steps completed with 3 or fewer errors. Face validity and content validity for the ARCR metrics, along with construct validity for the metrics and cadaveric shoulder, were verified. A proficiency benchmark was established based on the mean performance of an experienced group of arthroscopic shoulder surgeons. Validated procedural metrics combined with the use of a cadaveric shoulder can be used to accurately assess the performance of an ARCR.

Attitudes and awareness of suture anchor cost: a survey of shoulder surgeons performing rotator cuff repairs

The cost of health care in the United States accounts for 18% of the nation's gross domestic product and is expected to reach 20% by 2020. Physicians are responsible for 60%-80% of decisions resulting in health care expenditures. Rotator cuff repairs account for $1.2-$1.6 billion in UShealth care expenditures annually. The purpose of this study is to assess surgeons' cost awareness in the setting of rotator cuff repairs. The hypothesis is that practice environment and training affect cost consciousness and incentivization will lead to more cost-effective choices. In this cross-sectional study, a 21-item survey was distributed via the email list services of the American Shoulder and Elbow Surgeonsand Arthroscopy Association of North America. Data collected included demographics, variables regarding rotator cuff repair (technique, number of companies used, procedures per month), and knowledge of costs. Responses from 345 surgeons in 23 countries were obtained with the majority (89%) being from the United States. Most surgeons were "cost-conscious" (275, 70.7%). Of these surgeons, 62.9% are willing to switch suture anchors brands to reduce overall costs if incentivized. Cost-conscious surgeons were more likely to be fellowship trained in shoulder and elbow (51.81% vs. 38.57%, P = .048), be paid based on productivity (73.53% vs. 61.43%, P = .047), and receive shared profits (85.4% vs. 75%, P = .02). The majority of orthopedic surgeons are both cost-conscious and willing to change their practice to reduce costs if incentivized to do so. A better understanding of implant costs combined with incentives may help reduce health care expenditure.

The 2019 Arthroscopy Association of North America Traveling Fellowship—Los Gallos: New Friends on an Old Town Road

We came in with high expectations, yet the Arthroscopy Association of North America (AANA) Traveling Fellowship far exceeded them. The 4 traveling fellows came from different backgrounds, different parts of North America, and different practice settings, including an independent private practice, a hybrid private-academic practice, the military, and academia. We were lucky to have been ushered along the way by our godfather, the distinguished John Richmond, M.D., Past-President of AANA and Associate Editor Emeritus of Arthroscopy, who was gracious enough to give his time to the expedition. Over the course of the journey, this gang came together quickly and forged relationships that will last a lifetime. We are extremely grateful to AANA for the privilege and will cherish the memories for years to come.