Sports Medicine Fellowship Research Articles

Implant Cost Awareness Among Orthopaedic Surgeons at a Single Academic Institution

Introduction Despite the increasing costs of implants, surgeons’ awareness of these costs varies widely. The purpose of this study is to determine baseline awareness of sports-medicine-related implant cost among orthopaedic surgeons. Methods A survey including images of 10 different orthopaedic implants related to sports medicine was sent to 18 surgeons. All included surgeons practice in a single ambulatory surgery center and routinely perform sports-medicine-related procedures. Surgeons were asked to estimate the cost of each implant and answer questions about surgeon characteristics. Cost estimates were compared with implant cost found in the institutional charge master database. Results Cost estimates varied widely among providers regardless of fellowship training. The average percent error among all providers was 54.3%. Surgeons that rated knowledge of implant cost to be important most or all of the time had an average cost estimate error of 60.7% versus 48.0% error in their counterparts that stated that knowledge of cost was important to them only some of the time, though this did not reach statistical significance. Low-cost implants were more likely to be overestimated while high-cost implants were more often underestimated. Years of experience, sports medicine fellowship training, and involvement in contract negotiations had no effect on implant cost accuracy. Conclusion Implant cost awareness is dishearteningly low sports medicine orthopaedists despite the large economic impact of these devices. There is considerable room for improving cost awareness in sports medicine.

Evaluation and Management of Glenohumeral Instability in Adolescent Patients: An Expert Consensus Statement.

Management of glenohumeral instability in the adolescent population can be both challenging and controversial. There are no current guidelines for optimal management of glenohumeral instability in this population (unidirectional or multidirectional), and the cutoff ages for transition to adult treatment are not known. To develop consensus-based guidelines for the management of glenohumeral instability in adolescents. Consensus statement. A 26-question, multiple-choice survey was developed after 2 rounds of iterations and was submitted to the orthopaedic surgeons of the Pediatric Research in Sports Medicine (PRiSM) Society. The survey comprised 3 sections-demographics, practice setting, and decision-making-and included cutoff ages and management in 5 specific case scenarios. Consensus-based guidelines were generated with 66% response agreement. An indication score was then applied to each response related to more aggressive management to determine if variables related to consensus (or lack thereof) could be identified. A total of 54 responses were returned. Of the respondents, 59% were from academic practice, 84% were pediatric orthopaedic fellowship trained, and 46% performed >25 shoulder instability cases per year. In the setting of first-time anterior shoulder dislocation, nonoperative treatment was preferred for boys aged <14 years and girls aged <13 years. Besides age, proximal humerus physeal status, injury mechanism, sport, and presence of bony injury affected treatment selection. The presence of a Bankart lesion was an indication for stabilization in first-time dislocations for contact athletes with a closing or closed physis, but not in patients with an open physis or noncontact injury mechanisms. For recurrent anterior shoulder dislocation, stabilization was preferred irrespective of physis status. Initial nonoperative treatment was preferred for multidirectional instability. In the setting of first-time anterior shoulder dislocation in patients with open physes, nonoperative treatment was preferred for boys <14 years and girls <13 years. Future multicenter prospective studies focusing on outcomes would help to validate current practice patterns, especially in scenarios for which no consensus was reached.

The Development and Execution of An Orthopaedic Sports Medicine Fellowship Surgical Skills Assessment

Background: Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency. Purpose: To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows. Study Design: Case series; Level of evidence, 4. Methods: A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions. Results: Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement (P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement (P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship (P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship (P < .001). Conclusion: This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.

Survey Results Concerning Current Trends in Meniscus Repair Indications and Preferences from Members of the Pediatric Research in Sports Medicine (PRiSM) Society.

Meniscus repair has increased in frequency, especially among surgeons who focus on youth sports injuries. The aim of this study was to determine current trends in meniscus repair among a specific subset of meniscus repair surgeons. A cross-sectional survey utilizing several clinical vignettes was administered to orthopaedic surgeon members of the Pediatric Research in Sports Medicine (PRiSM) Society to investigate surgeon experience and training, number of meniscus repair procedures performed, and surgical and rehabilitation preferences. A statistical analysis of the responses was performed to determine associations between years in practice or type of fellowship training and the number of meniscus repair procedures performed, surgical indications, and rehabilitation preferences. The response rate to various questions ranged from 61.5 (59/96) to 63.5% (61/96). In all vignettes, a majority favored repair as well as some degree of weight-bearing and range-of-motion restrictions. Surgeons who had been in practice for 6 to 10 years performed significantly more meniscus repairs per year than those who had been in practice for greater than 20 years (p = 0.009) and those who had been in practice for 0 to 5 years (p = 0.05). Surgeons who had been in practice for greater than 20 years performed a significantly higher percentage of meniscectomies relative to meniscus repairs, compared with those in practice for 0 to 5 years (p = 0.002) or 6 to 10 years (p = 0.0003). When surgeons were grouped into those with less than 10 years of experience and those with greater than 10 years of experience, the former group performed a significantly higher number of meniscus repairs relative to meniscectomies than the latter group of surgeons (p < 0.0001). Less experienced surgeons are more likely to perform meniscus repair than meniscectomy, but all surgeons surveyed had a general preference for repair in all clinical vignettes. Repair technique preferences as well as rehabilitation protocols varied widely among surgeons.

Anatomic or Reverse Total Shoulder Arthroplasty? How Fellowship Training Affects Selection of Arthroplasty Type

While both anatomic (ATSA) and reverse total shoulder arthroplasty (RTSA) have been popularized as a means of treating individuals with degenerative shoulder conditions, the indications for each can vary widely amongst providers. While surgeons with differing fellowship training commonly perform these procedures, it is not understood how fellowship training influences choice of implant. A national database was queried to identify surgeons performing anatomic and reverse total shoulder arthroplasty. For all surgeons who performed more than 10 cases between 2010-2022, fellowship data was individually collected via online search. For each fellowship group, rates of anatomic and reverse total shoulder arthroplasty were identified using International Classification of Diseases (ICD) procedural codes. Those undergoing revision arthroplasty and those with a history of fracture, infection, or malignancy were excluded. Primary outcome measures included the proportion of primary and revision ATSA and RTSA by fellowship in addition to the rate of RTSA performed for a primary diagnosis of glenohumeral osteoarthritis. A total of 131,974 patients met the inclusion criteria and were retained for this study. RTSA increased from 50.1% of all primary shoulder arthroplasty cases in 2011 to 72.0% in 2022. After adjusting for age and comorbidities, Sports Medicine fellowship-trained (Sports) surgeons opted for primary RTSA over ATSA at a significantly higher rate than Shoulder and Elbow fellowship-trained (Shoulder) surgeons and surgeons who completed another type of fellowship or no fellowship (Other). Sports surgeons also chose RTSA more frequently for the diagnosis of glenohumeral osteoarthritis compared to Shoulder surgeons. Surgeons in the Other cohort were more likely to perform primary ATSA rather than RTSA in comparison to surgeons in the Shoulder and Sports cohorts. Sports surgeons were responsible for the greatest increase in percentage of all shoulder arthroplasty procedures from 2010-2022 (28.4% to 40.4%) while the Other group decreased by a comparable amount (45.9% to 32.4%) over the same period. Surgeons who have completed a Sports Medicine fellowship choose RTSA over ATSA at a higher rate than Shoulder and Elbow surgeons, both for all indications and also for a primary diagnosis of glenohumeral osteoarthritis. Those who have no fellowship training or fellowship training outside of Sports Medicine and Shoulder and Elbow surgery have the highest percentage of ATSA in their arthroplasty practice. Revision anatomic and revision reverse total shoulder arthroplasty represents a larger percentage of overall case volume for Shoulder and Elbow surgeons.

Analysis of supply and demand for sports medicine fellowship training: 2012-2022.

The recruitment of high-quality applicants is critical to the vitality of the sports medicine physician workforce. To analyze changes in the total number of available training positions, applicants, and unfilled training positions in the Sports Medicine Match from 2012 to 2022. This was a retrospective cohort study of sports medicine fellowship applicants. Accreditation Council for Graduate Medical Education-accredited sports medicine fellowship training programs. A total of 3763 individuals applying for sports medicine fellowship training from 2012 to 2022. Not applicable. Annual number of applicants, training positions, and number of unfilled training positions. From 2012 to 2022, the annual number of training positions in sports medicine increased from 177 to 353 (99% increase, p < .001) while the annual number of applicants increased from 256 to 428 (67% increase, p < .001). The annual applicant-to-training position ratio decreased (1.4 to 1.2, p < .001). Annual match rates increased for both U.S. MD graduates (64% to 86%, p < .001) and non-U.S. MD graduates (64% to 77%, p < .001). U.S. MD graduates had higher match rates than non-U.S. MD graduates in 2021 (79% vs 70%, p < .05) and 2022 (86% vs 77%, p < .05). The percentage of applicants who matched at their first (36%-36%, p > .05), second (14%-15%, p > .05), and third (9%-8%, p > .05) ranked programs did not change. The percentage of applicants who did not match decreased (33%-19%, p < .001). The percentage of available fellowship training positions that went unfilled decreased (8%-2%, p < .001). Interest in sports medicine fellowship training is increasing as evidenced by an increasing number of applications and decreasing rate of unfilled training positions. Continued monitoring of future match cycles is important given projected shortages in the physician workforce.

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.

Segond Fractures Can Be Identified With Excellent Accuracy Utilizing Deep Learning on Anteroposterior Knee Radiographs

PurposeTo 1) develop a deep learning model for detection of Segond fractures on AP knee radiographs and 2) to compare model performance to that of trained human experts. MethodsAP knee radiographs were retrieved from the Hospital for Special Surgery ACL Registry, which enrolled patients between 2009 and 2013. All images corresponded to patients who underwent ACL reconstruction by one of 23 surgeons included in the registry data. Images were categorized into one of two classes based on radiographic evidence of a Segond fracture and manually annotated. Seventy percent of the images were used to populate the training set, while 20% and 10% were reserved for the validation and test sets, respectively. Images from the test set were used to compare model performance to that of expert human observers, including an orthopedic surgery sports medicine fellow and a fellowship-trained orthopedic sports medicine surgeon with over 10 years of experience. ResultsA total of 324 AP knee radiographs were retrieved, of which 34 (10.4%) images demonstrated evidence of a Segond fracture. The overall mean average precision (mAP) was 0.985, and this was maintained on the Segond fracture class (mAP = 0.978, precision = 0.844, recall = 1). The model demonstrated 100% accuracy with perfect sensitivity and specificity when applied to the independent testing set and the ability to meet or exceed human sensitivity and specificity in all cases. Compared to an orthopedic surgery sports medicine fellow, the model required 0.3% of the total time needed to evaluate and classify images in the independent test set. ConclusionA deep learning model was developed and internally validated for Segond fracture detection on AP radiographs and demonstrated perfect accuracy, sensitivity and specificity on a small test set of radiographs with and without Segond fractures. The model demonstrated superior performance compared to expert human observers. Clinical RelevanceDeep learning can be used for automated Segond fracture identification on radiographs, leading to improved diagnosis of easily missed concomitant injuries, including lateral meniscus tears. Automated identification of Segond fractures can also enable large-scale studies on the incidence and clinical significance of these fractures, which may lead to improved management and outcomes for patients with knee injuries.

Screening for Relative Energy Deficiency in Sport and Female Athlete Triad: A Survey of Pediatric Sports Medicine Professionals

BACKGROUND: Relative Energy Deficiency in Sport, or RED-S, is a multi-scale physiological response to a mismatch between energy intake and exercise energy expenditure that affects up to 50% of adolescent athletes. RED-S symptomology was first described as the Female Athlete Triad (the Triad) and includes specifically low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density. Despite the wide impact of RED-S/the Triad, there is a lack of standardization of screening in adolescent athletes. Therefore, the purpose of this study was to assess if there are differences in practitioner demographics when screening for RED-S/the Triad in adolescent athletes. In addition, we sought to assess if providers’ screening habits differ based on specific patient characteristics. METHODS: We conducted a cross-sectional online questionnaire of members of the Pediatric Research in Sports Medicine (PRiSM) Society. PRiSM is an interdisciplinary group of professionals who are dedicated to advancing the research and medical care of young athletes. The questionnaire assessed screening tools that members used to assess for RED-S/the Triad, practices implemented when providers were concerned for RED-S/the Triad, demographic data, and type of training. RESULTS: Of 389 PRiSM members, 60 completed the survey and were included in subsequent analyses (15% response rate). Most participants were primary care sports medicine physicians (37%), orthopaedic surgeons (27%), or physical therapists (23%), and about half of respondents identified as a cis gender woman (55%). There was a trend toward more women screening for RED-S routinely than men (55% vs. 33%: p=0.10), and orthopaedic surgeons were less likely to screen than other specialties (25% vs. 52%, p = 0.06). Eating disorders (88%), menstrual dysfunction (76%), and bone stress injury (74%) were reported as specific red flags that make providers screen for RED-S/the Triad. Participants reported that lack of time (57%) and lack of resources (37%) were barriers to screen for RED-S/the Triad. The most commonly utilized tools to screen for RED-S/the Triad were the Female Athlete Screening Tool (FAST), Female Athlete Triad Risk Scale, Female Athlete Triad Consensus Panel Screening questions, and RED-S Specific Screening Tool (RST). CONCLUSION: Orthopaedic surgeons were less likely than other health care professionals to screen for RED-S/the Triad. Barriers that prevent healthcare providers from screening for RED-S/the Triad included limited time and resources. By describing current practices, we have identified gaps and areas of need to enhance screening for RED-S/the Triad across multiple sports medicine disciplines.

An evaluation of physical medicine and rehabilitation accredited sports medicine fellowship websites.

Due to the virtual format of fellowship applications, prospective physical medicine and rehabilitation (PM&R) sports medicine fellowship applicants commonly rely upon fellowship website content to make decisions about applications. Studies have shown that information available to fellowship applicants on program websites is inadequate, and there is no standard for important components of sports medicine fellowship websites. To determine what sports medicine fellowship program features PM&R residents, fellows, and attending physicians consider the most important to be listed on fellowship websites, as well as to assess the scope of information available on fellowship websites. We developed a 30-item list of criteria that fell into categories of general information, fellowship education, recruitment, experience, and academic research. Survey participants were asked to rank the importance of those various items. We then assessed the 21 PM&R accredited sports medicine fellowship websites for the presence of these criteria. Ninety-six survey respondents composed of PM&R residents, current sports medicine fellows, and attendings. Not applicable. Not applicable. Items ranked as most important were those in the categories of general information, fellowship experience, and fellowship recruitment. The most valued items were program location, program coordinator contact information, program length, specific requirements for applying, number of positions, types of procedures taught, and specific sites covered. Academic research items were ranked as least important. Survey respondents identified many fellowship website items as important factors when applying to programs. Many of these items were not listed on fellowship websites, suggesting that adding these criteria to fellowship sites might benefit applicants. Our findings can be used to develop standardized criteria for important components of sports medicine fellowship websites to improve the application and recruitment process.

ChatGPT Is Moderately Accurate in Providing a General Overview of Orthopaedic Conditions.

ChatGPT is an artificial intelligence chatbot capable of providing human-like responses for virtually every possible inquiry. This advancement has provoked public interest regarding the use of ChatGPT, including in health care. The purpose of the present study was to investigate the quantity and accuracy of ChatGPT outputs for general patient-focused inquiries regarding 40 orthopaedic conditions. For each of the 40 conditions, ChatGPT (GPT-3.5) was prompted with the text "I have been diagnosed with [condition]. Can you tell me more about it?" The numbers of treatment options, risk factors, and symptoms given for each condition were compared with the number in the corresponding American Academy of Orthopaedic Surgeons (AAOS) OrthoInfo website article for information quantity assessment. For accuracy assessment, an attending orthopaedic surgeon ranked the outputs in the categories of <50%, 50% to 74%, 75% to 99%, and 100% accurate. An orthopaedics sports medicine fellow also independently ranked output accuracy. Compared with the AAOS OrthoInfo website, ChatGPT provided significantly fewer treatment options (mean difference, -2.5; p < 0.001) and risk factors (mean difference, -1.1; p = 0.02) but did not differ in the number of symptoms given (mean difference, -0.5; p = 0.31). The surgical treatment options given by ChatGPT were often nondescript (n = 20 outputs), such as "surgery" as the only operative treatment option. Regarding accuracy, most conditions (26 of 40; 65%) were ranked as mostly (75% to 99%) accurate, with the others (14 of 40; 35%) ranked as moderately (50% to 74%) accurate, by an attending surgeon. Neither surgeon ranked any condition as mostly inaccurate (<50% accurate). Interobserver agreement between accuracy ratings was poor (κ = 0.03; p = 0.30). ChatGPT provides at least moderately accurate outputs for general inquiries of orthopaedic conditions but is lacking in the quantity of information it provides for risk factors and treatment options. Professional organizations, such as the AAOS, are the preferred source of musculoskeletal information when compared with ChatGPT. ChatGPT is an emerging technology with potential roles and limitations in patient education that are still being explored.

Orthopedic Team Surgeons in Major Professional Sports: An Analysis of Affiliation With the Top 10 Sports Medicine Fellowship Programs and Implications for Leadership and Diversity.

This paper examines the correlation between orthopedic team surgeons in major professional sports and their affiliation with the top 10 sports medicine fellowship programs. With a growing trend in post-residency fellowship training, particularly in sports medicine, the study focuses on the implications of fellowship program choice for aspiring major professional sports team physicians. By analyzing data from Major League Baseball (MLB), the National Basketball Association (NBA), the National Football League (NFL), and the National Hockey League (NHL), the research reveals that 61 of 124 (49.19%) team surgeons graduated from the top 10 sports medicine fellowship programs. The results identify a noticeable pipeline effect in professional sports, where teams often hire graduates from a select number of esteemed fellowship programs. The study suggests that choosing a fellowship program from the top 10 list may enhance the prospects of becoming a major league team surgeon. Additionally, our results found a significant gender disparity among team surgeons, with only two (1.6%) of all major professional team physicians being women. Thisemphasizes the imperative for diversity improvement in orthopedic sports medicine. In conclusion, the research underscores the impact of top-tier fellowship programs on professional team surgeons, with implications for aspiring sports medicine physicians and a call for addressing gender disparities.

Consensus-Based Guidelines for Management of First-Time Patellar Dislocation in Adolescents.

The management of first-time patellar dislocation remains variable, with limited evidence to support or compare different operative and nonoperative modalities. The primary aim was to establish consensus-based guidelines for different components of nonoperative treatment following a first-time patellar dislocation. The secondary aim was to develop guidelines related to management after failed nonoperative treatment. The tertiary aim was to establish consensus-based guidelines for the management of first-time patellar dislocation with a concomitant osteochondral fracture. A 29-question, multiple-choice, case-based survey was developed by 20 members of the Patellofemoral Research Interest Group of the Pediatric Research in Sports Medicine Society. The survey consisted of questions related to demographic information, management of first-time patellar dislocation without an osteochondral fracture, and management of first-time patellar dislocation with a 2cm osteochondral fracture. The survey underwent 2 rounds of iterations by Patellofemoral Research Interest Group members and the final survey was administered to Pediatric Research in Sports Medicine members, using REDCap. Consensus-based guidelines were generated when more than 66% of respondents chose the same answer. Seventy-nine of 157 (50%) eligible members responded. Sixty-one were orthopaedic surgeons and 18 were primary sports medicine physicians. Eleven consensus-based guidelines were generated based on survey responses. Those that met the criteria for consensus included initial knee radiographs (99% consensus), nonoperative treatment for first-time patellar dislocation without an osteochondral fracture (99%), physical therapy starting within the first month postinjury (99%), with return to sport after 2 to 4 months (68%) with a brace (75%) and further follow-up as needed (75%). Surgical treatment was recommended if there were patellar subluxation episodes after 6 months of nonoperative treatment (84%). Patellar stabilization should be considered for a first-time dislocation with an osteochondral fracture (81.5%). Consensus-based guidelines offer recommendations for the management of first-time patellar dislocation with or without an osteochondral fracture. Several changing trends and areas of disagreement were noted in clinical practice. In the absence of high-level evidence, consensus-based guidelines may aid in clinical decision-making when treating patients following a first-time patellar dislocation. These guidelines highlight the evolving trends in clinical practice for the management of first-time patellar dislocation. Areas not reaching consensus serve as topics for future research.

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.

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

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

Postoperative Management of Osteochondral Lesions of the Ankle: A Survey Among German-Speaking Foot and Ankle Surgeons.

To assess the current treatment of osteochondral lesions of the ankle (OCLA) by German-speaking foot and ankle surgeons, focusing on the management of postoperative care and rehabilitation. A questionnaire was created by a panel of 4 experienced foot and ankle surgeons on behalf of the "Clinical Tissue Regeneration" (CTR) working group of the German Society of Orthopaedics and Trauma Surgery (DGOU), and distributed electronically to members of the CTR, participants of the German Cartilage Registry (Knorpelregister DGOU©), and members of 6 German-speaking orthopedics or sports medicine societies. Results were classified depending on the consensus within the answers (agreement ≥75% "strong tendency," 50%-74% "tendency," 25%-49% "weak tendency," <25% "no tendency"). A total of 60 participants returned the questionnaire. The main results are as follows: regarding the frequency of surgical procedures for OCLA, refixation of the fragment, retrograde drilling, and bone marrow stimulation with or without using a matrix were performed by at least 75% of the surgeons and was considered a strong tendency. There was a strong tendency to stabilize the ankle (76.7%) and perform corrective osteotomies (51.7%). In total, 75.5% and 75% of the surgeons performed bone marrow stimulation with and without using a matrix, respectively. Corrective osteotomy and ankle stabilization were performed in 64.5% and 65.2% cases, respectively. Most participants included published recommendations on postoperative rehabilitation and the return to sports activities in their postoperative management. The main surgical procedures were considered the most critical factor in influencing the postoperative management by 81% of the participants (strong tendency). Adjunct surgical procedures such as corrective osteotomy and stabilization of the ankle were considered important by 67.8% of the respondents (tendency). The management of OCLA varies among German-speaking foot and ankle surgeons. Therefore, guidelines remain essential to standardize the management of OCLA, to achieve improved and stable results. This survey will assist clinicians and patients with rehabilitation to return to sports after treating the ankle's cartilage injury.

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.

Poster 372: Women in Leadership in Orthopaedic Sports Medicine Societies Throughout the World

Objectives: The proportion of women in orthopaedic surgery is low compared to other specialties, despite a equal numbers of women and men entering the field of medicine. This gender disparity persists across various aspects of orthopaedic sports medicine. The purpose of this study was to characterize the number of women in leadership positions in orthopaedic sports medicine and arthroscopy societies throughout the world and compare the percentages of women vs men in leadership positions. Methods: Publicly available websites for orthopaedic sports medicine societies throughout the world were evaluated during March 2022. Non-surgical sports medicine societies were excluded, as were societies lacking publicly available leadership information. Data were collected as listed on the websites, and categorized into Board of Directors, Executive Committee, Office, Council (all typically included Presidential line, Vice-President, Treasurer, Secretary, or other specific high-ranking members), and Committee Chairs (excluded general committee members). Results: Of the 46 societies, 16 (34.8%) were in Europe, 10 (21.7%) in Asia, 6 (13.0%) in South America, 5 (10.9%) in North America, 3 in the Middle East (6.5%), 2 in Africa (4.4%), 2 in Australia (4.4%), and 2 were international organizations (4.4%). Four countries had more than one orthopaedic sports medicine society: Argentina, Israel, Australia, and Mexico. As represented by Figure 1, the Board of Directors were comprised of 2.5% women (4/161), the Executive Committees were 7.1% women (11/154), Committee Chairs were 9.4% women (13/138), Officers were 15.8% women (3/19), Councils were 5.9% women (1/17), and Spokespersons were 16.7% women (1/6). For the Board of Directors, North America and Europe led in women representation with 4.0% and 3.8%, South America had 2.0%, and societies from the Middle East and Asia reported no women. Regarding Executive Committee, North America had the most women with 27.8%, and the remaining regions ranged from 0.0-7.9%. For Committee Chairs, both European and International societies had around 8% women in leadership (8.0% and 7.7%, respectively), yet North America had double with 16.7% women. Of the regions reporting Officers, Asia and Europe had similar percentages (16.7% and 18.2%), whereas Australia reported zero women in office. Only one region reported electing a Council and two regions listed Spokespersons. Conclusions: This study highlights the gender disparities in leadership positions in orthopaedic sports medicine societies throughout the world. The visibility of women in high-ranking positions may contribute to the interest of women and other minorities in the field of sports medicine and help improve diversity. Future studies should investigate factors contributing to the paucity of women in leadership positions and identify ways to increase the proportion of women in orthopaedic sports medicine.

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 154: Top Orthopaedic Sports Medicine Fellowship Programs as Perceived by Applicants

Objectives: Despite the high volume of orthopaedic sports medicine fellowship applicants and growing interest in the field, fellowship applicants’ attitudes and preferences towards programs are not well known. The objectives of this study were to determine the top orthopaedic surgery sports medicine fellowship programs in the United States and the most important aspects of fellowship programs as perceived by applicants. Methods: An anonymous survey was distributed via email and text message to all individuals who applied to one particular orthopaedic sports medicine fellowship program during the 2017-18 through 2021-22 application cycles. The survey asked applicants to rank what they considered to be the top-10 orthopaedic sports medicine fellowship programs in the United States prior to and after completion of their application cycle, based on operative and nonoperative experience, faculty, game coverage, research, and work/life balance. Final rank was calculated by awarding 10 points for a 1st place vote, 9 points for a 2nd place vote, etc., with total number of points used to determine final ranking for each program. Secondary outcomes included application patterns, relative importance of different fellowship program aspects, and preferred type of practice. Results: Ninety-three surveys were completed overall. Based on total numbers of points, applicants voted the top orthopaedic sports medicine fellowships programs to be: 1) the Steadman Philippon Research Institute, 2) Rush University, and 3) Hospital for Special Surgery, both prior to and following the application cycle (Table 1). Forty-two percent of applicants applied to all of their perceived top-10 programs with 66% of respondents applying to at least 8 of their top-10 programs. Interestingly, 10% of applicants applied to 4 or fewer of their top-10 programs. Of those who did not apply to all programs in their top-10, 92% thought the program did not fit their preferences and 47% thought they were not competitive for those programs. When asked to rank programs upon completion of the application cycle, each of the top-10 programs prior to the application cycle remained in the top-10 (Table 1). Nearly all of the applicants agreed/strongly agreed (99%) that the personalities of the attendings they met on their interviews influenced their rank list decision upon completion of the application cycle. When ranking fellowship program aspects, fellowship reputation and faculty members were most likely to be ranked highest in importance. Factors such as research opportunities, private practice versus academic setting, and number of fellows were all more likely to be ranked last in importance (Table 2). Most applicants (83%) applied to both academic and private practice programs. Conclusions: This study demonstrates that most orthopaedic sports medicine fellowship applicants highly valued program reputation and faculty member personalities in choosing a fellowship program and that the application/interview process did not have a significant effect on how individuals perceive the top programs. The findings of this study may have significant implications on future application cycles and the programs to which potential applicants may apply. [Table: see text][Table: see text]