Residents and Fellows of US Medical Residencies and Fellowships Strongly Prefer In-Person to Virtual Conference Format: A Cross-sectional Survey.

Introduction: Medical conferences are an integral aspect of medical education as they allow attendees to stay up to date with recent advancements in medicine, to develop presentation and communication skills, and to network and establish connections with professionals in their field of interest. But, when the coronavirus disease 2019 (COVID-19) pandemic was declared in March 2020, face-to-face medical conferences were suspended, and conference organizers began shifting their meetings to virtual platforms. These new virtual conferences afforded medical residents and fellows the unique opportunity to attend conferences from the comfort of their own home or workplace; however, the virtual meeting platforms did not provide attendees with the same networking experiences as in-person conferences. Since the end of the COVID-19 public health emergency, medical conferences are now faced with the question of whether they should remain virtual, shift back to in-person meetings, or develop a hybrid model of both options. Thus, the purpose of this study was to analyze medical resident and fellow sentiments and preferences by comparing virtual and in-person conference formats. Methods: A voluntary electronic survey was distributed to medical residents and fellows across the United States through their program coordinators and directors. Results: The main findings of this study suggest that medical residents and fellows largely prefer in-person conferences (85%) as compared to a virtual format because of the networking opportunities afforded to them along with the development of camaraderie with their peers. The findings in this study suggest that the largest benefit in attending a virtual conference is the flexibility to attend from any location (79% important or very important), which offered convenience, flexibility, and comfort to participants (n = 100). Conclusion: These results support our hypothesis that despite the convenience and portability afforded by attending conferences virtually, medical residents and fellows still ultimately prefer to attend conferences in person. Overall, the findings in this study are of relevance to conference organizers in understanding the driving forces behind attendance and should be considered in determining meeting format.

Hamstring Tendon Autograft Is Associated With Increased Knee Valgus Moment After Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis.

BACKGROUND: There is limited evidence related to the effects of autograft type on functional performance after anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS: This study aimed to compare biomechanical outcomes during a drop vertical jump (DVJ) between patients with a hamstring tendon (HT) autograft, quadriceps tendon (QT) autograft with bone block, QT autograft without bone block, and bone-patellar tendon-bone autograft at 6 months postoperatively in an adolescent population. The authors' hypothesized there would be differences in DVJ biomechanics between athletes depending on the type of autograft used. STUDY DESIGN: Controlled laboratory study. METHODS: Patients aged 8 to 18 years who underwent primary ACLR were included for analysis. Kinematic and kinetic data collected during a DVJ using a 3-dimensional computerized marker system were assessed at 6 months after ACLR and compared with the uninjured contralateral limb. RESULTS: A total of 155 participants were included. There were no significant differences in terms of age, sex, or affected leg (P≥ .1973) between groups. The HT group was significantly associated with a larger knee valgus moment at initial contact compared with the QT group (28 × 10-2 vs -35 × 10-2 N·m/kg, respectively; P = .0254) and a significantly larger maximum hip adduction moment compared with the QT with bone block group (30 × 10-2 vs -4 × 10-2 N·m/kg, respectively; P = .0426). Both the QT with bone block (-12 × 10-2 vs -3 × 10-2 N·m/kg, respectively; P = .0265) and QT (-13 × 10-2 vs -3 × 10-2 N·m/kg, respectively; P = .0459) groups demonstrated significantly decreased mean knee extension moments compared with the HT group. CONCLUSION: The findings of this study suggest that utilizing an HT autograft resulted in a significantly increased knee valgus moment at initial contact compared with a QT autograft without bone block at 6 months after ACLR in adolescent patients performing a DVJ. A QT autograft was found to be associated with significantly decreased extensor mechanism function compared with an HT autograft. CLINICAL RELEVANCE: This study adds unique kinematic and kinetic information regarding various ACLR autograft options and highlights the biomechanical deficits that should be taken into consideration in rehabilitation.

Biomechanical Gender Differences in the Uninjured Extremity After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: A Retrospective Motion Analysis Study.

Introduction Subsequent anterior cruciate ligament (ACL) injury is more common in the pediatric population and encompasses graft failure and subsequent contralateral tears. Females are at a higher risk. The purpose of the present study was to compare the knee valgus angles at initial contact, knee extension moments, anterior and lateral knee joint forces, hip flexion angles, hip adduction moments, and ankle inversion during the drop vertical test in the uninjured extremity between adolescent males and females who had previously undergone an anterior cruciate ligament reconstruction (ACLR). Methods This IRB-approved retrospective chart review included patients aged 8-18 years who were seen at the five to seven month postoperatively following ACL reconstruction. A total of 168 patients met our inclusion criteria (86 girls and 82 boys.) Using three-dimensional motion capture technology (CORTEX software, Motion Analysis Corp., Rohnert Park, CA), data were collected while the subject performed the drop vertical test over floor-mounted force plates (FP-Stairs, AMTI, Watertown, MA) under the direct supervision of a pediatric physical therapist. The Wilcoxon rank sum was used, and p < 0.05 was considered statistically significant. Results Females demonstrated a larger average knee joint extension moment (0.31 vs 0.28 N*m/kg, p = 0.0408), a larger anterior knee joint force at initial contact (3.51 vs. 2.79, N/kg, p = 0.0458), larger average hip flexion angle (41.50° vs. 35.99°, p = 0.0005), a smaller maximum hip adduction moment (0.92 vs. 1.16, N*m/kg, p = 0.0497), and a smaller average ankle inversion angle (5.08° vs. 6.41°, p = 0.03231). No significant differences were found regarding knee abduction angle or lateral knee joint force. Conclusions The biomechanical profile of the contralateral extremity varies significantly between the genders after ACLR. In the uninjured extremity, females may have larger hip flexion angles, smaller hip adduction moments, larger anterior knee joint forces, larger knee extension moments, and smaller ankle inversion angles as compared to males after ACLR. These findings may explain the higher incidence of subsequent contralateral injury in female adolescent athletes. Further work is required to develop a composite score that determines at-risk athletes.

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

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

Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation: A Systematic Review.

BACKGROUND: The success of anterior cruciate ligament (ACL) reconstruction is influenced by effective rehabilitation. Previously published, comprehensive systematic reviews evaluating rehabilitation after ACL reconstruction have studied Level-I and II evidence published through 2012. Interval studies continue to evaluate the efficacy of various rehabilitative modalities. METHODS: A total of 824 articles from 2012 to 2020 were identified using multiple search engines. Fifty Level-I or II studies met inclusion criteria and were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) criteria and National Institutes of Health (NIH) Study Quality Assessment Tools. RESULTS: Accelerated rehabilitation can be effective for patients with semitendinosus-gracilis grafts. Blood flow restriction (BFR) training with high-intensity exercise is not effective for ACL reconstruction recovery. Postoperative bracing does not offer any advantages or improve limb asymmetry. Cryotherapy is an effective analgesic when used perioperatively. The early introduction of open kinetic chain exercises may improve ACL reconstruction outcomes, and high-intensity plyometric exercise is not effective. Estimated pre-injury capacity (EPIC) levels may be more accurate than the Limb Symmetry Index (LSI) when using functional test results to predict reinjury rates, and hip external rotation strength may be the most accurate predictor of the hop test performance. Nerve blocks can provide postoperative analgesia with minimal complication risk. Neuromuscular electrical stimulation is effective when used independently and in combination with rehabilitative exercises. Psychological readiness should be evaluated both objectively and subjectively before allowing patients to safely return to sport. Electromyography biofeedback may help to regain muscular function, and whole-body vibration therapy can improve postural control. Supervised rehabilitation is more effective than unsupervised rehabilitation. CONCLUSIONS: Various rehabilitative modalities following ACL reconstruction are effective in improving surgical outcomes and return-to-sport rates. Further evidence and improved study design are needed to further validate modalities including accelerated rehabilitation, BFR training, functional testing, and return-to-sport criteria. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Posterior Wear on Reverse Shoulder Glenoid Fixation.

INTRODUCTION: Achieving glenoid fixation with posterior bone loss can be challenging. The purpose of this study was to quantify the impact of two different sizes of posterior glenoid defects (10° and 20°) on reverse shoulder arthroplasty (rTSA) glenoid baseplate fixation and determine if utilizing different sizes of posterior augmented baseplates (8° and 16°) with off-axis reaming provides comparable fixation to using a standard baseplate with different amounts of eccentric reaming. METHODS: We quantified the impact of 10° and 20° posterior glenoid defects on rTSA baseplate fixation in composite scapulae using the ASTM F2028-14 rTSA glenoid loosening test method. Forty-two total implants (N = 7 for each size defect and for each type of baseplate) were tested at 750 N for 10,000 cycles. Baseplate displacement was measured before and after cyclic loading in the superior-inferior and anterior-posterior directions. Statistical analysis was performed with a two-tailed unpaired Student's t-test (significance defined as p < 0.05) to compare prosthesis displacements relative to each scapula (10° and 20° posterior defects for each type of baseplate versus the non-defect control) before and after cyclic loading. RESULTS: All glenoid baseplates remained well-fixed after cyclic loading in composite scapulae without a defect and in scapulae with posterior defects. Increased pre- and post-cyclic displacement was observed with increased posterior defect size and differences in displacement were observed between standard and augmented baseplates. Augmented baseplates were observed to remove significantly less bone than standard baseplates when correcting posterior defects, regardless of size. DISCUSSION: Both standard baseplates with eccentric reaming and two different sizes of augmented baseplates with off-axis reaming successfully maintained fixation following cyclic loading in composite scapula with corrected 10° and 20° posterior glenoid defects. Augmented glenoids may be more advantageous long-term from a fixation perspective as they preserve more subchondral glenoid bone due to the minimal reaming occurring by the off-axis method. Mid and long-term clinical follow-up comparisons of outcomes are necessary between these two techniques.