Understanding Burnout in Orthopaedic Surgery Residency: A Guide to Making Impactful Changes.

» Physician burnout is an occupational crisis that consists of emotional exhaustion, depersonalization, and reduced perceived sense of personal accomplishment. It is highly prevalent among orthopaedic surgeons, with the highest rate seen in residents.» Burnout can have a detrimental impact on resident mental and physical health, patient care through medical errors and poor patient interactions, and the healthcare system.

Effect of Initial Graft Tension on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 15-Year Follow-up.

Background: The graft tension applied during anterior cruciate ligament (ACL) graft fixation (subsequently referred to as initial graft tension) could potentiate posttraumatic osteoarthritis (PTOA) and influence other outcomes.

Purpose/hypothesis: The purpose of this study was to analyze the effects of initial graft tension on imaging and patient-reported outcomes related to PTOA 15 years postreconstruction surgery. Clinical and functional outcomes were also assessed.

Personal Financial Literacy for the Orthopaedic Trainee and Early Career Surgeon: A Review of the Basics.

Personal finance is a topic that has historically been shunned as a point of conversation in academia, often avoided and seldom discussed in medical training. However, this aversion leaves trainees and early career surgeons to make complex financial decisions without sufficient understanding while simultaneously facing the pressures of building an orthopaedic practice-a recipe destined for burnout. This simple review serves to equip young orthopaedic surgeons with the fundamental personal financial concepts essential for making wise financial choices early in their careers.

Optimizing Safe Opioid Prescribing: A Paradigm Shift in Buprenorphine Management for Orthopaedic Surgery.

The worsening opioid epidemic in the United States, exacerbated by the COVID-19 pandemic, necessitates innovative approaches to pain management. Buprenorphine, a long-acting opioid, has gained popularity due to its safety profile and accessibility. Orthopaedic surgeons, encountering an increasing number of patients on buprenorphine, face challenges in perioperative management.

Role of Quadriceps Tendon Autograft in Primary and Revision Anterior Cruciate Ligament Reconstruction.

» The quadriceps tendon (QT) autograft is becoming increasingly popular in both primary and revision anterior cruciate ligament reconstruction (ACLR).» The biomechanical properties of the QT are similar to those of the native ACL, the hamstring tendon (HT), and bone-patellar tendon-bone (BTB) autografts.» QT autograft allows surgeons to be flexible with their graft size and reconstruction technique.

Arthroscopic Training: Historical Insights and Future Directions.

Arthroscopy is an orthopaedic technique that provides surgical solutions in a minimally invasive fashion. Since its introduction, arthroscopy has become a preferred surgical approach for treating various orthopaedic pathologies, such as meniscal tears, anterior cruciate ligament ruptures, rotator cuff tears, and wrist, elbow, ankle, and hip conditions. Despite its ubiquity, surgical training in arthroscopy poses several challenges for educators and trainees.

Risk Factors and Outcomes for Preoperative Stiffness Requiring Intervention Before Anterior Cruciate Ligament Reconstruction.

Background: To date, there is a scarcity of literature related to the incidence of prolonged stiffness after an anterior cruciate ligament (ACL) tear that requires manipulation under anesthesia/lysis of adhesions (MUA/LOA) in the preoperative period before ACL reconstruction (ACLR) and how preoperative stiffness influences outcomes after ACLR.

Hypothesis: Preoperative stiffness requiring MUA/LOA would increase the risk for postoperative stiffness, postoperative complications, and the need for subsequent procedures after ACLR.

Study Design: Cohort study; Level of evidence, 3.

Resilience in Residency and Beyond.

» Distinct from the burnout and wellness continuum, resilience is a developed and refined characteristic that propels an individual toward personal and professional success.» We propose a clinical resilience triangle consisting of 3 components that define resilience: grit, competence, and hope.» Resilience is a dynamic trait that should be built during residency and constantly fortified in independent practice so that orthopaedic surgeons may acquire and hone the skills and mental fortitude required to take on the overwhelming challenges that we all inevitably face.

Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration.

Background: Quantitative magnetic resonance imaging (qMRI) methods were developed to establish the integrity of healing anterior cruciate ligaments (ACLs) and grafts. Whether qMRI variables predict risk of reinjury is unknown.

Purpose: To determine if qMRI measures at 6 to 9 months after bridge-enhanced ACL restoration (BEAR) can predict the risk of revision surgery within 2 years of the index procedure.

A Review of Abductor Tendon Tears: The Hidden Lesion of the Hip.

»: Greater trochanteric pain syndrome consists of a group of associated conditions involving the lateral hip that can be debilitating to patients, mostly women between ages 40 and 60 years.

»: Abductor tendon tears are becoming a more recognized cause of lateral hip pain in patients without hip osteoarthritis.

»: Diagnosis of this condition is critical to patient care because misdiagnosis often leads to unnecessary prolonged pain and even unnecessary procedures that address different pathologies.

Preoperative Risk Factors for Subsequent Ipsilateral ACL Revision Surgery After an ACL Restoration Procedure.

Background: Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction.

Purpose: To identify the preoperative risk factors for ACL revision surgery within the first 2 years after BEAR.

Effects of Initial Graft Tension and Patient Sex on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 10- to 12-Year Follow-up.

Background: The initial graft tension applied during anterior cruciate ligament (ACL) graft fixation may promote posttraumatic osteoarthritis (PTOA).

Purpose/hypothesis: This study sought to assess the effect of initial graft tension and patient sex on PTOA outcomes at 10 to 12 years after ACL reconstruction (ACLR). The hypothesis was that there would be no group- or sex-based differences in outcomes.

Design Features and Rationale of the BEAR-MOON (Bridge-Enhanced ACL Restoration Multicenter Orthopaedic Outcomes Network) Randomized Clinical Trial.

Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon-bone (BPTB) ACL reconstruction, another clinically standard treatment.

Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial).

The role of magnetic resonance imaging in evaluating postoperative ACL reconstruction healing and graft mechanical properties: a new criterion for return to play?

Disruption of the anterior cruciate ligament (ACL) is a common injury. In active patients, it is routinely treated with ACL reconstruction surgery. Following reconstruction, one of the critical decisions that must be made is the optimal timing of return to sport.

Bridge-Enhanced Anterior Cruciate Ligament Repair: The Next Step Forward in ACL Treatment.

Anterior cruciate ligament (ACL) injuries are common in young and active patients. In this patient population, surgical treatment with an autograft tendon is recommended to reconstruct a new ACL. ACL reconstruction has a high patient satisfaction, improved patient reported outcomes and allows young patients to return to an active lifestyle, including sports.

High Case Volume Predicts Greater Odds of Autograft Use and Meniscal Repair for Anterior Cruciate Ligament Reconstruction.

Purpose: To evaluate how both annual surgeon and facility volume affect the cost and outcomes of anterior cruciate ligament reconstruction surgery. We also aimed to identify trends in how surgeon caseload predicts graft selection.

Methods: The 2014 State Ambulatory and Surgical Database from Florida was used.

Long-term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper.

ACL injuries place the knee at risk for post-traumatic osteoarthritis (PTOA) despite surgical anterior cruciate ligament (ACL) reconstruction. One parameter thought to affect PTOA risk is the initial graft tension. This randomized controlled trial (RCT) was designed to compare outcomes between two graft tensioning protocols that bracket the range commonly used.

Evaluation of Graft Tensioning Effects in Anterior Cruciate Ligament Reconstruction between Hamstring and Bone-Patellar Tendon Bone Autografts.

This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone-tendon-bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity ("low-tension";  = 46) and (2) AP laxity overconstrained by 2 mm ("high-tension";  = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure.

Opioid-Limiting Regulation: Effect on Patients Undergoing Knee and Shoulder Arthroscopy.

Purpose: To determine the effect prescription-limiting legislation passed in Rhode Island has had on opioids prescribed following arthroscopic knee and shoulder surgery at various time points, up to 90 days postoperatively.

Methods: All patients undergoing the 3 most common arthroscopic procedures at our institution (anterior cruciate ligament reconstruction, partial meniscectomy, and rotator cuff repair) were included. Patients were selected from 2 6-month study periods (prepassage and postimplementation of the law).

Return to Play Following Meniscal Repair.

Meniscal injuries in athletes present a challenging problem. Surgeons must balance the needs of the healing meniscus with the desire of the athlete to return to play as quickly as possible. Evidence-based rehabilitation protocols are important for ensuring a successful meniscal repair and preventing athletes from returning to play prematurely.

Comparison of three fixation techniques for arcuate fractures.

Purpose: Proximal fibula avulsion fractures, or "arcuate fractures", are an often discussed but poorly defined injury pattern which represent a destabilizing injury to the posterolateral corner of the knee. Historical and recent literature discussing reconstruction and repair techniques exist, but there has been little biomechanical evaluation of repair techniques. The purpose of this study was to evaluate the strength of three type of fixation techniques for arcuate fractures: bone tunnels, a screw and washer, and a novel suture anchor technique.

Anatomic Features of the Tibial Plateau Predict Outcomes of ACL Reconstruction Within 7 Years After Surgery.

Background: Multiple anatomic features of the femoral condyles and tibial plateau have been shown to influence knee biomechanics and risk of anterior cruciate ligament (ACL) injury. However, it remains unclear how these anatomic factors affect the midterm outcomes of ACL reconstruction.

Hypothesis: Decreased femoral notch width, increased posterior and coronal slopes, and decreased concavity of the tibial plateau are associated with inferior clinical, patient-reported, and osteoarthritis-related outcomes 7 years after ACL reconstruction.

Osteochondral Allograft Transplantation: Identifying the Biomechanical Impact of Using Shorter Grafts and Pulsatile Lavage on Graft Stability.

This study seeks to identify the ability of shorter osteochondral allografts (OCAs) to resist displacement/failure. Additionally, this study seeks to evaluate the effect of pulsatile lavage (PL) on the biomechanical stability of the OCA. Fifteen-millimeter diameter, human cadaveric, OCAs of 4, 7, and 10 mm in depth were harvested for comparison of resistance to compressive and tensile loads.

Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection.

Purpose: To investigate tibial tunnel widening in ACL reconstruction patients over seven years to establish the effects of initial graft tension on tibial widening and clinical outcomes when using both patellar tendon (BTB) and hamstring tendon (HS) grafts.

Methods: Ninety patients, who were reconstructed with BTB or HS autografts, were randomized using one of two initial graft tension protocols; 1) tensioned to restore normal anteroposterior laxity ("low-tension"; n = 46) and 2) tensioned to over-constrain anteroposterior (AP) laxity by two millimeters ("high-tension"; n = 44). Seventy patients had post-surgical data with 45 available for review at seven years.

The arcuate fracture: A descriptive radiographic study.

Purpose: To assess plain radiographic morphology of arcuate fractures in order to identify patterns and help shape treatment algorithm for proximal fibula fracture.

Methods: A search of radiographic reports at a level 1 trauma center from 2014 to 2016 using MONTAGE search software for the phrases "arcuate fracture", "fibular head avulsion", or "fibular head fracture" was conducted. Descriptive measurements were obtained including dimensions of the fragment, the displacement of the fragment from its anatomic position, and the orientation of the primary fracture line relative to the axis of the fibular diaphysis in both the sagittal and coronal plane.