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Journal of Bone & Joint Surgery
Journal Prestige (SJR): 2.722
Citation Impact (citeScore): 4
Number of Followers: 187  
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ISSN (Print) 0021-9355 - ISSN (Online) 1535-1386
Published by Journal of Bone and Joint Surgery Homepage  [4 journals]
  • What’s New in Spine Surgery
    • Authors: Buchowski; Jacob M.; Adogwa, Owoicho
      Abstract: No abstract available
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the
           Treatment of Small and Medium-Sized Rotator Cuff Tears
    • Authors: Moosmayer; Stefan; Lund, Gerty; Seljom, Unni S.; Haldorsen, Benjamin; Svege, Ida C.; Hennig, Toril; Pripp, Are H.; Smith, Hans-Jørgen
      Abstract: imageBackground: Tendon repair and physiotherapy are frequently used treatment methods for small and medium-sized rotator cuff tears. In 2 previous publications of the 1 and 5-year results of this study, we reported significant but small between-group differences in favor of tendon repair. Long-term results are needed to assess whether the results in both groups remain stable over time.Methods: In this study, 103 patients with a rotator cuff tear not exceeding 3 cm were randomly assigned to primary tendon repair or physiotherapy with optional secondary repair. Blinded follow-up was performed after 6 months and 1, 2, 5, and 10 years. Outcome measures included the Constant score; the self-report section of the American Shoulder and Elbow Surgeons score; the measurement of shoulder pain, motion, and strength; and patient satisfaction. Magnetic resonance imaging (MRI) was performed on surgically treated shoulders after 1 year, and ultrasound was performed on all shoulders after 5 and 10 years. The main analysis was by 1-way analysis of covariance and by intention to treat.Results: Ninety-one of 103 patients attended the last follow-up. After 10 years, the results were better for primary tendon repair, by 9.6 points on the Constant score (p = 0.002), 15.7 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.8 cm on a 10-cm visual analog scale for pain (p < 0.001), 19.6° for pain-free abduction (p = 0.007), and 14.3° for pain-free flexion (p = 0.01). Fourteen patients had crossed over from physiotherapy to secondary surgery and had an outcome on the Constant score that was 10.0 points inferior compared with that of the primary tendon repair group (p = 0.03).Conclusions: At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears had increased, with better results for primary tendon repair.Level of Evidence: Therapeutic Level I. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Risk Factors for Failure After 1-Stage Exchange Total Knee Arthroplasty in
           the Management of Periprosthetic Joint Infection
    • Authors: Citak; Mustafa; Friedenstab, Jasmin; Abdelaziz, Hussein; Suero, Eduardo M.; Zahar, Akos; Salber, Jochen; Gehrke, Thorsten
      Abstract: imageBackground: One-stage exchange arthroplasty in the management of periprosthetic joint infection was introduced at our institution. The purpose of this study was to analyze the risk factors of failure after periprosthetic joint infection following total knee arthroplasty treated with 1-stage exchange.Methods: Ninety-one patients who underwent failed treatment following 1-stage exchange total knee arthroplasty due to periprosthetic joint infection from January 2008 to December 2017 were included. From the same period, we randomly selected a 1:1 matched control group without a subsequent revision surgical procedure. Bivariate analyses, including preoperative, intraoperative, and postoperative factors, as well as logistic regression, were performed to identify risk factors for failure.Results: Bivariate analysis yielded 10 predictors (variables with significance at p < 0.05) for failure involving re-revision for any reason and 11 predictors for failure involving re-revision for reinfection. The binary logistic regression model revealed the following risk factors for re-revision for any reason: history of a 1-stage exchange for infection (odds ratio [OR], 26.706 [95% confidence interval (CI), 5.770 to 123.606]; p < 0.001), history of a 2-stage exchange (OR, 3.948 [95% CI, 1.869 to 8.339]; p < 0.001), and isolation of enterococci (OR, 16.925 [95% CI, 2.033 to 140.872]; p = 0.009). The risk factors for reinfection in the binary logistic regression analysis were history of 1-stage or 2-stage exchange arthroplasty, isolation of enterococci, and isolation of streptococci (OR, 6.025 [95% CI, 1.470 to 24.701]; p = 0.013).Conclusions: We identified several risk factors of failure after 1-stage exchange arthroplasty for periprosthetic joint infection, most of which were not related to the patient comorbidities. Among them, previous exchange due to periprosthetic joint infection and the isolation of Enterococcus or Streptococcus species were associated with a higher risk of failure. Besides a multidisciplinary approach, being aware of the identified risk factors when evaluating patients with periprosthetic joint infection could lead to better outcomes.Level of Evidence: Prognostic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Factors Related to Patient Dissatisfaction Versus Objective Failure After
           Arthroscopic Shoulder Stabilization for Instability
    • Authors: Park; In; Kang, Jun-Seok; Jo, Yoon-Geol; Shin, Sang-Jin
      Abstract: imageBackground: After arthroscopic stabilization procedures for recurrent anterior shoulder instability, patients are not always satisfied with their shoulder, even when the operation successfully restored stability. The aim of this study was to evaluate the factors associated with subjective patient dissatisfaction after arthroscopic stabilization procedures for recurrent anterior shoulder instability and to compare these factors with those associated with objective surgical failure.Methods: A total of 195 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability were included in this study. At the 2-year postoperative visit, subjective patient dissatisfaction was assessed with a 15-point scale. Objective surgical failure was defined as postoperative dislocation or subluxation events requiring revision surgery. Several factors, including age at the first dislocation, age at the time of the operation, presence of an off-track Hill-Sachs lesion, width of the Hill-Sachs lesion, size of the glenoid bone defect, and number of instability events, were recorded. Multivariable linear regression analysis and multivariable logistic regression analysis were performed using a backward stepwise procedure as the variable selection method.Results: Fifteen patients (7.7%) had recurrent instability requiring revision surgery. In the group of 180 patients without surgical failure, the width of the Hill-Sachs lesion (regression coefficient: 0.052, p = 0.011) and number of instability events (regression coefficient: 0.103, p = 0.029) were positively correlated with subjective patient dissatisfaction, whereas concomitant repair of a SLAP (superior labrum anterior-posterior) lesion showed negative correlation (regression coefficient: −0.926, p = 0.004). In the total cohort of patients, objective surgical failure was correlated with the age at the time of the operation (odds ratio [OR]: 0.851, p = 0.042), size of the glenoid bone defect (OR: 1.172, p < 0.001), and number of instability events (OR: 1.147, p = 0.048). Other variables, including an off-track Hill-Sachs lesion or a concomitant remplissage procedure, were not correlated with subjective patient dissatisfaction or objective surgical failure.Conclusions: Factors related to subjective patient dissatisfaction differed from those related to objective surgical failure. For a better understanding of the clinical outcomes after surgery, surgeons should assess the factors that correlate with subjective patient dissatisfaction and objective surgical failure.Level of Evidence: Prognostic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Medial Unicompartmental Knee Arthroplasty for the Treatment of Focal
           Femoral Osteonecrosis
    • Authors: Greco; Nicholas J.; Lombardi, Adolph V. Jr.; Hurst, Jason M.; Morris, Michael J.; Berend, Keith R.
      Abstract: imageBackground: Previous research has indicated that unicompartmental arthroplasty may be an effective treatment for focal osteonecrosis in the knee; however, these reports have been composed of small patient cohorts and without characterization of the osteonecrotic lesions. Therefore, the purpose of this study was to investigate the effectiveness of unicompartmental arthroplasty for the treatment of focal osteonecrosis within the medial femoral condyle including an assessment of lesion size.Methods: A consecutive series of>5,000 unicompartmental knee arthroplasties performed at a single institution was retrospectively reviewed to identify cases of medial femoral condyle osteonecrosis with a minimum 2-year follow-up. Lesion size was classified according to the ratio of lesion width to condylar width, as well as lesion depth relative to condylar depth. Patient-reported outcome measures and need for a revision procedure were studied.Results: Sixty-four patients (32 males, 32 females; 65 knees) with a mean age of 64 years were included. The mean patient follow-up was 5.3 years (range, 2 to 12 years). The mean ratio of lesion width to condylar width was 64%, the mean lesion depth was 1.11 cm, and 82% of cases demonstrated subchondral collapse. At the time of the latest follow-up, patients demonstrated substantial improvements in the pain, function, and clinical components of the Knee Society Score, by 36, 25, and 51, respectively. Four patients (6%) required a revision, of which only 1 was for aseptic loosening of the femoral component.Conclusions: Unicompartmental arthroplasty is an effective treatment for advanced-stage focal osteonecrosis of the medial femoral condyle. Loss of component fixation to the femoral condyle did not appear to be a substantial concern because there was only 1 femoral failure as a result of aseptic loosening, despite lesions affecting a significant portion of the femoral condyle.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Tibiofemoral Kinematics During Compressive Loading of the ACL-Intact and
           ACL-Sectioned Knee: Roles of Tibial Slope, Medial Eminence Volume, and
           Anterior Laxity
    • Authors: Wang; Dean; Kent, Robert N. III; Amirtharaj, Mark J.; Hardy, Brendan M.; Nawabi, Danyal H.; Wickiewicz, Thomas L.; Pearle, Andrew D.; Imhauser, Carl W.
      Abstract: imageBackground: Tibial geometry and knee laxity have been identified as risk factors for both noncontact anterior cruciate ligament (ACL) rupture and instability in the setting of ACL insufficiency via clinical studies; yet, their biomechanical relationships with tibiofemoral kinematics during compressive loading are less well understood. The purpose of this study was to identify the relative contributions of sagittal tibial slope, medial tibial eminence volume, and anterior knee laxity to tibiofemoral kinematics with axial compression in both ACL-intact and ACL-sectioned cadaveric knees.Methods: Computed tomography (CT) data were collected from 13 human cadaveric knees (mean donor age, 45 ± 11 years; 8 male). Validated algorithms were used to calculate the sagittal slope of the medial and of the lateral tibial plateau as well as volume of the medial tibial eminence. Specimens were then mounted to a robotic manipulator. For both intact and ACL-sectioned conditions, the robot compressed the knee from 10 to 300 N at 15° of flexion; the net anterior tibial translation of the medial and lateral compartments and internal tibial rotation were recorded. Simple and multiple linear regressions were performed to identify correlations between kinematic outcomes and (1) osseous geometric parameters and (2) anterior laxity during a simulated Lachman test.Results: In ACL-intact knees, anterior tibial translation of each compartment was positively correlated with the corresponding sagittal slope, and internal tibial rotation was positively correlated with the lateral sagittal slope and the sagittal slope differential (p ≤ 0.044). In ACL-sectioned knees, anterior tibial translation of the medial compartment was positively associated with medial sagittal slope as well as a combination of medial tibial eminence volume and anterior laxity; internal tibial rotation was inversely correlated with anterior knee laxity (p < 0.05).Conclusions: Under compressive loading, sagittal slope of the medial and of the lateral tibial plateau was predictive of kinematics with the ACL intact, while medial tibial eminence volume and anterior laxity were predictive of kinematics with the ACL sectioned.Clinical Relevance: The relationships between tibial osseous morphology, anterior laxity, and knee kinematics under compression may help explain heightened risk of ACL injury and might predict knee instability after ACL rupture.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • The Main Predictors of Length of Stay After Total Knee Arthroplasty:
           Patient-Related or Procedure-Related Risk Factors
    • Authors: Piuzzi; Nicolas S.; Strnad, Gregory J; Sakr Esa, Wael Ali; Barsoum, Wael K.; Bloomfield, Michael R.; Brooks, Peter J.; Higuera-Rueda, Carlos A.; Joyce, Michael J.; Kattan, Michael W.; Klika, Alison A.; Krebs, Viktor; Mesko, Nathan W.; Mont, Michael A.; Murray, Trevor G.; Muschler, George F.; Nickodem, Robert J.; Patel, Preetesh D.; Schaffer, Jonathan L.; Spindler, Kurt P.; Stearns, Kim L.; Suarez, Juan C.; Zajichek, Alexander; Molloy, Robert M.; Cleveland Clinic Orthopaedic Arthroplasty Group
      Abstract: imageBackground: Often, differences in length of stay after total knee arthroplasty are solely attributed to patient factors. Therefore, our aim was to determine the influence of patient-related and procedure or structural-related risk factors as predictors of length of stay after total knee arthroplasty.Methods: A prospective cohort of 4,509 patients (54.6% of whom had Medicare for insurance) underwent primary total knee arthroplasty across 4 facilities in a single health-care system (from January 1, 2016, to September 30, 2017). Risk factors were categorized as patient-related risk factors (demographic characteristics, smoking status, Veterans RAND 12 Item Health Survey Mental Component Summary score [VR-12 MCS], Charlson Comorbidity Index, surgical indication, Knee injury and Osteoarthritis Outcome Score [KOOS], deformity, range of motion, and discharge location probability assessed by a nomogram predicting location after arthroplasty) or as procedure or structural-related risk factors (hospital site, surgeon, day of the week when the surgical procedure was performed, implant type, and surgical procedure start time). Multivariable cumulative link (proportional odds logistic regression) models were built to identify significant predictors from candidate risk factors for 1-day, 2-day, and ≥3-day length of stay. Performance was compared between a model containing patient-related risk factors only and a model with both patient-related and procedure or structural-related risk factors, utilizing the Akaike information criterion (AIC) and internally validated concordance probabilities (C-index) for discriminating a 1-day length of stay compared with>1-day length of stay.Results: Patient-related risk factors were significant predictors of length of stay (p < 0.05). A longer length of stay was predicted by older age, higher body mass index (BMI), higher Charlson Comorbidity Index, lower VR-12 MCS, and female sex. However, when the procedure or structural factors were added to the patients’ risk factors, the AIC decreased by approximately 1,670 units. This indicates that procedure or structural-related risk factors provide clinically relevant improvement in explaining length of stay in addition to patient-related risk factors.Conclusions: Despite patient-related factors such as age, sex, and comorbidities providing substantial predictive value for length of stay after total knee arthroplasty, the main driving predictors of single-day length of stay after total knee arthroplasty were procedure or structural-related factors, including hospital site and surgeon. Understanding the risk factors that affect outcomes after total knee arthroplasty provides the opportunity to influence and potentially modify them favorably to optimize care.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Long-Term Results of Treating Large Posttraumatic Tibial Plateau Lesions
           with Fresh Osteochondral Allograft Transplantation
    • Authors: Abolghasemian; Mansour; León, Sebastián; Lee, Paul T.H.; Safir, Oleg; Backstein, David; Gross, Allan E.; Kuzyk, Paul R.T.
      Abstract: imageBackground: The use of fresh osteochondral allograft (FOCA) transplantation is a treatment option for large posttraumatic tibial osteochondral defects in young, high-demand patients. We aimed to assess the long-term outcomes of this procedure and factors impacting graft survivorship.Methods: Evaluated were patients with a posttraumatic tibial plateau defect of>3 cm in diameter and>1 cm in depth who were treated with use of a FOCA, with or without a realignment osteotomy, before September 2007. The primary outcome was survivorship according to Kaplan-Meier analysis, with conversion to arthroplasty or another allograft procedure as the end point. The secondary outcome was the functional outcome of knees with a surviving FOCA, as assessed using the modified Hospital for Special Surgery (mHSS) scoring system. Multivariate Cox regression analysis of the role of potential variables was performed for both outcomes.Results: Included were 113 patients (67 female) with a mean age at the time of the index surgery of 43 years (range, 24 to 72 years) and a mean follow-up of 13.8 years (range, 1.7 to 34 years). Forty-eight conversions to arthroplasty or another FOCA procedure had been performed at a mean of 11.6 years (range, 1.7 to 34 years) after the index surgery. The remaining 65 patients had a mean follow-up of 15.5 years (range, 4.3 to 31.7 years). The mean mHSS score among those with a surviving FOCA was 85.5 (range, 56 to 100) at the most recent follow-up, which was significantly higher than the preoperative value of 69 (range, 48 to 85) (p < 0.001). Graft survivorship was 90% at 5 years, 79% at 10 years, 64% at 15 years, and 47% at 20 years. Complications included infection (1.8%), nonunion (0.9%), and knee pain from hardware (8.8%). Multivariate analysis revealed that older age at the time of surgery, involvement of the medial plateau, and a higher number of previous surgeries were inversely associated with graft survivorship. Having a Workers’ Compensation file was associated with less improvement in the mHSS score, and the score tended to decline over time for knees with a surviving FOCA.Conclusions: FOCA transplantation is a viable option for posttraumatic tibial osteochondral defects, with satisfactory survivorship and functional outcome. Although approximately half of the patients in our study demonstrated graft failure by 20 years, FOCA was an excellent option that delayed the need for arthroplasty. Older patients, those with medial defects, and those with multiple previous surgeries had a less favorable prognosis.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Cardiopulmonary Function in Patients with Congenital Scoliosis: An
           Observational Study
    • Authors: Lin; Youxi; Shen, Jianxiong; Chen, Lixia; Yuan, Wangshu; Cong, Hui; Luo, Jinmei; Kwan, Kenny Yat Hong
      Abstract: imageBackground: Patients with congenital scoliosis often have restrictive pulmonary dysfunction on static pulmonary function testing (PFT). Although frequently asymptomatic during daily activities, these patients are generally assumed to have reduced exercise capacity. The aim of this study was to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity and its association with spinal deformity in patients with congenital scoliosis.Methods: Sixty patients with congenital scoliosis who underwent preoperative spinal radiography, PFT, and CPET were included from January 2014 to November 2017. The impact of thoracic spinal deformity and rib anomalies on pulmonary function and physical capacity was investigated.Results: A significant deterioration in pulmonary function with increases in the severity of the major thoracic curve was demonstrated by the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (all p < 0.001). The ratio of FEV1 to FVC was similar regardless of thoracic curve severity. A smaller tidal volume during exercise testing reflected restrictive dysfunction in the patients with the most severe curves. CPET also revealed a significant trend of faster breathing by patients with a severe thoracic curve (p < 0.001). Exercise capacity indicators such as work rate (p = 0.019), heart rate (p = 0.015), and oxygen saturation (p = 0.006) were significantly reduced only in patients with a thoracic curve of>100°. Pulmonary dysfunction was the major contributor to exercise intolerance. Compared with mild pulmonary dysfunction, moderate and severe dysfunction was associated with an abnormal breathing pattern and lower work rate (p = 0.032) and peak oxygen intake (p = 0.042), indicating worse exercise tolerance.Conclusions: Congenital scoliosis leads to restrictive pulmonary dysfunction, which reduces the tidal volume and forces patients to accelerate respiratory rates during exercise. Patients with a thoracic curve of>100° are unable to compensate and have significantly reduced exercise capacity.Level of Evidence: Prognostic Level II. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • The Laxity of the Native Knee: A Meta-Analysis of in Vitro Studies
    • Authors: Ferle; Manuel; Guo, Ruipeng; Hurschler, Christof
      Abstract: imageBackground: Although soft-tissue balancing plays an important role in knee arthroplasty, we are aware of no objective target parameters describing the soft-tissue tension of the native knee. In the present study, we aimed to meta-analyze data from studies investigating native knee laxity to create a guide for creating a naturally balanced knee joint.Methods: PubMed and Web of Science were searched for studies with laxity data published from 1996 through 2016. Graphs were digitally segmented in cases in which numerical data were not available in text or table form. Three-level random-effects meta-analyses were conducted.Results: Seventy-six studies evaluating knee laxity at various flexion angles (0° to 90°) were included. Knee laxity was significantly different between 0° and 90° of flexion (p < 0.001) in all 6 testing directions, with mean differences of 0.94 mm and −0.35 mm for anterior and posterior translation, 1.61° and 4.25° for varus and valgus rotation, and 1.62° and 6.42° for internal and external rotation, respectively.Conclusions: Knee laxity was dependent on the flexion angle of the knee joint in all degrees of freedom investigated. Furthermore, asymmetry between anterior-posterior, varus-valgus, and internal-external rotation was substantial and depended on the joint flexion angle.Clinical Relevance: If the goal of knee arthroplasty is to restore the kinematics of the knee as well as possible, pooled laxity data of the intact soft tissue envelope could be useful as a general guide for soft-tissue balancing in total knee arthroplasty.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • What’s Important: Appreciating Serendipity
    • Authors: Chapman; Michael W.
      Abstract: No abstract available
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • EMTALA (Emergency Medical Treatment and Active Labor Act) Obligations: A
           Case Report and Review of the Literature
    • Authors: Zhou; Joanne Y.; Amanatullah, Derek F.; Frick, Steven L.
      Abstract: imageBackground: The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 in the United States to address “patient dumping,” or refusing to provide emergency care to patients and instead transferring them to other hospitals. Under EMTALA, the “reverse-dumping” provision prevents hospitals from refusing patients who require specialized capabilities or facilities if the hospital has the capacity to treat them. Despite this provision, patients continue to be transferred to distant tertiary care centers.Methods: We reviewed the literature on EMTALA in the context of a critically ill woman with an infection associated with an orthopaedic implant who was rejected from 2 geographically closer tertiary care centers and was ultimately transferred by helicopter ambulance to an academic teaching hospital that was 169 miles away from her home.Results: After transfer to our tertiary care, level-I trauma center, the patient spent 61 days in the intensive care unit; she required 9 operative procedures, which totaled 1,520 minutes of operative time. Eighteen medical specialties and 8 ancillary medical consulting teams were involved in her care. She underwent 1,436 laboratory and 83 radiographic studies. The total reimbursement from Medi-Cal (California’s Medicaid program) for her care in our tertiary care center was $463,753; the hospital charges were more than tenfold higher.Conclusions: Dumping and reverse dumping continue despite compromise of patient care and the high financial burden of the accepting institutions. This may be due to ineffective monitoring and enforcement, lack of uniformity among the courts, and lack of incentive to receive uninsured or poorly funded patients. Under EMTALA, it is difficult for tertiary care centers to argue lack of specialized capabilities or capacity to accept patients, and neither hospitals nor physicians are compensated for the charges of providing care to uninsured or underinsured patients. Moving forward, efforts to better align financial incentives through cost-sharing between community hospitals and tertiary care centers, increased clinician literacy regarding the provisions of EMTALA, and increased transparency with hospital transfers may help improve EMTALA compliance and patient care.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Orthopaedic Faculty and Resident Sex Diversity Are Associated with the
           Orthopaedic Residency Application Rate of Female Medical Students
    • Authors: Okike; Kanu; Phillips, Donna P.; Swart, Eric; O’Connor, Mary I.
      Abstract: imageBackground: The representation of women in orthopaedics in the United States remains among the lowest in all fields of medicine, and prior research has suggested that this underrepresentation may stem from lower levels of interest among female medical students. Of the many proposed reasons for this lack of interest, the male-dominated nature of the field is one of the most commonly cited. The purpose of this study was to determine the degree to which the representation of women among orthopaedic faculty and residents influences female medical students at that institution to apply for a residency in orthopaedics.Methods: Using data provided by the Association of American Medical Colleges, we identified all U.S. medical schools that were affiliated with an orthopaedic surgery department and an orthopaedic surgery residency program (n = 107). For each institution, data on the representation of women among the orthopaedic faculty and residents from 2014 through 2016 were collected, as well as data on the proportion of female medical school graduates who applied to an orthopaedic residency program from 2015 through 2017. The association between institutional factors and the female medical student orthopaedic application rate was assessed.Results: Of 22,707 women who graduated from medical school during the 3-year study period, 449 (1.98%) applied to an orthopaedic surgery residency program. Women who attended medical school at institutions with high orthopaedic faculty sex diversity were more likely to apply for a residency in orthopaedics (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.04 to 1.64; p = 0.023), as were women who attended medical school at institutions with high orthopaedic resident sex diversity (OR, 1.30; 95% CI, 1.05 to 1.61; p = 0.019).Conclusions: In this study, we found that increased sex diversity among orthopaedic faculty and residents was associated with a greater likelihood that female medical students at that institution would apply for an orthopaedic residency. These results suggest that at least some of the factors currently impeding female medical student interest in orthopaedics may be modifiable. These findings may have important implications for efforts to improve the sex diversity of the field of orthopaedics going forward.
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • A Changing View: How Should We Define Our Goals with Rotator Cuff Tear
           Treatment': Commentary on an article by Stefan Moosmayer, MD, PhD, et
           al.: “At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy
           in the Treatment of Small and Medium-Sized Rotator Cuff Tears”
    • Authors: Keener; Jay D.
      Abstract: No abstract available
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Steeper Tibial Slopes, Like Steeper Ski Slopes, Might Lead to More ACL
           Stress and Tears: Commentary on an article by Dean Wang, MD, et al.:
           “Tibiofemoral Kinematics During Compressive Loading of the ACL-Intact
           and ACL-Sectioned Knee. Roles of Tibial Slope, Medial Eminence Volume, and
           Anterior Laxity”
    • Authors: LaPrade; Robert F.
      Abstract: No abstract available
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Procedure-Related Risk Factors May Be More Important in Predicting Length
           of Stay After Total Knee Arthroplasty: Commentary on an article by the
           Cleveland Clinic Orthopaedic Arthroplasty Group, “The Main Predictors of
           Length of Stay After Total Knee Arthroplasty. Patient-Related or
           Procedure-Related Risk Factors”
    • Authors: Delanois; Ronald E.; Mistry, Jaydev B.; Etcheson, Jennifer I.; Gwam, Chukwuweike U.
      Abstract: No abstract available
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
  • Erratum: Embracing Differences to Improve Success: American Orthopaedic
           Association Presidential Address, Boston, Massachusetts, June 23, 2017
    • Abstract: No abstract available
      PubDate: Wed, 19 Jun 2019 00:00:00 GMT-
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