Banff Centre

Patient-reported outcome measures are essential tools for assessing function and quality of life. The Banff Patellofemoral Instability Instrument Version 2.0 (BPII 2.0) is specifically designed to evaluate adolescents and adults experiencing patellofemoral instability (PFI). Because no French version was available, this study aimed to translate and validate a Canadian-French (CF) version of the BPII 2.0. Cohort study (Diagnosis); Level of evidence, 3. The BPII 2.0 was translated using a forward-backward translation method (BPII 2.0-CF), following guidelines from the American Association of Orthopaedic Surgeons and the Institute for Work & Health. Participants aged ≥14, fluent in French, and with a confirmed diagnosis of PFI were included. Patients completed the questionnaire at their initial consultation, 7 days later, and 6 months after treatment. Construct validity was assessed through Spearman correlation with the Kujala score. Internal consistency was evaluated using the Cronbach alpha coefficient, and test-retest reliability using the intraclass correlation coefficient (ICC). Responsiveness to change was analyzed using the Wilcoxon signed-rank test and the corresponding effect size r. A total of 45 participants were included (female, n = 33; 73%), with a median age of 21 years (range, 14-54). The median symptom duration before consultation was 48 months (range, 0.5-480.0). Mean ± SD BPII 2.0-CF scores were 38.46 ± 14.48 (N = 45), 39.52 ± 15.99 (n = 34), and 60.99 ± 20.24 (n = 29) at baseline, day 7, and 6 months after surgery, respectively. No floor or ceiling effects were observed. The construct validity of the translated BPII 2.0 and the French Kujala score at baseline was fair and statistically significant (r = 0.56; 95% CI, 0.28-0.77; P < .001). Internal consistency was acceptable with Cronbach alpha coefficient of .87. Retest reliability was good with an ICC of 0.75 (95% CI, 0.56-0.87; P < .001), and the response to change showed strong reactivity with an effect size of 0.79 (95% CI, 0.60-0.90; P < .001). The CF version of the BPII 2.0 is a valid, reliable, and appropriate tool for assessing patients with PFI. The rigorous translation and validation process supports its use in Francophone clinical settings.

The purpose of this study was to investigate the relationships between career burnout and the barriers to gender equity identified by Canadian female orthopaedic surgeons. A secondary purpose was to assess relationships between the female surgeons' demographic characteristics and career burnout and job satisfaction. An electronic survey was distributed to 330 Canadian female orthopaedic surgeons. Demographic variables including age, stage and years of practice, practice setting, and marital status were collated. The survey included the Gender Bias Scale (GBS) questionnaire and two questions each about career burnout and job satisfaction. Pearson r correlation coefficient evaluated the relationships between the higher- and lower-order factors of the GBS, burnout, and job satisfaction. Spearman rank correlation coefficient assessed relationships between burnout, job satisfaction, and demographic variables. Survey responses were received from 218/330 (66.1%). Agreement or strong agreement for career burnout was reported by 110/218 (50.5%) of the surgeons (median=4). Burnout was positively correlated with the GBS higher-order factors of Male Privilege (r=0.215, p&lt;.01), Devaluation (r=0.166, p&lt;.05), and Disproportionate Constraints (r=0.152, p&lt;.05). Job satisfaction was reported by 168/220 (77%) of the surgeons (median 4), and 66% were also satisfied or very satisfied with their role in the workplace (median 4). Burnout was significantly negatively correlated to surgeon age and job satisfaction. Over 50% of female orthopaedic surgeons reported symptoms of career burnout. Statistically significant relationships were evident between burnout and barriers to gender equity. Identification of the relationships between gender-equity barriers and burnout presents an opportunity to modify organizational systems to dismantle barriers and reduce this occupational syndrome.

The purpose of this study was to evaluate patient engagement with, and acceptability of, a digital exercise program for primary anterior cruciate ligament (ACL) reconstruction during the first 6-months post-operative. A secondary purpose was to determine if engagement with the digital exercise program also improved overall patient involvement in rehabilitation. Patients that underwent primary ACL reconstructive (ACLR) surgery between 2019 and 2021 were enrolled in PhysioAid and received an email-delivered digital ACL rehabilitation exercise program. The customised ACLR PhysioAid program was provided in addition to the standard rehabilitation protocol. The digital program delivered 12 phases of exercise prescription videos every 2 &amp; 3 weeks for 35 weeks post-operative. Patient engagement with PhysioAid was measured by the number of exercise prescriptions opened. Patient acceptability of PhysioAid was evaluated via an online questionnaire. Overall patient engagement was measured by number of email queries related to rehabilitation, completion of 6-month post-operative ACL-QOL questionnaire, and attendance at the 6-month post-operative functional testing clinic. Data was descriptively analysed using means, SD and qualitative measures. Four hundred and fifty patients were enrolled in the PhysioAid program. Two hundred and eighty-nine patients (64%) accessed at least one exercise prescription, with 49% accessing 6 or more of the 12 prescriptions. Overall, 242 patients (54%) responded to the online survey, with 221 (49%) returning completed questionnaires. Of the patients that accessed PhysioAid, 62% responded to the online questionnaire, compared with 39% that did not access any exercise prescriptions. Of those respondents, 80% responded they followed the PhysioAid exercise prescriptions. In addition, 75% of respondents indicated that they found the prescriptions helpful in someway, with 86% responding they accessed the prescriptions over the 6-month period with a frequency of about 30% or greater. Most respondents (61%) also agreed that the PhysioAid exercise prescriptions were an essential part of their rehabilitation program due to COVID-19 restrictions. Patients that accessed PhysioAid exercise prescriptions were more likely to send email queries regarding their rehabilitation compared to those that didn't access the program (24.2% versus 14.9%), were more likely to complete their 6-month post-operative ACL-QOL questionnaire (40.8% versus 28.0%), and attend their scheduled 6-month functional testing clinic (49.8% versus 39.1%). The addition of a digital rehabilitation program to the standard-of-care protocol increased patient engagement with their rehabilitation. Patients who accessed the exercise prescriptions were more likely to attend the 6-month post-operative appointment and complete the ACL-QOL. Further research is needed to determine if the incorporation of a digital exercise program during ACLR rehabilitation improves patient outcomes.

Background:One of the most consistent pathoanatomic findings in lateral patellofemoral instability is trochlear dysplasia. Trochleoplasty is a procedure designed to deepen the trochlear groove, thus correcting trochlear pathoanatomy and improving patellofemoral tracking.Indications:Patients with high-grade trochlear dysplasia that includes anteriorization of the floor of the trochlear groove (trochlear bump >5 mm), with lateral patellofemoral instability.Technique Description:The technique described is a thin flap trochleoplasty. By an open lateral parapatellar approach, trochlear cartilage is elevated. A new groove is created by removing subchondral bone with a burr. The cartilage flap is then reduced on the subchondral bone, and gentle pressure is applied to the cartilage. Plastic deformity occurs, and the cartilage is fixed with bioabsorbable nails. This technique should be accompanied by a stabilizing procedure, such as a medial patellofemoral ligament reconstruction.Results:Thin-flap trochleoplasty has low redislocation rates (3%-4%) in appropriately selected patients. Multiple clinical studies and meta-analyses have shown good postoperative patient-reported outcome scores and improved postoperative knee scores. There is a high rate of patient satisfaction, return to work, and return to sports following surgery (>85%). Notable complications include patellofemoral osteoarthritis (7%-18%), knee ankylosis (4.4%), and the need for additional surgery (8%-11%). However, the risk of complications seems to be similar to other patellar-stabilizing procedure.Discussion/Conclusion:Trochleoplasty is a technically demanding surgical procedure but is safe, reliable, and effective in appropriately selected patients.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: Trochlear dysplasia is present in 68% to 85% of patients with recurrent lateral patellofemoral instability (LPI) compared with 3% to 6% of healthy controls. Trochlear dysplasia has been associated with medial patellofemoral ligament (MPFL) graft failure and lower quality-of-life (QOL) outcome scores. The correction of trochlear dysplasia with trochleoplasty is indicated in patients with recurrent LPI and high-grade trochlear dysplasia with a trochlear bump and a significant J-sign. Purpose: To assess the clinical and patient-reported outcomes after patella-stabilizing surgery, including thin flap sulcus deepening trochleoplasty, and to explore the influence of pathoanatomic variables on postoperative QOL scores in patients who have undergone patellar stabilization, including trochleoplasty. Study Design: Case series; Level of evidence, 4. Methods: A total of 63 consecutive knees in 46 patients with recurrent LPI and high-grade trochlear dysplasia who underwent MPFL reconstruction with thin flap trochleoplasty were followed for 2 years postoperatively. Clinical outcomes and Banff Patellofemoral Instability Instrument (BPII) 2.0 scores were collected prospectively. The t test was used to determine changes in QOL. Multiple linear regression was conducted to determine significant pathoanatomic variables that affected outcomes after MPFL reconstruction. Results: Overall, 63 knees with a mean follow-up of 32.9 ± 17.0 months (range, 12-84 months) were included. All patients had preoperative high-grade trochlear dysplasia (Dejour type B: 46%; Dejour type D: 54%), with a mean trochlear bump height of 6.1 ± 1.8 mm (range, 3.2-10.5 mm). The BPII 2.0 score increased significantly from preoperatively (29.3 ± 12.4) to postoperatively (71.8 ± 17.4) (P < .001), with a large effect size (Cohen d = −2.41). There was 1 redislocation (1.6%) and 3 reoperations (4.8%). Persistent apprehension and the J-sign were present in 8.5% and 13.6% of the knees, respectively. Multiple linear regression analysis demonstrated no statistically significant predictive relationship between the 24-month postoperative BPII 2.0 score and the preoperative BPII 2.0 score, tibiofemoral rotation, the Beighton score, or trochlear bump height (R = 0.47; R2 = 0.22; F = 5.23; P = .13). Conclusion: Thin flap trochleoplasty combined with MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in low redislocation and reoperation rates at a mean of 33 months. Disease-specific QOL scores were statistically significantly improved from preoperatively to postoperatively.

➤ Extended reality is a term that encompasses different modalities, including virtual reality, augmented reality, and mixed reality.➤ Although fully immersive virtual reality has benefits for developing procedural memory and technical skills, augmented and mixed reality are more appropriate modalities for preoperative planning and intraoperative utilization.➤ Current investigations on the role of extended reality in preoperative planning and intraoperative utilization are still in the early stages, but preliminarily show that extended reality technologies can help surgeons to be more accurate and efficient.

Orthopaedic surgery is the surgical specialty with the lowest proportion of women. Conflicting evidence regarding the potential challenges of pregnancy and parenthood in orthopaedics, such as the implications of delayed childbearing, may be a barrier to recruitment and retainment of women in orthopaedic surgery. A summary of studies is needed to ensure that women who have or wish to have children during their career in orthopaedic surgery are equipped with the relevant information to make informed decisions. In this systematic review, we asked: What are the key gender-related barriers pertaining to (1) family planning, (2) pregnancy, and (3) parenthood that women in orthopaedic surgery face? Embase, MEDLINE, and PsychINFO were searched on June 7, 2021, for studies related to pregnancy or parenthood as a woman in orthopaedic surgery. Inclusion criteria were studies in the English language and studies describing the perceptions or experiences of attending surgeons, trainees, or program directors. Studies that sampled surgical populations without specific reference to orthopaedics were excluded. Quantitative and qualitative analyses were performed to identify important themes. Seventeen articles including surveys (13 studies), selective reviews (three studies), and an environmental scan (one study) met the inclusion criteria. The population sampled included 1691 attending surgeons, 864 trainees, and 391 program directors in the United States and United Kingdom. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices tool was used to evaluate the risk of bias in survey studies. A total of 2502 women and 560 men were sampled in 13 surveys addressing various topics related to pregnancy, parenthood, and family planning during an orthopaedic career. Three selective reviews provided information on occupational hazards in the orthopaedic work environment during pregnancy, while one environmental scan outlined the accessibility of parental leave policies at 160 residency programs. Many of the survey studies did not report formal clarity, validity, or reliability assessments, therefore increasing their risk of bias. However, our analysis of the provided instruments as well as the consistency of identified themes across multiple survey studies suggests the evidence we aggregated was sufficiently robust to answer the research questions posed in the current systematic review. These data revealed that many women have witnessed or experienced discrimination related to pregnancy and parenthood, at times resulting in a decision to delay family planning. In one study, childbearing was reportedly delayed by 67% of respondents (304 of 452) because of their career choice in orthopaedics. Orthopaedic surgeons were more likely to experience pregnancy complications (range 24% to 31%) than the national mean in the United States (range 13% to 17%). Lastly, despite these challenging conditions, there was often limited support for women who had or wished to start a family during their orthopaedic surgery career. Maternity and parental leave policies varied across training institutions, and only 55% (56 of 102) of training programs in the United States offered parental leave beyond standard vacation time. The potential negative effects of these challenges on the orthopaedic gender gap can be mitigated by increasing the availability and accessibility of information related to family planning, parental leave, and return to clinical duties while working as a woman in orthopaedic surgery. Future research could seek to provide a more global perspective and specifically explore regional variation in the environment faced by pregnancy or parenting women in orthopaedic surgery. Level III, prognostic study.

Tailings management is multifaceted in its ultimate goal of zero harm to people and the environment, in line with the Global Industry Standard on Tailings Management (GISTM). Gold Fields is committed to conforming with the GISTM and achieving its environment, social and governance (ESG) priorities, of which one is investigating the feasibility of tailings innovation projects, such as the tailings moisture content reduction. There is significant mining industry interest in developing geo-stable tailings storage facilities, combining tailings and mine waste to form a geochemically and physically stable landform. However, while geo-stable materials are a topic of industry-wide interest, there is a lack of a sound knowledge base and testing protocols to assess, compare and validate the performance of different technical approaches across different mineralogical and operational situations. The paper presents the characterisation of material used to construct geo-stable tailings and waste rock management facilities and the performance of such facilities at the trial pad scale. The ultimate aim in the commingling journey at this site is to form single-footprint waste management systems with a reduced total footprint area compared to constructing separate tailings storage facilities and waste rock dumps. The material characteristics, operational environment, trial pad construction, placement and testing methods will be discussed as part of this initial step in the geo-waste journey.