TRIA Orthopaedic Center

Patellofemoral instability (PFI) is common in adolescents and may require surgical treatment. Patient-reported outcome scores (PROs) are frequently used to evaluate outcomes after treatment. Commonly used PROs for PFI include disease-specific Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) and region-specific measures such as the Kujala Anterior Knee Pain Scale (Kujala), Pediatric International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS). The study aimed to compare the performance of disease-specific and region-specific PROs in adolescents after PFI surgery, and to evaluate their sensitivity to change. It was hypothesized that disease-specific PROs would perform better than region-specific PROs. Case series; Level of evidence, 4. The JUPITER (Justifying Patellar Instability Treatment by Early Results) study database was used to evaluate PROs in 256 adolescents (263 knees) aged ≤18 years who underwent surgical treatment for PFI. Four commonly used PRO scores were analyzed at baseline and at least 1 year postoperatively. Statistical analysis included comparisons between pre- and postoperative scores, calculation of minimal clinically important difference (MCID), correlations among the 4 scores, and evaluation of their sensitivity to change, floor effects, and ceiling effects. The median age was 15 years. Isolated medial patellofemoral ligament reconstruction was the most common procedure. The mean BPII 2.0 scores were lower at baseline and postoperatively, and showed the most substantial change at 1-year follow-up. There was a moderate correlation between the BPII 2.0 and the Kujala, Pedi-IKDC, and KOOS scores, and a strong correlation among the latter 3 scores. All scores were more sensitive to change among those at the lower 50th percentile of baseline scores. The BPII 2.0 was the only PRO that did not exhibit ceiling effects at follow-up. When comparing the performance of disease-specific (BPII 2.0) and region-specific (Kujala, Pedi-IKDC, and KOOS) PROs, the BPII 2.0 was found to be the most sensitive to change after PFI surgery in adolescents, and the only scale that did not have a ceiling effect at baseline and 1-year follow-up. There was a moderate correlation-and thus limited interchangeability-between the BPII 2.0 and the Kujala, Pedi-IKDC, and KOOS scores, both at baseline and at 1-year follow-up, and a strong correlation among the latter 3 knee-specific PROs. The BPII 2.0 should be considered the PRO of choice when evaluating adolescent patients with PFI.

ABSTRACTObjectives:The purpose was to report pre–COVID-19 and post–COVID-19 trends in training and job searches for recent orthopaedic trauma fellowship graduates. The pandemic occurred within the survey period, so the aim was to evaluate the pandemic's effects, particularly regarding training and jobs. It was hypothesized that the pandemic and other societal changes that occurred during the survey period had broad-reaching effects on graduate medical education and job selection for graduating traumatologists, including fewer surgical repetitions, strained interviews, and altered trends in job characteristic prioritization extending beyond the pandemic.Design:Cross-sectional survey.Setting:Orthopaedic Trauma Association (OTA/AO) surveys.Participants:Orthopaedic surgeons who graduated from United States (US) trauma fellowships from 2017 to 2023 were eligible.Main Outcome Measurement:A 56-question survey was emailed to recent trauma fellowship graduates assessing training, job searches, and job types selected.Results:In total, 240/600 (40%) orthopaedic surgeons who graduated from US trauma fellowships from 2017 to 2023 participated. Most (68%) trained at academic level 1 trauma fellowships. Of 2020–2023 graduates, 52% reported lighter caseloads, while 27% felt telehealth made their clinical experience less valuable. Many (42%) reported fewer jobs. Sought-after job characteristics included 51–70 work hours/wk (63%), 4–6 night-calls/month (36%), and 401–500 cases/year (27%). The most common salary was $501,000–$600,000/y (22%).Conclusion:For trauma fellows, COVID-19 resulted in training disadvantages, including fewer hands-on experiences, and job search obstacles, including less employment opportunities and compensation. Recognizing trends in recently graduated traumatologists will help maximize training and enhance professional satisfaction for young surgeons.Level of Evidence:V.

Background: The purpose of this study is to determine the relationship between hand dominance and patient-reported outcomes (PROs) after operative treatment for carpometacarpal (CMC) arthritis. We hypothesized that hand dominance is not correlated with PROs. Methods: All patients who underwent primary operative treatment for end-stage CMC arthritis at a single healthcare system between April 2018 and December 2022 were eligible for this study. Our exclusion criteria included concomitant procedures, revision operations, and patients without PROs at baseline or any postoperative timepoint. Retrospective review of each patient's chart for demographics, surgical characteristics, and PROs was conducted. Results: A total of 174 patients were included in this study; of those, 123 (70.7%) were women and 88 (50.6%) had operations on their dominant hand. There was no difference in age, tourniquet time, surgical procedure, primary surgeon, type of anesthetic, or sex distribution between the 2 cohorts. There were no significant differences in baseline patient-rated wrist/hand evaluation (PRWHE) or single assessment numeric evaluation (SANE) between the 2 cohorts. The average 6-month change in PRWHE was -44.5 ± 22.6 for those with operations on their dominant hand versus -43.8 ± 23.4 for the cohort that received operations on their nondominant hand (P = .854). Average change in SANE score did not differ significantly between groups, with dominant-operative patients averaging an increase of 37.5 ± 30.6 versus 33.1 ± 32.9 in their nondominant-operative counterparts. Conclusions: This study reveals no significant difference in PROs at any time point between patients who received CMC arthroplasty on their dominant versus nondominant hand. Surgeons should counsel patients to expect similar outcomes regardless of hand dominance after operation.

The purpose of this study was to define the anatomic relationship between the femoral origin of the posterior cruciate ligament (PCL) and medial femoral condyle (MFC) osteochondritis dissecans (OCD) lesions. Ninety-four magnetic resonance imaging (MRI) studies of a series of patients with MFC OCDs seen at a single institution from 2004 to 2014 were reviewed. The distances from the center of the PCL to the center of the OCD as well as the shortest distance from the PCL to the OCD were calculated in both the sagittal and coronal planes. The orientation of the OCD relative to the PCL was noted. The median distance between the center of the PCL origin and the center of the OCD was 14 mm in the coronal plane and 11mm in the sagittal plane. The median distance from any point on the OCD to any point on the PCL origin was 3mm in both planes. The OCD was within 1cm of the PCL in all but 2 patients. 46.8% of OCD lesions were located posterior to the PCL origin in the sagittal plane. The classic medial femoral condyle OCD lesion is consistently in close proximity to the femoral origin of the PCL, and most lesions are medial and posterior to the PCL. Level III.

Thumb carpometacarpal (CMC) arthritis is common in the community. There are a variety of ways to perform CMC arthroplasty with the basic technique revolving around trapeziectomy. The purpose of this study was to identify key factors in the determination of cost of CMC arthroplasty and if procedure type affects cost. Patients from 2018 to 2022 from a single health care system who received primary CMC arthroplasty using ligament reconstruction tendon interposition (LRTI), simple suture suspensionplasty, or suture tape-based reconstruction techniques were identified. Surgical costs were determined using time-driven activity-based cost accounting. A total of 173 patients were included. The average age was 63.6 years and 70.5% (n=122) were women. The most common technique was suture suspensionplasty (n=142, 82.1%). The average surgical cost was $2,830.36±$619.41. Suture suspensionplasty had the shortest operative time, followed by LRTI, and lastly suture tape-based reconstruction (62.9±16.0, 70.7±19.6 and 102.7±16.6 minutes, respectively, P<0.001). Procedure type and anchor use predicted surgical costs (R2=0.85, P<0.001). Suture suspensionplasty had the shortest operative time and had the lowest cost of CMC arthroplasty techniques. The use of an anchor was associated with increased cost. Surgeons should keep these cost drivers in mind as they develop treatment plans. Surgeons and organizations should collaborate to provide high-value and economically-responsible care. [Orthopedics. 2025;48(4):e177-e181.].

The purpose of this study was to determine the patient-driven and surgical characteristics that drive day-of-surgery (DOS) costs for repair of isolated supraspinatus tears. All patients who underwent primary rotator cuff repair (RCR) for isolated supraspinatus tears within one health care system from 2016 to 2022 were inclusion eligible. Exclusion criteria included concomitant tear of infraspinatus, teres minor, or subscapularis; previous RCR or fractures of affected shoulder; diagnosis of rheumatoid arthritis; and incomplete baseline or 1-year patient-reported outcomes. Patient demographic information, injury characteristics, surgical technique/supplies, operative time stamps, symptomatic retear, and reoperation rates data were extracted from patients' electronic medical records and retrospectively reviewed. Time-driven activity-based costing was derived from direct and indirect DOS cost of care. A total of 236 patients who underwent primary RCR for isolated supraspinatus tears from 2016 to 2022 were included. The average DOS cost was $2,443 ± $832. The average implant cost was $1,066 ± $654, accounting for 87% of variation in DOS costs. Upon univariate analysis, depression (p = 0.045), full-thickness tears (p < 0.001), double-row repair (p < 0.001), subacromial decompression (p < 0.001), distal clavicle excision (p = 0.003), biceps tenodesis (p < 0.001), number of suture anchors (p < 0.001), and operating surgeon (p < 0.001) were associated with higher DOS costing. Multivariable linear regression analysis using characteristics that demonstrated statistical significance on univariate analysis revealed that depression, full-thickness tears, double-row repairs, subacromial decompression, distal clavicle excision, biceps tenodesis, and number of suture anchors were significant predictors of cost (p < 0.05). Significant predictors of DOS costing for isolated supraspinatus RCRs include depression, full-thickness tear, double-row repair, subacromial decompression, distal clavicle excision, biceps tenodesis, number of suture anchors, and operating surgeon. Providing surgeons with this information can enable greater cost-transparency and, in conjunction with clinical judgement and patient preference, better equip them to deliver high-quality value-based care. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Bone stress injuries, commonly referred to as stress reactions and stress fractures, represent overuse injuries to bone. These injuries result in physical limitations in activity and can be career-ending for high-level athletes. While bone stress injuries have received increased attention in recent years, international consensus is lacking on definitions, risk factors and strategies for management and prevention. This study aimed to ascertain and improve the level of agreement on bone stress injuries by utilising a three-part modified Delphi approach on (1) pathophysiology, diagnosis, terminology and classification systems; (2) risk factors, screening and prevention; and (3) management and return to sport. A multidisciplinary steering committee initiated the consensus process. A panel of 41 members from six continents was formed to complete three rounds of voting, including experts (scientists and clinicians) and representatives (athletes and coaches). Thirty-three, 28 and 28 panel members completed Delphi rounds 1, 2 and 3, respectively. Consensus was reached on 41 out of 58 statements. Findings from this Delphi study outline a multifactorial approach to identify and manage bone stress injuries and to promote bone health in athletes. This includes recommendations for diagnostic workup and treatment to assist clinicians in caring for patients with bone stress injuries. Finally, this consensus process identifies knowledge gaps and provides a framework for future research to advance the clinical care and prevention of bone stress injuries.