Elizabeth Matzkin

Adequacy of Education in Musculoskeletal Medicine

BACKGROUND Basic musculoskeletal knowledge is essential to the practice of medicine. A validated musculoskeletal cognitive examination was given to medical students, residents, and staff physicians in multiple disciplines of medicine to assess the adequacy of their musculoskeletal medicine training. METHODS The examination was given to 334 volunteers consisting of medical students, residents, and staff physicians. Analysis of the data collected and comparisons across disciplines were performed. RESULTS The average cognitive examination score was 57%. Sixty-nine participants (21%) obtained a score of >/=73.1%, the recommended mean passing score. Of the sixty-nine with a passing score, forty (58%) were orthopaedic residents and staff physicians with an overall average score of 94%. Differences in the average scores for the orthopaedic residents compared with all other specialties were significant (p < 0.001). The average score was 69% for the 124 participants who stated that they had taken a required or an elective course in orthopaedics during their training compared with an average score of 50% for the 210 who had not taken an orthopaedic course (p < 0.001). When the scores of those in orthopaedics were excluded, the average score for the participants who had taken an orthopaedic course was 59%; this difference remained significant (p < 0.001). CONCLUSIONS Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination. This suggests that training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs. Among the nonorthopaedists, scores were significantly better if they had taken a medical school course or residency rotation in orthopaedics, suggesting that a rotation in orthopaedics would improve the general level of musculoskeletal knowledge.

American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee.

Summary of Recommendations The following is a summary of the recommendations in the AAOS’ clinical practice guideline, The Treatment of Osteoarthritis (OA) of the Knee. This guideline was explicitly developed to include only treatments less invasive than knee replacement (arthroplasty). This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will also see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility. This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician and other healthcare practitioners. Patient Education and Lifestyle Modification

The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition.

The AAOS Evidence-Based Guideline on Treatment of Osteoarthritis of the Knee, 2nd Edition, includes only less-invasive alternatives to knee replacement. This brief summary of the AAOS Clinical Practice Guideline contains a list of the recommendations and the rating of strength based on the quality of the supporting evidence. Discussion of how each recommendation was developed and the complete evidence report are contained in the full guideline at www.aaos.org/guidelines. ### Conservative Treatments: Recommendations 1-6 #### RECOMMENDATION 1 We recommend that patients with symptomatic osteoarthritis of the knee participate in self-management programs, strengthening, low-impact aerobic exercises, and neuromuscular education; and engage in physical activity consistent with national guidelines. Strength of Recommendation: Strong #### RECOMMENDATION 2 We suggest weight loss for patients with symptomatic osteoarthritis of the knee and a BMI ≥25. Strength of Recommendation: Moderate #### RECOMMENDATION 3A We cannot recommend using acupuncture in patients with symptomatic osteoarthritis of …

Revision knee arthroplasty with patella replacement versus bony shell.

A study was undertaken to assess the clinical results of revision total knee arthroplasty in which an unresurfaced bony shell was left after removing a patellar component versus those in which a patellar component was implanted. Followup was obtained in 123 of 130 consecutive revision total knee replacements (94%) from three centers. In 21 knees a shell of patellar bone was left and 92 knees had a patellar component in place. Ten patients had a patellectomy and were excluded from consideration. The group with the bony shell had a lower postoperative knee score but the preoperative Knee Society clinical score was significantly lower as well in this group of patients. Compared with the group of patients with the patellar component in place, the group of patients with knees left with a bony shell had a significantly higher percentage of patients who had difficulty using stairs, a higher percentage of patients who were not satisfied with their surgery, and a higher percentage of patients who rated their surgery as unsuccessful in returning them to normal daily activities. When a patellar component was not able to be implanted in revision total knee arthroplasty, a lower quality result was observed.

Barbed Versus Traditional Sutures: Closure Time, Cost, and Wound Related Outcomes in Total Joint Arthroplasty

The purpose of this study was to compare barbed sutures to traditional sutures in three domains: time, cost, and wound related outcomes in total knee arthroplasty (TKA) and total hip arthroplasty (THA). A total of 34 patients were enrolled in a prospective randomized controlled trial to assess time to wound closure and cost. In addition, a retrospective chart review of an additional 100 patients was conducted to further assess wound-related outcomes. On average, barbed sutures decreased time to wound closure by 9.72 min (P<0.05) after controlling for length of incision, patients BMI and number of physicians closing. Further, using barbed sutures saved an average of

Barefoot Running: Does It Prevent Injuries?

549.59 per case. However, increased frequency and severity of wound complications were associated with barbed sutures.

A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications.

Endurance running has evolved over the course of millions of years and it is now one of the most popular sports today. However, the risk of stress injury in distance runners is high because of the repetitive ground impact forces exerted. These injuries are not only detrimental to the runner, but also place a burden on the medical community. Preventative measures are essential to decrease the risk of injury within the sport. Common running injuries include patellofemoral pain syndrome, tibial stress fractures, plantar fasciitis, and Achilles tendonitis. Barefoot running, as opposed to shod running (with shoes), has recently received significant attention in both the media and the market place for the potential to promote the healing process, increase performance, and decrease injury rates. However, there is controversy over the use of barefoot running to decrease the overall risk of injury secondary to individual differences in lower extremity alignment, gait patterns, and running biomechanics. While barefoot running may benefit certain types of individuals, differences in running stance and individual biomechanics may actually increase injury risk when transitioning to barefoot running. The purpose of this article is to review the currently available clinical evidence on barefoot running and its effectiveness for preventing injury in the runner. Based on a review of current literature, barefoot running is not a substantiated preventative running measure to reduce injury rates in runners. However, barefoot running utility should be assessed on an athlete-specific basis to determine whether barefoot running will be beneficial.

Prevalence of Internet and social media usage in orthopedic surgery

Arthroscopic or open shoulder surgery can be performed using the lateral decubitus or beach-chair position. Advantages of the lateral decubitus position include better visualization and instrument access for certain procedures and decreased risk for cerebral hypoperfusion. Complications associated with this position include traction injuries, resulting in neurapraxia, thromboembolic events, difficulty with airway management, and the potential need to convert to an anterior open approach. One advantage of the beach-chair position is easier setup from a supine to upright position, which allows the surgeon the option to convert to an open procedure if necessary. Although rare, patients in this position may experience cerebral hypoperfusion and complications that range from cranial nerve injury to infarction. Other complications related to this position include cervical traction neurapraxia, blindness, and cardiac and embolic events. The surgeon must be cognizant of the complications associated with both positions and take extra care in the initial patient setup and coordination with the anesthesiologist to minimize the risk of complications and morbidity.

Trevorʼs disease: the clinical manifestations and treatment of dysplasia epiphysealis hemimelica

Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752) between December 2012 to January 2013 in a major academic orthopaedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopaedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9%) relative to other services (9.8-17.9%) and was statistically higher when compared to the joints/tumor service (P<0.0001). Younger age was the biggest indicator predicting the use of social media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day’s travel (120-180 miles) to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals.

Female Athlete Triad: Past, Present, and Future

Trevors disease is a rare abnormality characterized by aberrant osteocartilaginous growth from an epiphysis. We describe six new cases from our institution. A patient with isolated tibial tuberosity involvement is described for the first time. Each patient was classified according to Azouz into localized (three), classical (two) and generalized (one) form. We recommend that parents be counseled regarding the progressive nature of this disorder owing to the chance of worsening deformity with surgical excision alone, and the need to be followed until skeletal maturity.