In 2016, 1,137 fourth year medical students submitted applications for orthopedic surgery residency positions. Students applied to an average of 79 programs, resulting in in a total of 89,846 applications being submitted for 727 first year residency positions. This ratio of 124 applications per position is two SDs above the mean relative to other medical specialties. The average applicant for orthopaedic surgery residency attends 2.4 away rotations, as attending 2 away rotations increases an applicant's odds of matching, and submits 83 applications. This excessive number of applications overburdens programs, subjects applicants to considerable costs, and diminishes the quality of fit between interviewees and programs. Eighty-three percent of program directors use step 1 United States Medical Licensing Examination scores as a screening tool to decrease the number of applications necessary for review. The average matched applicant attended 11.5 interviews, and Step 1 scores, research productivity, and Alpha Omega Alpha (AOA) status can be used to predict the number of applications necessary to obtain 12 interviews. AOA membership has the strongest influence on interview yield. Applicants report spending an average of approximately $7,000 on the interview process, and 72% borrow money to cover these costs. Post-interview contact, although forbidden by the National Resident Matching Program , has been reported by 60% to 64% of applicants.

Background:There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown.Purpose:This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury.Study Design:Descriptive epidemiological study.Methods:A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position.Results:NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05).Conclusion:In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in players with a history of previous ACL injury were retears. Skilled offensive players and linebackers had the greatest injury risk, and significantly more ACL tears occurred among interior linemen than perimeter linemen. The month of August had the highest incidence of ACL injuries, probably because of expanded roster sizes at that point in the NFL season.

These results provide the best available evidence from RCTs on pain control regimens after ACL reconstruction.

Background:Much controversy still exists surrounding graft choice in anterior cruciate ligament (ACL) reconstruction. Over the past decade, an increase in comparative studies with longer follow-up has enhanced our understanding of current graft options and outcomes.Purpose:To describe the long-term comparative outcomes of ACL reconstruction with autograft bone–patellar tendon–bone (BPTB) versus autograft hamstring (HS) ACL reconstruction with regard to clinical and radiographic outcomes.Study Design:Systematic review; Level of evidence, 2.Methods:A search of the PubMed, MEDLINE, Cochrane, and Scopus databases was performed to identify studies in the English language with outcome data comparing ACL reconstruction utilizing autograft BPTB and autograft HS; only studies with a minimum 5-year follow-up were included. Outcome data included failure and complications, manual and instrumented laxity, patient-reported outcomes, and radiographic risk of osteoarthritis.Results:Twelve studies with a total of 953 patients met the inclusion criteria. Of these studies, 8 were level 1 evidence and 2 were level 2. Mean follow-up was 8.96 years (range, 5-15.3 years). No differences in graft failure or manual or instrumented laxity were seen in any studies. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 1 and 2 studies, respectively. Two of 4 studies reporting on anterior knee pain, and 3 of 7 that recorded kneeling pain found it more frequently among BPTB patients. One study found significantly increased reoperation rates in HS patients, while another found a similar result in BPTB, and 1 study reported a significant increase in contralateral ACL tears in BPTB patients. Three of 5 studies reporting on radiographic evidence of osteoarthritis noted significantly increased rates in BPTB patients.Conclusion:This systematic review comparing long-term outcomes after ACL reconstruction with either autograft BPTB or autograft HS suggests no significant differences in manual/instrumented laxity and graft failures between graft types. An increase in long-term anterior knee pain, kneeling pain, and higher rates of osteoarthritis were noted with BPTB graft use.

Objective Intraspinal microstimulation (ISMS) is a promising method for activating the spinal cord distal to an injury. The objectives of this study were to examine the ability of chronically implanted stimulating wires within the cervical spinal cord to (1) directly produce forelimb movements, and (2) assess whether ISMS stimulation improved subsequent volitional control of paretic extremities following injury. Approach We developed a technique for implanting intraspinal stimulating electrodes within the cervical spinal cord segments C6-T1 of Long-Evans rats. Beginning 4 weeks after a severe cervical contusion injury at C4–C5, animals in the treatment condition received therapeutic ISMS 7 hours/day, 5 days/week for the following 12 weeks. Main Results Over 12 weeks of therapeutic ISMS, stimulus-evoked forelimb movements were relatively stable. We also explored whether therapeutic ISMS promotes recovery of forelimb reaching movements. Animals receiving daily therapeutic ISMS performed significantly better than unstimulated animals during behavioral tests conducted without stimulation. Quantitative video analysis of forelimb movements showed that stimulated animals performed better in the movements reinforced by stimulation, including extending the elbow to advance the forelimb and opening the digits. While threshold current to elicit forelimb movement gradually increased over time, no differences were observed between chronically stimulated and unstimulated electrodes suggesting that no additional tissue damage was produced by the electrical stimulation. Significance The results indicate that therapeutic intraspinal stimulation delivered via chronic microwire implants within the cervical spinal cord confers benefits extending beyond the period of stimulation, suggesting future strategies for neural devices to promote sustained recovery after injury.

Background:Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population.Purpose:To quantify the impact of ACL injuries on salary and career length in NFL athletes.Study Design:Cohort study; Level of evidence, 3.Methods:Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of the NFL. The main outcomes were the percentage of players remaining in the NFL and mean salary at 1, 2, 3, and 4 years after injury. Cohorts were subdivided based on initial salary: group A, <$500,000; group B, ≤$500,000 to $2,000,000; and group C, >$2,000,000. Mean cumulative earnings were calculated by multiplying the percentage of players remaining in the league by their mean salaries and compounding this each season.Results:NFL athletes suffered 219 ACL injuries from 2010 to 2013. The 7504 other player seasons in the NFL during this time were used as controls. Significantly fewer ACL-injured players than controls remained in the NFL at each time point (P < .05). In group A, significantly less ACL-injured players remained in the NFL at 1 to 3 seasons after injury (P < .05), and in group B, significantly less ACL-injured players remained in the NFL at 1 and 2 seasons after injury (P < .05). There was no significant decrease in group C. Players in groups A and B remaining in the NFL also had a lower mean salary than controls (P < .05 in season 1). The mean cumulative earnings over 4 years for ACL-injured players was $2,070,521 less per player than uninjured controls.Conclusion:On average, ACL-injured players earned $2,070,521 less than salary-matched controls over the 4 years after injury. Players initially earning less than $2 million per year have lower mean salaries and are less likely to remain in the league than uninjured controls. The careers of players initially earning over $2 million per year, meanwhile, are not negatively affected. This demonstrates the degree of negative impact these injuries have on the careers of NFL players. It also indicates that a player’s standing within the league before injury strongly influences how much an ACL injury will affect his career.

Level II, systematic review of Level I and II studies.

Background:Anterior cruciate ligament (ACL) injuries pose a significant risk to the careers of players in the National Football League (NFL). The relationships between draft round and position on return to play (RTP) among NFL players are not well understood, and the ability to return to preinjury performance levels remains unknown for most positions.Purpose:To test for differences in RTP rates and changes in performance after an ACL injury by position and draft round. We hypothesized that skilled positions would return at a lower rate compared to unskilled positions. We further hypothesized that early draft-round status would relate to a greater rate of RTP and that skilled positions and a lower draft round would correlate with decreased performance for players who return to sport.Study Design:Case-control study; Level of evidence, 3.Methods:Utilizing a previously established database of publicly available information regarding ACL tears among NFL players, athletes with ACL tears occurring between the 2010 and 2013 seasons were identified. Generalized linear models and Kaplan-Meier time-to-event models were used to test the study hypotheses.Results:The overall RTP rate was 61.7%, with skilled players and unskilled players returning at rates of 64.1% and 60.4%, respectively (P = .74). Early draft-round players and unskilled late draft-round players had greater rates of RTP compared to skilled late draft-round players and both unskilled and skilled undrafted free agents (UDFAs). Skilled early draft-round players constituted the only cohort that played significantly fewer games after an injury. Unskilled UDFAs constituted the only cohort to show a significant increase in the number of games started and ratio of games started to games played, starting more games in which they played, after an injury.Conclusion:Early draft-round and unskilled players were more likely to return compared to their later draft-round and skilled peers. Skilled early draft-round players, who displayed relatively high rates of RTP, constituted the only cohort to show a decline in performance. Unskilled UDFAs, who exhibited relatively low rates of RTP, constituted the only cohort to show an increase in performance. The significant effect of draft round and position type on RTP may be caused by a combination of differences in talent levels and in opportunities given to returning to play.