The COVID-19 global pandemic has upended nearly every medical discipline, dramatically impacted patient care and has had far-reaching effects on surgeon education. In many areas of the country, elective orthopedic surgery has completely stopped to ensure that resources are available for the critically ill and to minimize the spread of disease. COVID-19 is forcing many around the world to re-evaluate existing processes and organizations and adapt to carry out business, of which medicine and education are not immune. Most national and international orthopedic conferences, training programs, and workshops have been postponed or canceled, and we are now critically evaluating the delivery of education to our colleagues as well as residents and fellows. This article describes the evolution of orthopedic education and significant paradigm shifts necessary to continue to teach ourselves and the future leaders of our noble profession.

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The purposes of this study were 1) to carefully define the anatomic distribution of the infrapatellar branches of the saphenous nerve, 2) to provide the surgeon with reliable parameters for where the nerve is most commonly encountered, and 3) to provide specific surgical recommendations to minimize the risk of nerve injury. To accomplish these goals, we dissected 20 cadaveric, fresh-frozen, matched-pair knees. Calipers were used to measure the distance from the nerve to three clinically relevant and easily reproducible landmarks: the inferior pole of the patella, the medial border of the patella at its midpoint, and a point 2 cm medial to the patellar ligament at the level of the joint line. Distances were recorded with the knees in extension and in 90 degrees of flexion to examine the effect of dynamic knee motion on nerve position. We consistently found two main trunks of the nerve that traverse the knee primarily in a medial to lateral but somewhat proximal to distal direction. Because of this, we recommend that incisions for arthroscopy portals be made in a horizontal fashion to decrease the likelihood of nerve injury. Measured from both the inferior pole of the patella and the medial border of the patella, the nerve moved distally with knee flexion. We therefore recommend that incisions across the anterior aspect of the knee be made with the knee in flexion. In 8 of our 20 specimens, the nerve was actually found at the landmark located 2 cm medial to the patellar ligament. This is an extremely high-risk area and should be avoided if possible.

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The COVID-19 pandemic has had immediate impact on the practice of medicine and on orthopaedic education. As the practice of social distancing has been put into place to help slow the spread of disease as well as to conserve medical supplies and equipment, elective surgery has come to a grinding halt. This dramatic change has forced our leaders to evaluate critically the delivery of education and skills training for our residents, fellows and all orthopaedic surgeons. We must continue to develop technologies, such as virtual meeting platforms, distance learning, simulation-based training, virtual reality and augmented reality to open up the new world of orthopaedic education.

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This retrospective study evaluated outcome and associated complications in 48 patients with 50 knee dislocations treated between 1968 and 1993. Average follow-up was 8.3 years. Thirty-one knees underwent operative treatment, and 19 knees underwent nonoperative treatment. Open dislocations occurred in 26% of knees, and associated injuries occurred in 58%. Peroneal nerve injuries occurred most frequently (36%), followed by popliteal artery injuries (24%). Six knees treated nonoperatively required either aboveknee amputation (4) or knee arthrodesis (2). Mean Lysholm at follow-up was 80.2 and Hospital for Special Surgery (HSS) score was 76.8. Differences in HSS score (P = .001), Lysholm score (P = .007), pain with rest, knee flexion, and return to athletics were statistically significant between patients treated operatively and nonoperatively, with operative patients scoring better. Patients treated surgically were less likely to develop severe radiographic degenerative changes. These findings demonstrate patients treated operatively for knee dislocations have better functional results.[J Knee Surg. 2008;21:261-268.]