The COVID-19 global pandemic presents a challenge to orthopaedic education. Around the world, including in the United States, elective surgeries are being deferred and orthopaedic residents and fellows are being asked to make drastic changes to their daily routines. In the midst of these changes are unique opportunities for resident/fellow growth and development. Educational tools in the form of web-based learning, surgical simulators, and basic competency tests may serve an important role. Challenges are inevitable, but appropriate preparation may help programs ensure continued resident growth, development, and well-being while maintaining high-quality patient care.

Background As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their pre-injury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. Purpose The purpose of this review is to summarize the literature reporting on variables proposed to be associated with return to sport following anterior cruciate ligament reconstruction. Study Design Systematic Review Methods Medline, Embase, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: 1) included patients with primary ACLR, 2) reported at least one knee impairment, function or psychological measure, 3) reported a return to sport measure and 4) analyzed the relationship between the measure and return to sport. Results Weak evidence existed in sixteen articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher pre-operative knee self-efficacy, lower kinesiophobia and higher pre-operative self-motivation. Conclusion Weak evidence supports an association between knee impairment, functional, and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilizing evidence-based return to sport guidelines following ACLR may ensure athletes are physically and psychologically capable of sports participation, which may reduce re-injury rates and the need for subsequent surgery.

In this survey study of trauma and F&A surgeons, significant variation existed regarding most aspects of posterior malleolar ankle fracture treatment. Most notably, factors other than fragment size most impacted surgical indications. Newer techniques such as direct exposure and plating of the posterior malleolus are chosen more frequently than traditional techniques of indirect reduction and percutaneous screw fixation.

Peripheral T-cell lymphomas (PTCL) are uniquely vulnerable to epigenetic modifiers. We demonstrated in vitro synergism between histone deacetylase inhibitors and DNA methyltransferase inhibitors in preclinical models of T-cell lymphoma. In a phase 1 trial we found oral 5-azacytidine (AZA) and romidepsin (ROMI) to be safe and effective, with lineage-selective activity among patients with relapsed/refractory (R/R) PTCL. Patients with treatment-naïve (TN) or R/R PTCL received AZA 300 mg daily, days 1-14 and ROMI 14 mg/m2, days 8, 15, and 22, every 35 days. The primary objective was overall response rate (ORR). Targeted next-generation sequencing was performed on tumor samples to correlate mutational profiles and response. Among 25 enrolled patients the ORR and complete response rates were 61% and 48%, respectively. However, patients with T-follicular helper cell (tTFH) phenotype exhibited higher ORR (80%) and complete remission rate (67%). The most frequent grade 3-4 adverse events were thrombocytopenia (48%), neutropenia (40%), lymphopenia (32%) and anemia (16%). At a median follow-up of 13.5 months the median PFS, DOR, and OS were 8.0 months, 20.3 months, and not reached, respectively. The median PFS and OS were 8.0 months and 20.6 months, respectively, in patients with R/R disease. Patients with tTFH enjoyed a particularly long median survival (median not reached). Responders harbored a higher average number of mutations in genes involved in DNA methylation and histone deacetylation. Combined AZA and ROMI are highly active in PTCL patients and could serve as a platform for novel regimens in this disease. The trial was registered at www.clinicaltrials.gov, #NCT01998035