Background: Reported infection rates following anterior cruciate ligament (ACL) reconstruction are low, but infections are associated with high morbidity including reoperations and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with a vancomycin irrigant. Methods: All ACL reconstructions performed between May 2009 and August 2018 at a single academic institution were reviewed and categorized based on vancomycin use. Patients with <90-day follow-up, intraoperative graft preparation with an antibiotic other than vancomycin, or previous ipsilateral knee infection were excluded. Infection was defined as a return to the operating room for irrigation and debridement within 90 days after ACL reconstruction. Descriptive and inferential statistical analysis using t tests and Poisson regression were performed, with significance defined as p < 0.05. Results: In total, 1,640 patients (952 males; 58.0%) with a mean age (and standard deviation) of 27.7 ± 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%), whereas 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin. In total, 11 reconstructions (0.7%) were followed by infection, which occurred in 10 (1.2%) of the patients in whom the graft was not soaked in vancomycin and in 1 (0.1%) of the patients in whom the graft was soaked in vancomycin (p = 0.032). Age (p = 0.571), sex (p = 0.707), smoking (p = 0.407), surgeon (p = 0.124), and insurance type (p = 0.616) were not associated with postoperative infection risk. Autograft use was associated with decreased infections (p = 0.045). There was an 89.4% relative risk reduction with the use of intraoperative vancomycin. An increased body mass index (BMI) (p = 0.029), increased operative time (p = 0.001), and the absence of ACL graft preparation with vancomycin (p = 0.032) independently predicted postoperative infection. Conclusions: The use of vancomycin-soaked grafts was associated with a 10-fold reduction in infection after ACL reconstruction (0.1% versus 1.2%; p = 0.032). Other risk factors for infection after ACL reconstruction included increased BMI and increased operative time. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized. Purpose: To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM). Study Design: Cross-sectional study. Methods: Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally. Results: Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons ( P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women’s National Basketball Association (31.3%). Conclusion: Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.

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Objectives: The purpose of this study was to evaluate the demographics of female representation among team physicians in the National Collegiate Athletic Association (NCAA) and professional sports organizations. We hypothesized that female team physicians are underrepresented at the collegiate and professional level despite controlling for the percentage of women in orthopaedics overall. Methods: Team physicians responsible for providing medical care to athletes in the “Power Five” conferences (Southeastern Conference [SEC], Atlantic Coast Conference [ACC], BIG-10, BIG-12, PAC-12) and select professional organizations [Major League Baseball(MLB), National Football League (NFL), National Basketball Association (NBA), Women’s National Basketball Association (WNBA)] were surveyed using the most current publicly available online information for both collegiate and professional organizations (range, 2012-2018). Demographic data was used to sort physicians by gender. Team physicians were further stratified into orthopaedic and primary care sports medicine (PCSM) categories. The proportion of females in each field was analyzed using univariate analysis, with statistical significance defined as p<0.05. Results: Analysis found that 100% of the teams in the NFL, NBA, and MLB as well as 82% of teams in the WNBA had male team physician representation, including either a male orthopaedic surgeon or male PCSM provider. Females (orthopaedic and PCSM) were represented among 13.3% of NBA teams, 55% of WNBA teams, 13.3% of MLB teams, and 6.3% of NFL teams. Specifically, female orthopaedic surgeons were represented in 3.33% of NBA, 45.45% of WNBA, 10% of MLB, and 3.13% of NFL teams. In the ”Power Five” conferences, female orthopaedic surgeons were represented in 7.14% of teams in the SEC, 8.33% in the ACC, 30.77% in the BIG-10, 0% in the BIG-12, and 50% in the PAC-12. The total number of male orthopaedic surgeons was significantly higher in the “Power Five” collegiate conferences, with team orthopaedic surgeons 1,483 times more likely to identify as male compared to female (p<0.001). The representation of female orthopaedic surgeons in the PAC 12 (p=0.004) and BIG 10 (p=0.005) was significantly higher as compared to female representation among physician members of the American Academy of Orthopaedic Surgeons (AAOS).The proportion of female orthopaedic surgeons in the AAOS was 5.4% (1568/28988) versus 94.6% male physicians (27420/28988) (AAOS 2016 Consensus Report). Conclusion: There is a paucity of data describing representation of female team physicians among major athletic organizations. This analysis found that male orthopaedic surgeons represent a significantly higher proportion of team or orthopaedic physicians in several Division I collegiate conferences and professional sports compared to female physicians. Interestingly, the overall representation of female orthopaedic surgeons in the PAC12 and BIG 10 conferences was higher than their representation in the AAOS. However, female representation among team physicians has not kept pace with increasing numbers of female participation in collegiate and professional athletics. Overall, female team physicians are underrepresented in sports medicine in the United States at both the collegiate and professional levels. Further exploration of educational pathways and hiring processes for team physicians may be warranted. [Table: see text]

Objectives: Septic arthritis is a rare but devastating complication following anterior cruciate ligament (ACL) reconstruction. Reported infection rates following ACL reconstruction are low, but associated with high morbidity including reoperation and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with vancomycin irrigant. Methods: All ACL reconstructions performed from May 2009-August 2018 at a single, large academic institution were reviewed and categorized based on vancomycin use. Those with <90-day follow-up, intraoperative graft preparation with an antibiotic other than vancomycin, or previous ipsilateral knee infection were excluded. Infection was defined as a return to the operating room for irrigation and debridement within 90 days of ACL reconstruction. Descriptive and inferential statistical analysis using t-tests and Poisson regression were performed, with statistical significance defined as p<0.05. Results: In total, 1,640 patients (952 males; 58.0%) with a mean age of 27.7 + 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%) while 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin. There were eleven total infections (0.7%), with ten infections occurring in patients without vancomycin-soaked grafts (1.2%) and one infection occurring in grafts soaked in vancomycin (0.1%; p=0.008). Age (p=0.571), gender (p=0.707), smoking (p=0.407), surgeon (p=0.124), and insurance type (p=0.616) were not associated with postoperative infection. There was an 89.5% relative risk reduction with the use of intraoperative vancomycin. Increased body mass index (BMI) (p=0.029), increased operative time (p=0.001), and absence of ACL graft preparation with vancomycin (p=0.032) independently predicted postoperative infection. Conclusion: The use of vancomycin-soaked grafts was associated with a ten-fold reduction in postoperative infection after ACL reconstruction (0.1% versus 1.2%; p=0.032). Other risk factors for postoperative infection after ACL reconstruction included increased BMI and increased operative time. [Table: see text][Table: see text][Table: see text][Table: see text]

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