Brinkman, Joseph C.

Abstract Glenohumeral bone loss is a significant risk factor for recurrent instability after shoulder dislocation. The Hill‐Sachs lesion is an osseous defect of the posterior humeral head that is commonly recognized after anterior shoulder dislocation. Several procedures exist to address humeral‐sided bone loss, including soft tissue filling procedures, osteoarticular allografts, bone plugs, rotation osteotomies, and humeral head replacements. However, among the most common of these procedures is the arthroscopic remplissage. This technique involves capsulotenodesis of the posterior shoulder capsule and infraspinatus tendon into a Hill‐Sachs lesion. Previously described techniques use knotted suture anchors. In this report, we describe a modified technique for remplissage using knotless, all‐suture anchors to perform capsulotenodesis of a Hill‐Sachs lesion. Benefits of this technique include a single skin incision, improved bone preservation, and easier facilitation of revision surgery if required. Technique Video video See video under supplementary data.

Background: Decreases in Medicare reimbursement have been noted among many medical specialties. An in-depth analysis of the subspecialty of orthopaedic sports medicine is needed to determine changes in Medicare reimbursement in this field. Purpose/Hypothesis: The purpose was to elucidate the trends in inflation-adjusted Medicare reimbursement for orthopaedic sports medicine procedures between 2000 and 2020. It was hypothesized that Medicare reimbursement decreased substantially during the study period. Study Design: Economic decision and analysis; Level of evidence, 4. Methods: The Physician Fee Schedule Look-up Tool was used to extract Medicare reimbursement information between 2000 and 2020 for 67 procedures related to orthopaedic sports medicine. These values were adjusted for inflation using the Consumer Price Index. The compound annual growth rate (CAGR) was calculated to measure the annual rate of change, and descriptive analyses were performed using the Student t test. Results: Between 2000 and 2020, inflation-adjusted Medicare reimbursement for the 67 included procedures decreased by an average of 33% (CAGR = –2.2%; R 2 = 0.78). Reimbursement decreased for procedures related to the shoulder and elbow by 34% (CAGR = –2.3%; R 2 = 0.80), for hip-related procedures by 23% (CAGR = –1.4%; R 2 = 0.77), for knee-related procedures by 31% (CAGR = –2.0%; R 2 = 0.81), and for procedures relating to the foot and ankle by 38% (CAGR = –2.5%; R 2 = 0.79). Conclusion: Study findings indicated that inflation-adjusted Medicare reimbursement decreased substantially between 2000 and 2020 for orthopaedic sports medicine procedures, ranging from a 23% decrease for hip-related procedures to a 38% decrease for foot and ankle–related procedures. The results of this study could be used to provide further context for health care policy decisions and help ensure sustainable financial environments for orthopaedic sports medicine surgeon.

Purpose To use the National Collegiate Athletic Association Injury Surveillance Program (NCAA‐ISP) from the 2009‐2010 through the 2014‐2015 seasons to report lumbar spine injury rates, characteristics, and time lost from sport in soccer players. Methods Characteristics of lumbar spine injuries by season, competition/practice, and time lost from sport were determined using the NCAA‐ISP database. Rates of injury were calculated as the number of injuries divided by the number of athlete exposures (AEs). AEs are any athlete participation in a competition or practice. Incidence rate ratios (IRRs) were calculated to compare rates between event types and time of season. Injury proportion ratios (IPRs) were used to evaluate differences in injury rates between men and women. Results The NCAA‐ISP estimated 4,464 LSIs over 5 years. The rate of LSI in men was 2.1/10,000 AEs and 3.0/10,000 AEs in women. Women were 1.43 times more likely to suffer an LSI compared to men. Women were 2.15 times as likely to suffer an LSI in competition compared to in practice while men were 1.10 times as likely. Women were 2.15 times as likely to be injured in the preseason compared to the regular season, while men were 3.76 times as likely. Non‐contact injuries were the most common cause of lumbar spine injuries (LSIs) in men (35%); however, contact injuries were more common in women (33%). Most athletes both male (57%) and female (59%) returned to play within 24 hours. Conclusion This study provides information on the characteristics of LSIs in NCAA soccer. The overall injury rate to the lumbar spine is relatively low. Injury rates are highest in the preseason and in competition. Women suffer from more recurrent LSI’s than men, and men acquired more injuries through non‐contact mechanisms. More than one‐half of athletes returned to sport within 24 hours.

Purpose Integrated plastic surgery residency programs have increased their social media presence to educate and recruit prospective residents. This study aims to understand the impact of integrated plastic surgery residency program social media on the 2020 to 2021 applicants' evaluation of prospective programs, particularly during the coronavirus disease 2019 pandemic. Materials and Methods An optional 20-item online survey was sent to integrated plastic surgery residency applicants applying to the authors' program. Results Surveys were sent to 300 integrated plastic surgery residency applicants with an average of 168 responses (56% response rate). Social media resources included official residency program website (87.1%), Instagram (70.2%), and Doximity (46.8%). The most frequently used resource by applicants was the official residency program website (43.9%); Instagram was the second most frequently used (40.2%) followed by Doximity (8.3%). Most respondents agreed that social media was an effective means to inform applicants (66.1%), and it positively impacted their perception of the program (64.8%). The cited benefits were helping the program exhibit its culture and comradery among residents, faculty, and staff (78.4%). Among applicants, 73.6% noted that it had a significant impact on their perceptions of programs. Most respondents truncated their planned plastic surgery subinternships, completing 1 instead of 3 planned subinternships because of coronavirus disease 2019 limitations. Conclusions During the 2020 to 2021 plastic surgery application cycle, applicants used social media accounts of plastic surgery residency programs to inform and educate themselves about prospective programs. This study suggests that investing resources into a social media residency accounts is a meaningful pursuit for integrated plastic surgery programs and is an important aspect in today's recruitment.

Purpose To analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020. Methods We performed a retrospective cross‐sectional analysis of orthopaedic surgeon practice size in the United States using 2012 and 2020 data obtained from the Physician Compare database. Results Although we observed an increase from 21,216 unique orthopaedic surgeons in 2012 to 21,553 in 2020 (1.6% increase), the number of practices experienced a large decrease from 7,299 practices in 2012 to 5,829 in 2020 (20.1% decrease). The proportion of orthopaedic surgeons working in solo practices decreased from 13.2% (2,790) in 2012 to 7.4% (1,595) in 2020, and the proportion of orthopaedic surgeons working in groups sized 2 to 24 decreased from 35.3% (7,482) in 2012 to 22.2% (4,775) in 2020. In contrast, groups sized 25 to 99 have grown from 20.7% (4,387) of all orthopaedic surgeons to 23.4% (5,048) in 2020. Groups sized 100 to 499 have increased from 16.9% (3,593) in 2012 to 24.1% (5,190) in 2020, whereas groups sized 500 or greater have grown from 14% (2,964) in 2012 to 22.9% (4,945) in 2020. The number of unique group practices showed a significant decrease in the number of solo groups, which comprised 43.8% (3,200) of the total number of individual practices in 2012, decreasing to 32% (1,886) in 2020. All other groups increased in number and proportionally from 2012 to 2020. Conclusions This study shows that over the period from 2012 to 2020, there has been a substantial trend of orthopaedic surgeons shifting to increasing practice sizes, potentially indicating that more orthopaedic surgeons are working for large health care organizations rather than small independent practices. Clinical Relevance The impact of these changes should be examined to determine large‐scale effects on patient care, payment models, access, and outcomes, along with physician compensation, lifestyle, and satisfaction.

Background: Although lower back injuries (LBIs) are common among National Collegiate Athletic Association (NCAA) female volleyball athletes, their incidence and etiology has not been well-defined. Purpose: To describe the epidemiology of LBIs in collegiate female volleyball athletes over a 5-year period from the academic years 2009 to 2010 and 2013 to 2014. Study Design: Descriptive epidemiology study. Methods: The incidence and characteristics of spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries by the total number of athlete-exposures (AEs). AEs were defined as any student participation in any single NCAA-sanctioned practice or competition. The injury rate was computed as the number of injuries per the total number of AEs and reported as a ration of injuries per 10,000 exposures. The ratio was then reported as overall number as well as stratified for event, time of season, and athletic NCAA division. Incidence rate ratios were then calculated to compare rates between event type. Results with 95% CIs that did not include 1.0 were considered statistically significant. Results: An estimated 3384 LBIs occurred in NCAA female volleyball players during this 5-year time frame. These LBIs occurred at a rate of 4.89 injuries per 10,000 AEs. LBIs were 2.76 times more likely in preseason when compared with regular season. More injuries occurred in practice (85%) when compared with competition (15%). The outside hitter and middle blocker were the most commonly position to sustain an LBI. Almost 70% of injuries were new injuries, and another 29% were recurrent injuries. The most common mechanism of injury was equally split between contact (50.4%) and overuse (45.5%) injuries, whereas the remaining mechanisms of injury were secondary for unknown reasons (4.14%). Most players returned to play within 24 hours (72.3%) followed by 1 to 6 days (16.4%), and finally 7 to 12 days (11.3%). No patient required surgical intervention. Conclusion: The rate of LBIs was high (4.89/10,000 AEs) and injuries commonly recurred (29.2%). Most injuries were new, with most athletes returning to play with 24 hours.

Purpose To describe and compare the epidemiology of lumbar spine injuries (LSIs) in women’s and men’s ice hockey during the 2009‐2010 to 2013‐2014 academic years and to investigate sex‐specific differences, using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) database. Methods The incidence and characteristics of LSIs were identified utilizing the NCAA ISP. Rates of injury were calculated as number of injuries divided by total number of athlete exposures (AEs). AEs were defined as any student participation in one NCAA‐sanctioned practice or competition. Incidence rate ratios (IRRs) were calculated to compare rates of injury between season, event type, mechanism, injury recurrence, and time lost from sport, and injury proportion ratios (IPRs) were calculated to examine the differences in injury rates between men and women. Results There were a total of 165 LSIs from an average of 10 and 19 women’s and men’s teams, respectively, calculated to 1,254 LSIs nationally. Women were 2.48 times more likely to suffer a noncontact injury than men (95% CI: 1.33‐4.61), whereas men were more likely than women to suffer contact LSIs (IPR: .51 [95% CI: .28‐.92]). In Divisions II and III, women were 6.64 (95% CI: 4.14‐10.64) and 1.28 (95% CI: 1.12‐1.46) times more likely to suffer LSIs than men, respectively. Conclusions Women and men were similarly likely to suffer an LSI, but sex‐specific differences existed in a mechanism of injury and likelihood of injury within NCAA Divisions.

Purpose To determine the objective characteristics of orthopaedic foot and ankle fellowship directors (FDs) by concentrating on the demographic characteristics, academic background, institutional history, research experience, and professional affiliations of these leaders. Methods Data for each FD were collected by searching institutional biographies, personal websites, or publicly available curricula vitae. Data collection included the following variables: age, sex, race/ethnicity, previous training institutions, residency and fellowship graduation years, advanced degrees, military affiliation, institutional loyalty, year hired, FD career timeline, total number of publications, total number of citations, and h ‐index. Results Of the 47 FDs, 44 (93.6%) were men and 3 (6.4%) were women. The mean age was 50.8 ± 9.4 years. Most orthopaedic foot and ankle FDs were white (n = 42, 89.4%), followed by Asian (n = 4, 8.5%) and black or African American (n = 1, 2.1%). The mean Scopus h ‐index, total number of publications, and total number of citations for all foot and ankle FDs were 13.3 ± 9.5, 47.5 ± 45.8, and 898.1 ± 1,040.3, respectively. Among all foot and ankle FDs, the mean tenure in the FD position was 5.8 ± 4.6 years. Conclusions Orthopaedic foot and ankle FDs are primarily white men in their 50s, with minimal female and minority representations. These FDs are distinguished by their high level of research productivity. Additionally, orthopaedic foot and ankle training backgrounds seem to play an important role, given that most of the appointed FDs trained in only a few select programs. Clinical Relevance This study outlines some of the most important characteristics among foot and ankle FDs and identifies important disparities within this population of leaders that may have detrimental effects on the field.

Background: Spine injuries are common in collegiate wrestlers and can lead to reinjury, persistent pain, and time lost from participation. Purpose: To describe the epidemiology of spine injuries in National Collegiate Athletic Association (NCAA) wrestlers between academic years 2009 to 2010 and 2013 to 2014. Study Design: Descriptive epidemiology study. Methods: The incidence and characteristics of spine injuries were identified utilizing the NCAA–Injury Surveillance Program database. Spine injuries were assessed for injury type, injury mechanism, time of season, event type, recurrence, participation restriction, and time lost from participation. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). Injury rate ratios (IRRs) were calculated for event type and time of season, and results with 95% confidence intervals that did not include 1.0 were considered statistically significant. Results: There were an estimated 2040 spine injuries reported in the database over the 4-year period, resulting in an injury rate of 0.71 per 1000 AEs. Spine injuries were over twice as likely to occur in competitions as in practices (IRR, 2.02; 95% confidence interval, 1.10-3.69). More injuries occurred in both the preseason (0.94 per 1000 AEs) and the postseason (1.12 per 1000 AEs) compared with the regular season (0.55 per 1000 AEs). Contact injuries (42%) were the most common mechanism of injury, and brachial plexus injury (20%) was the most common diagnosis. Only 1.3% of injuries required surgery, and athletes most commonly returned to sport within 24 hours (33%) or within 6 days (25%). Conclusion: This investigation found an overall injury rate of 0.71 per 1000 AEs in wrestling athletes between academic years 2009 to 2010 and 2013 to 2014. The majority of these injuries were new, and athletes most commonly returned to sport within 24 hours. The injury rate was highest in competition, and both the preseason and the postseason showed a higher injury rate than that in season. Efforts to improve injury prevention and management should be informed by these findings.

Purpose To examine and characterize extremely negative Yelp reviews of orthopedic sports surgeons in the United States. Methods A search for reviews was performed using the keywords “Orthopedic Sports Medicine” on Yelp.com for 8 major metropolitan areas. Single‐star reviews were isolated for analysis, and individual complaints were then categorized as clinical or nonclinical. The reviews were classified as surgical or nonsurgical. Results A total of 11,033 reviews were surveyed. Of these, 1,045 (9.5%) were identified as 1‐star, and 289 were ultimately included in the study. These reviews encompassed 566 total complaints, 133 (23%) of which were clinical, and 433 (77%) of which were nonclinical in nature. The most common clinical complaints concerned complications (32 complaints; 6%), misdiagnosis (29 complaints; 5%), and uncontrolled pain (21 complaints; 4%). The most common nonclinical complaints concerned physicians’ bedside manner (120 complaints; 21%), unprofessional staff (98 complaints; 17%), and finances (78 complaints; 14%). Patients who had undergone surgery wrote 47 reviews that resulted in 114 complaints (20.5% of total complaints), whereas nonsurgical patients were responsible for 242 reviews and a total of 452 complaints (81.3% of total complaints). The difference in the number of complaints by patients after surgery and patients without surgery was statistically significant ( P < 0.05) for all categories except for uncontrolled pain, delay in care, bedside manner of midlevel staff, and facilities. Conclusion Our study of extremely negative Yelp reviews found that 77% of negative complaints were nonclinical in nature. The most common clinical complaints were complications, misdiagnoses and uncontrolled pain. Only 16% of 1‐star reviews were from surgical patients. Clinical Relevance Patients use online review platforms when choosing surgeons. A comprehensive understanding of factors affecting patient satisfaction and dissatisfaction is needed. The results of our study could be used to guide future quality‐improvement measures and to assist surgeons in maintaining favorable online reputations.