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Meena A, Das S, Runer A, Tapasvi K, Hegde P, D'Ambrosi R, Hiemstra L, Tapasvi S. Revision ACL reconstruction in female athletes: current concepts. J ISAKOS 2024:S2059-7754(24)00035-X. [PMID: 38403190 DOI: 10.1016/j.jisako.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
The challenge of revision anterior cruciate ligament (ACL) reconstruction lies in its complexity, varied presentation, and technical intricacies. A successful ACL reconstruction should allow patients to safely return to preinjury activities. However, it is only sometimes simple, and many risk factors and concurrent pathologies come into play. Evaluating and analysing the cause of failure and associated conditions is paramount to addressing them effectively. Despite a plethora of research and improvements in knowledge and technology, e gaps exist in issues such as optimal techniques of revision surgery, graft options, fixation, concurrent procedures, rehabilitation and protocol for return to sports of high-level athletes. Female athletes need additional focus since they are at higher risk of re-injury, suboptimal clinical outcomes, and lower rates of return to sport following revision reconstruction. Our understanding about injury prevention and the protection of ACL grafts in female athletes needs to be improved. This review focuses on the current state of revision ACL surgery in female athletes and provides recommendations and future directions for optimising outcomes in this high-risk group.
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Affiliation(s)
- Amit Meena
- Division of Orthopedics, Shalby Multi-Specialty Hospital, Jaipur, 302021, India; Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria.
| | - Saubhik Das
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria
| | - Armin Runer
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Komal Tapasvi
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Prathik Hegde
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, 20161, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, 20133, Italy
| | - Laurie Hiemstra
- Banff Sport Medicine, University of Calgary, T1W 0L5, Canada
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Tanguilig G, Meyers J, Ierulli VK, Hiemstra L, Mulcahey MK. Women in Leadership in Orthopaedic Sports Medicine Societies Throughout the World. J ISAKOS 2024:S2059-7754(24)00037-3. [PMID: 38403193 DOI: 10.1016/j.jisako.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/10/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES The proportion of women in orthopaedic surgery is low compared to other specialties, despite equal numbers of male and female students entering the medical profession. This gender disparity persists across various aspects of orthopaedic sports medicine, such as academic leadership, medical education, and on the sidelines. The purpose of this study was to characterize the number of women in leadership positions in orthopaedic sports medicine and arthroscopy societies throughout the world. METHODS Publicly available websites for orthopaedic sports medicine societies throughout the world were evaluated. For societies that met inclusion criteria, the following data was collected: types of leadership positions available and breakdown of male and female orthopaedic surgeons in those positions. RESULTS There were a total of 55 societies analyzed from North America (5, 9.1%), South America (8, 14.5%), Europe (18, 32.7%), Asia (13, 23.6%), Africa (2, 3.6%), the Middle East (3, 5.5%) and Australia (3, 5.5%), as well as 3 international societies (5.5%). North America had the highest percentage of women in leadership positions with 19 of 97 positions (19.6%), followed by international societies with 11 of 92 (12.0%) positions filled by women. The Middle East and Australia had the fewest number of women, with all-male leadership. Globally, female orthopaedic surgeons served in 11 of 181 (6.1%) Board of Directors positions, 16 of 192 (8.3%) Executive Committees positions, 17 of 143 (11.9%) Committee Chair positions, 2 of 18 (11.1%) Officer positions, 1 of 12 (8.3%) Council positions, and 2 of 7 (28.6%) Spokesperson positions. CONCLUSION While some countries have higher representation than others, the number of women in leadership positions in orthopaedic sports medicine societies throughout the world does not reflect the global number of women in the specialty. Providing equitable opportunities for women to rise into high-ranking positions in orthopaedic sports medicine may contribute to the interest of women and other minorities in the field of sports medicine and help improve diversity.
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Affiliation(s)
| | - Jade Meyers
- Tulane University School of Medicine, New Orleans, LA
| | | | - Laurie Hiemstra
- Banff Sport Medicine, Alberta, Canada; University of Calgary, Calgary, Canada
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center.
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Vivekanantha P, Dao A, Hiemstra L, Shields M, Chan A, Wadey V, Ferguson P, Shah A. Gender Representation in Major Orthopaedic Surgery Meetings: A Quantitative Analysis. JB JS Open Access 2023; 8:e23.00067. [PMID: 37920560 PMCID: PMC10619889 DOI: 10.2106/jbjs.oa.23.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background Orthopaedic surgery suffers from gender disparity, and annual conferences are visible opportunities to quantify gender representation within a field. Therefore, the purpose of this manuscript was to investigate the prevalence of female speakers and moderators, and male-only panel sessions, at 10 major Orthopaedic Surgery meetings. Methods Conference programs and details of faculty moderating or presenting in 10 Orthopaedic Surgery annual meetings in 2021 were retrieved. Conferences were selected with the aim of size and diversity in subspecialty topics and included American Association of Hip and Knee Surgeons, American Association for Hand Surgery, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Canadian Orthopaedic Association (COA), European Federation of National Associations of Orthopaedics and Traumatology, North American Spine Society, Orthopaedic Research Society (ORS), Orthopaedic Trauma Association, and Pediatric Orthopaedic Society of North America (POSNA). Primary outcomes included percentage of female chairs and speakers and percentage of male-only panels, while secondary outcomes included number of publications, number of citations, and H-indexes of faculty. Further subgroup comparisons were performed between male-only panels and non-male-only panels and female members and male members. Results Of 207 included sessions, 121 (58.5%) were male-only panels and 150 (12.6%) of 1,188 faculty members were women. Conferences organized by the COA, ORS, and POSNA had higher percentages of female representation, while spine surgery and adult hip/knee reconstruction sessions had more than 70% male-only panels and fewer than 10% female members. There were no significant differences between male members and female members regarding years of practice; however, male members were more likely to hold the title of professor (p < 0.001). Male members and female members stratified by quartiles of publications, citations, and H-indexes, moderated or participated in similar numbers of sessions, indicating an absence of selection bias. Conclusions There is a high prevalence of male-only panels (58.5%) and an overall lack of female representation (12.6%) in 10 major Orthopaedic Surgery meetings. Male members and female members from these conferences were found to have similar qualifications academically. Specific strategies such as the elimination of male-only panels, selecting diverse conference organizers, and forming conference equity, diversity, and inclusion committees can help achieve cultural change. Level of Evidence Level V.
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Affiliation(s)
| | - Andre Dao
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Laurie Hiemstra
- Banff Sports Medicine, Department of Surgery, University of Calgary, Calgary, ON, Canada
| | - Maegan Shields
- Division of Orthopaedic Surgery, Postgraduate Medical Education, University of Toronto, Toronto, ON, Canada
| | - Andrea Chan
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Veronica Wadey
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ajay Shah
- Division of Orthopaedic Surgery, Postgraduate Medical Education, University of Toronto, Toronto, ON, Canada
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Kopka M, Sheehan B, Degen R, Wong I, Hiemstra L, Ayeni O, Getgood A, Beavis C, Volesky M, Outerbridge R, Matache B. Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Knee Osteoarthritis. Orthop J Sports Med 2019; 7:2325967119860110. [PMID: 31367647 PMCID: PMC6643188 DOI: 10.1177/2325967119860110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Michaela Kopka
- Michaela Kopka, MD, FRCSC, DipSportMed, Banff Sport Medicine, PO
Box 1300, Banff, AB T1L 1B3, Canada (
)
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Wong I, Hiemstra L, Ayeni OR, Getgood A, Beavis C, Volesky M, Outerbridge R, Sheehan B, McCormack R, Litchfield R, Whelan D, Mohtadi N, Coady C, MacDonald PB. Position Statement of the Arthroscopy Association of Canada (AAC) Concerning Arthroscopy of the Knee Joint-September 2017. Orthop J Sports Med 2018; 6:2325967118756597. [PMID: 29511702 PMCID: PMC5833175 DOI: 10.1177/2325967118756597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Ivan Wong
- Ivan Wong, MD, MACM, FRCSC, DipSportMed, Dalhousie University, 2nd Floor, Room 2106, Camp Hill Veteran’s Memorial Building, 5955 Veteran’s Memorial Lane, Halifax, Nova Scotia B3H 2E1 Canada ()
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Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T, Amis A, Bin SI, Bugbee W, Caborn D, Carter T, Chan KM, Cohen C, Cohen M, Condello V, DeBerardino T, Dirisamer F, Engebretsen L, Farr J, Gomoll A, Harner C, Heard M, Hiemstra L, Kim JG, Kim J, Kim JM, Kon E, Laggae K, Lee BS, Litchfield R, Marcacci M, McCormack R, McDermott I, Monlau JC, Myers P, Noyes F, Patsch C, Robinson J, Rodeo S, Seo SS, Sherman S, Siebold R, Snow M, Stone K, Tashman S, Thompson P, van Arkel E, van der Merwe W, Verdonk R, Williams A, Zaffagnini S. International Meniscus Reconstruction Experts Forum (IMREF) 2015 Consensus Statement on the Practice of Meniscal Allograft Transplantation. Am J Sports Med 2017; 45:1195-1205. [PMID: 27562342 DOI: 10.1177/0363546516660064] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes.
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Affiliation(s)
- Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario, Canada
| | | | - Peter Verdonk
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | - Wayne Gersoff
- Advanced Orthopedic and Sports Medicine Specialists, Denver, Colorado, USA
| | - Brian Cole
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Abstract
BACKGROUND Clinical management of patellofemoral (PF) instability is a challenge, particularly considering the number of variables that should be taken into consideration for treatment. Quality of life is an important measure to consider with this patient population. PURPOSE To factor analyze and reduce the total number of items in the Banff Patella Instability Instrument (BPII). Subsequent to the factor analysis, the new, item-reduced BPII 2.0 was tested for validity, reliability, and responsiveness. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Quality of life was measured for PF instability patients (N = 223) through use of the original BPII at their initial consultation. Data from the BPII scores were used in a principal components analysis (PCA) to factor analyze and reduce the total number of items in the original BPII, to create a revised BPII 2.0. The BPII 2.0 underwent content validation (Cronbach alpha, patient interviews, and grade-level checking), construct validation (analysis of variance comparing the initial visit and the 6-, 12-, and 24-month postoperative visits, eta-square), convergent validation (Pearson r correlation to the original BPII), responsiveness testing (eta-square, anchor-based distribution testing), and reliability testing (intraclass correlation coefficient [ICC]). RESULTS The BPII was successfully reduced from 32 to 23 items with excellent Cronbach alpha values in the new BPII 2.0: initial visit = 0.91; 6-month postoperative visit = 0.96; 12-month postoperative visit = 0.97; and 24-month postoperative visit = 0.76. Grade-level reading for all items was assessed as below grade 12. The BPII 2.0 was able to discriminate between all time periods with significant differences between groups (P < .05). Eta-square was 0.40, demonstrating a medium to large effect size. The BPII significantly correlated with the BPII 2.0 (0.82, 0.90, 0.90, and 0.94 at the initial visit and 6-, 12-, and 24-month postoperative visits, respectively), providing evidence of convergent validity. A significant correlation was found between the 7-point scale and 24-month postoperative BPII 2.0 scores, a sign of anchor-based responsiveness. ICC (2,k) was 0.97, indicating strong reliability. CONCLUSION The BPII 2.0 is valid, reliable, and responsive for assessment of patients with PF instability, both surgically and nonsurgically treated.
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Affiliation(s)
- Mark R Lafave
- Department of Health & Physical Education, Mount Royal University, Calgary, Alberta, Canada
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Butterwick DJ, Brandenburg MA, Andrews DM, Brett K, Bugg BH, Carlyle KJ, Freeman TR, Hiemstra L, Lafave M, Laird J, Lun V, Meyers MC, Miller C, Mohtadi N, Nebergall R, Temes RT, Teochi LF, Wiley P, Meeuwisse W. Agreement statement from the 1st international rodeo research and clinical care conference: calgary, alberta, Canada (july 7-9, 2004). Clin J Sport Med 2005; 15:192-5. [PMID: 15867568 DOI: 10.1097/01.jsm.0000160553.87755.2a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Dale J Butterwick
- University of Calgary, Sport Medicine Center, Faculty of Kinesiology, Calgary, Alberta, Canada.
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Erasmus L, Bester CJ, Hiemstra L, Ramlachan P. Letter to the Editor. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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