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The objective of this work was to delineate career progression and research productivity of women practicing cardiothoracic surgery in the academic setting.Cardiothoracic surgeons at the 79 accredited US cardiothoracic surgery training programs in 2020 were included in this cross-sectional analysis. Data regarding subspecialization, training, practice history, and publications were gathered from public sources including department websites, CTSNet, and Scopus.A total of 1065 surgeons (51.3% cardiac, 32.1% thoracic, 16.6% congenital) were identified. Women accounted for 10.6% (113) of the population (7.9% of cardiac, 15.5% of thoracic, 9.6% of congenital surgeons). The median number of cardiothoracic surgeons per institution was 12 (interquartile range [IQR], 10-17), with a median of 1 woman (IQR, 0-2). Fifteen of 79 programs (19%) had no women. Among women faculty 5.3% were clinical instructors, 51.3% were assistant professors, 23.0% were associate professors, 16.8% were full professors, and 3.5% had unspecified titles (vs 2.0%, 32.9%, 23.0%, 37.5%, and 4.6% among men, respectively; P.001). Women and men authored a comparable number of first-author (0.4 [IQR, 0.0-1.3] vs 0.5 [IQR, 0.0-1.1], P = .56) publications per year but fewer last-author (0.1 [IQR, 0.0-0.7] vs 0.4 [IQR, 0.0-1.3], P.0001) and total publications per year (2.7 [IQR, 1.0-6.2] vs 3.7 [IQR, 1.3-7.8], P = .05) than men. The H-index was lower for women than for men overall (8.0 [IQR, 3.0-15.0] vs 15.0 [IQR, 7.0-28.0], P.001) but was similar between men and women who had been practicing for 10 to 20 years.Gender disparities persist in academic cardiothoracic surgery. Efforts should be made to support women in achieving senior roles and academic productivity.

The National Institutes of Health (NIH) recently developed the relative citation ratio (RCR), calculated as article citations benchmarked to NIH-funded publications in the same field. Here, we characterized the scholarly impact of academic cardiothoracic (CT) surgeons and their research using the RCR.Using a database of 992 CT surgeons, we calculated the RCR for all articles published by each surgeon since 1980 using the NIH iCite database. All data were collected from publicly available online sources. Data are presented as median (interquartile range) or as odds ratios (ORs) for multivariable logistic regression analysis.Where RCR 1.00 indicates equal impact as an NIH-funded publication, the RCR among all 37,402 CT surgery articles was 0.84 (0.33-1.83) and the RCR among NIH-funded CT surgery articles was 1.07 (0.53-2.17). CT surgeons exhibited a career median RCR of 0.82 (0.54-1.13) and maximum RCR of 6.20 (3.04-13.57). Predictors of career median RCR1.00 included female gender (OR 2.23, P = 0.001), thoracic subspecialization (OR 2.50, P 0.001), full professor rank (OR 1.89, P = 0.001), and NIH funding (OR 1.75, P = 0.001). Predictors of career maximum RCR50th percentile among CT surgeons included male gender (OR 1.87, P = 0.030), thoracic subspecialization (OR 2.05, P 0.001), full professor rank (OR 4.89, P 0.001), NIH funding (OR 3.17, P 0.001), and career duration (OR 1.03, P = 0.002).We present the first assessment of the NIH-validated RCR for academic CT surgery. CT surgery research is highly impactful, although gender disparities persist with respect to the highest-impact research of our specialty.

OBJECTIVE Advanced clinical fellowship training has become a popular option for surgical trainees seeking to bolster their clinical training and expertise. However, the long-term academic impact of this additional training following a traditional thoracic surgery fellowship is unknown. This study aimed to delineate the impact of an advanced clinical fellowship on subsequent research productivity and advancement in academic career among general thoracic surgeons. METHODS Using an internally constructed database of active, academic general thoracic surgeons who are current faculty at accredited cardiothoracic surgery training programs within the United States, surgeons were dichotomized according to whether an advanced clinical fellowship was completed or not. Academic career metrics measured by research productivity, scholarly impact (H-index), funding by the National Institutes of Health, and academic rank were compared. RESULTS Among 285 general thoracic surgeons, 89 (31.2%) underwent an advanced fellowship, whereas 196 (68.8%) did not complete an advanced fellowship. The most commonly pursued advanced fellowship was minimally invasive thoracic surgery (32.0%). There were no differences between the two groups in terms of gender, international medical training, or postgraduate education. Those who completed an advanced clinical fellowship were less likely to have completed a dedicated research fellowship compared to those who had not completed any additional clinical training (58.4% vs. 74.0%, p = 0.0124). Surgeons completing an advanced clinical fellowship demonstrated similar cumulative first-author publications (p = 0.4572), last-author publications (p = 0.7855), H-index (p = 0.9651), National Institutes of Health funding (p = 0.7540), and years needed to advance to associate professor (p = 0.3410) or full rank professor (p = 0.1545) compared to surgeons who did not complete an advanced fellowship. These findings persisted in sub-analyses controlling for surgeons completing a dedicated research fellowship. CONCLUSIONS Academic general thoracic surgeons completing an advanced clinical fellowship demonstrate similar research output and ascend the academic ladder at a similar pace as those not pursuing additional training.

Surgeons are traditionally categorized as working either in academic or private/community practice, but some transition between the two environments. Here, we profile current academic cardiothoracic surgeons who began their attending careers in private or community practice. We hypothesized that research activity may distinguish cardiothoracic surgeons who started in non-academic versus academic practice.Publicly available data regarding professional history and research productivity were collected for 992 academic cardiothoracic surgeons on faculty at the 77 cardiothoracic surgery training programs in the United States in 2018. Data are presented as medians analyzed with the Mann-Whitney test or proportions analyzed with Fisher exact test or the χA total of 80 (8.1%) academic cardiothoracic surgery faculty started their careers in non-academic practice, and 912 (91.9%) started directly in academia. Those who started in non-academic practice spent a median 7.0 y in private/community practice and were more likely to be cardiac surgeons (68.8% vs 51.6%, P = .0132). They were equally likely to pursue a protected research fellowship (56.3% vs 57.0%, P = .9067) and publish research during training (92.5% vs 91.1%, P = .8374), but they published fewer total papers by the end of cardiothoracic surgery fellowship (3.0 vs 7.0, P = .0001) and fewer papers per year as an academic attending (0.8 vs 2.9, P.0001). Nevertheless, the majority of cardiothoracic surgery faculty who started in non-academic practice are currently active in research (68.8%), and 2 such surgeons received National Institutes of Health R01 funding.Transitioning from non-academic to academic practice is an uncommon but feasible pathway for interested cardiothoracic surgeons.

Background: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon–femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients. Purpose: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens. Study Design: Descriptive laboratory study. Methods: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface. Results: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. Conclusion: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens. Clinical Relevance: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

Background: The Micheli technique for anterior cruciate ligament (ACL) reconstruction (ACLR) has proven to be a reliable method with a minimal risk for growth disturbance among skeletally immature patients. Purposes: To evaluate the Micheli technique of iliotibial band (ITB) graft passage for ACLR using cadaveric knee models and to measure the distance between the surgical instrument tip and the neurovascular bundle in the posterior knee joint: specifically, the peroneal nerve, tibial nerve, and popliteal artery. Study Design: Descriptive laboratory study. Methods: Gross dissection was performed on 17 pediatric cadaveric knees (12 male and 5 female) aged between 4 and 12 years. To simulate ITB graft passage, we passed a curved-tip hemostat clamp through the posterior capsule, with the knee flexed from 90° to 100°. Next, clinical photographs were taken, and digital imaging software was used to measure the distance in centimeters from the clamp tip to each respective neurovascular structure. Results: The mean distances from the clamp tip to the tibial nerve, popliteal artery, and peroneal nerve were 0.875 cm (range, 0.468-1.737 cm), 0.968 cm (range, 0.312-1.819 cm), and 1.149 cm (range, 0.202-2.409 cm), respectively. Mean values were further calculated for age groups of ≤8, 9-10, and 11-12 years. The mean distance from the clamp tip to the peroneal nerve was 1.400 cm larger for 11- to 12-year-old specimens than for ≤8-year-old specimens (95% CI, 0.6-2.2 cm; P = .005). Conclusion: The neurovascular structures in the posterior knee were in close proximity to the path of graft passage, with distances Clinical Relevance: As the incidence of ACL tears is continuously increasing within the pediatric population, there are a larger number of ACLR procedures being performed. Although neurovascular injuries during ACLR are rare, this study clarifies the close proximity of neurovascular structures during ITB graft passage using the Micheli technique of ACLR.

A paucity of data exists on the treatment of pediatric lateral meniscus root tears (LMPRTs). This study aims to characterize the biomechanics of the lateral knee joint in pediatric cadavers following LMPRT and root repair. Our hypotheses were: (1) compared with the intact state, LMPRT would be associated with decreased contact area; (2) compared with the intact state, LMPRT would be associated with increased contact pressures; and (3) compared with LMPRT, root repair would restore contact area and pressures toward intact meniscus values.Eight cadaver knees (ages 8-12 years) underwent contact area and pressure testing of the lateral compartment. Tekscan pressure mapping sensors covering the tibial plateau were inserted underneath the lateral meniscus. Appropriate pressure load equivalents were applied by a robot at degrees of flexion: 0, 30, 60. Three meniscus conditions were tested: (1) intact, (2) complete root tear, and (3) repaired root tear. Root repairs were performed with transtibial pullout sutures. Statistical analysis was performed.Root tear significantly decreased mean contact area at 30° (Transosseous pullout repair is a clinically validated treatment for LMPRT. This study provides baseline biomechanics data of transtibial pullout repair of pediatric LMPRTs.

Background: Substantial research about the mechanical properties of adult knee ligaments exists, but comparatively little is known about the pediatric knee. Choosing a graft for ligament reconstruction in pediatric patients is limited by the lack of knowledge of the mechanical properties of those ligaments and potential graft options in the skeletally immature. Purpose: Describe the mechanical properties of the ACL, PCL, MCL, LCL, and iliotibial band (ITB) in pediatric patients. Methods: Skeletally immature fresh frozen whole knees from 18 human cadavers (mean specimen age = 10.4 years) were thawed and the ligaments grossly dissected with bone block attachments intact, and length, width, and thickness were measured. Specimens were tested as a single unit (for those containing multiple bundles) and hydrated throughout testing. Each specimen was secured in an MTS machine and underwent a tensile loading protocol to measure ultimate tensile strength, ultimate tensile strain, and linear modulus. Results: Under testing, the ACL exhibited ultimate tensile strength (8.7 +/- 4.1 MPa), ultimate tensile strain (54.4 +/- 20.8%), and linear modulus (31.0 +/- 22.8 MPa) that were similar to the PCL (9.8 +/- 6.6 MPa, 48.6 +/- 22.1%, and 47.9 +/- 53.5 MPa, respectively). The LCL ultimate tensile strength was 18.7 +/- 6.5 MPa, ultimate tensile strain was 57.2 +/- 22.2%, and linear modulus was 68.7 +/- 50.8 MPa, compared to the MCL (19.5 +/- 13.9 MPa, 38.9 +/- 15.7%, and 93.3 +/- 75.1 MPa, respectively). Finally, the ITB demonstrated an ultimate tensile strength of 11.8 +/- 4.4 MPa, ultimate tensile strain of 42.6 +/- 14.9%, and linear modulus of 55.5 +/- 27.7 MPa. Conclusion: The ITB demonstrated greater ultimate tensile strength and a higher linear modulus than the ACL and PCL, with a lower ultimate tensile strain. Conversely, the ITB demonstrated lower values for ultimate tensile strength and linear modulus than the LCL and MCL. The ITB may serve as a reasonable substitute for native ACL and PCL reconstruction due to similar ultimate tensile strengths. The ITB may be less well-suited to reconstruct the LCL and MCL due to more significant differences in ultimate tensile strength. [Table: see text][Figure: see text]

Background: The anatomy of the trochlea plays a significant role in patella stability. Surgical approaches to alter the anatomy of the trochlea and associated structures to influence patella tracking continue to evolve. Unlike the development of the pediatric hip joint which has been well studies for decades, the developmental anatomy of the trochlea and its relationship to patella stability remains poorly understood. An improved understanding of trochlear growth and development may alter both the timing and type of surgical procedures for patella stability. Purpose: The purpose of this study was to describe the developmental changes of the osseous and cartilage trochlear morphology in skeletally immature specimens. Methods: Fifty-five skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using 0.625mm computed tomography scans. In the axial plane, measurements included medial and lateral osseous condylar height, medial and lateral cartilaginous condylar height, osseous and cartilaginous sulcus angles, osseous and cartilaginous condylar height asymmetry, and trochlear depth. Results: Analysis of trochlear morphology using osseous and cartilaginous measurements of condylar height, condylar height asymmetry, and trochlear depth demonstrated an increase in the size of the medial and lateral trochlea as age increased. The osseous and cartilaginous sulcus angles decreased (became deeper) with age until around age 8 and then plateaued. This corresponded with an increase in trochlear depth that plateaued also around age 8. In contrast, medial and lateral condylar height continued to increase through age 11. Cartilaginous condylar asymmetry rose slightly with age with the lateral condyle consistently larger than the medial condyle. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. Conclusions: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. These changes in height continue to be seen through age 11 suggesting a still developing trochlea past this age. By age 8, a plateau in sulcus angle and sulcus depth suggests more proportionate growth after this point. Access to pediatric cadaveric specimens is exceptionally rare. This study provides a unique evaluate of the developing trochlea in young children, especially those under age 7, who rarely receive advanced imaging. [Figure: see text][Figure: see text]

Background: For patients with significant growth remaining, the Micheli-Kocher (iliotibial band) ACL reconstruction technique has proven to be a reliable procedure with minimal risk for growth disturbance. Recent cadaveric studies have demonstrated that graft passage over the top of the femur may bring the graft and instrument close to the critical neurovascular structures. Purpose: The purpose of this study was to evaluate the over-the-top graft passage technique using pediatric cadaveric knees, and measure the distance between instruments and the peroneal nerve, tibial nerve, popliteal artery. Methods: Seventeen skeletally immature cadaveric knees between the ages of 4 and 12 years old were dissected and prepared for visualization of iliotibial band graft passage procedure. A curved hemostat clamp was used, creating a path through the posterior capsule. To avoid neurovascular injury, the tip of the instrument was kept close to the posterior and lateral cortex of the femur. Once the clamp was safely positioned in the posterior knee joint, photographs were taken. Digital imaging software was used to measure the distance in centimeters from clamp tip to peroneal nerve laterally, and the popliteal artery and tibial nerve medially for all specimens, FIGURE 1. Distances were averaged and stratified to assess differences in age, FIGURE 2. Results: The average distances from clamp to neurovascular bundle were 0.875cm (range: 0.468-1.737cm), 0.968cm (range: 0.312-1.819cm), and 1.149cm (range: 0.202-2.409cm) for tibial nerve, popliteal artery and peroneal nerve, respectfully. Means were further calculated for age groups ≤8, 9-10, and 11-12 years old. Conclusion: Iliotibial band graft ACL reconstruction is one of the best options in the skeletally immature, as it has the lowest risk of growth plate complications and growth arrest. The neurovascular structures are very close to the path for over-the-top graft clamp placement with distances