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The COVID-19 pandemic is a traumatic stressor resulting in anxiety, depression, post-traumatic stress, and burnout among healthcare workers. We describe an intervention to support the health workforce and summarize results from its 40-week implementation in a large, tri-state health system during the COVID-19 pandemic.We conducted 121 virtual and interactive Stress and Resilience Town Halls attended by 3555 healthcare workers. Town hall participants generated 1627 stressors and resilience strategies that we coded and analyzed using rigorous qualitative methods (Kappa = 0.85).We identify six types of stressors and eight types of resilience strategies reported by healthcare workers, how these changed over time, and how town halls were responsive to emerging health workforce needs. We show that town halls dedicated to groups working together yielded 84% higher mean attendance and more sharing of stressors and resilience strategies than those offered generally across the health system, and that specific stressors and strategies are reported consistently while others vary markedly over time.The virtual and interactive Stress and Resilience Town Hall is an accessible, scalable, and sustainable intervention to build mutual support, wellness, and resilience among healthcare workers and within hospitals and health systems responding to emerging crises, pandemics, and disasters.

Rotator cuff repair in the setting of a chronic tear or poor tissue quality presents a surgical challenge because of the high risk of structural failure. Patients with an increased risk of retear may be candidates for enthesis augmentation with a novel, biphasic allograft, composed of a demineralized cancellous matrix with a layer of mineralized bone. This interpositional graft was designed with the intention to promote both soft-tissue and osseous integration into the matrix, thereby conferring greater stability and regeneration of the transitional zone of the rotator cuff enthesis. Here, we describe a technique for a transosseous-equivalent supraspinatus repair with placement of a biphasic interpositional allograft.

Achievement of appropriate mechanical knee alignment is crucial to ensure optimal clinical outcomes following osteotomy procedures about the knee. The use of patient-specific instrumentation (PSI) to assist in preoperative planning and intraoperative realignment has gained increasing popularity. The purpose of this article is to describe a surgical technique involving a medial closing wedge high tibial osteotomy performed using three-dimensional (3D) PSI and cutting guide to revise residual valgus deformity following failed distal femoral osteotomy. The correction angle, 3D position of the hinge and wedge, as well as final plate and screw position are planned preoperatively using virtual software and computed tomography imaging to allow precise surgical execution., Technique Video Video 1 This video demonstrates the medial closing wedge high tibial osteotomy technique using three-dimensional patient-specific instrumentation and cutting guide for valgus malalignment.

Purpose: To establish a better understanding of the variations in pain management protocols and prescribing patterns for pediatric patients undergoing anterior cruciate ligament (ACL) reconstruction or repair. Methods: A 20-question multiple-choice survey was distributed to 3 professional orthopaedic societies to assess the pre-emptive and postoperative pain management prescribing patterns for pediatric patients undergoing ACL reconstruction or repair. Clinical agreement (defined as agreement between >80% of participants) and general agreement (defined as agreement between >60% of participants) were calculated based on responses as previously reported. Results: Clinical agreement was observed among the 68 respondents in use of a single shot nerve block before induction of anesthesia versus continuous use when a peripheral nerve block was used, “always” counseling patients on postoperative pain control, the prescribing of opioids postoperatively, and a lack of change in postoperative protocol when concomitant meniscal repair or meniscectomy was performed. General agreement was observed in the use of a peripheral nerve block, some pre-emptive analgesia practices, and the lack of counseling patients with regard to disposal of unused opioid pain medication postoperatively. Opioids were prescribed by 88% of participants postoperatively, with 48% prescribing 11 to 19 pills and 15% prescribing ≥20 pills. Conclusions: While pain management practices before and following ACL reconstruction and repair in the pediatric population remain varied, opioids are frequently prescribed postoperatively with many providers neglecting to provide instruction on excess opioid disposal. Clinical Relevance: ACL reconstruction and repair is becoming increasingly common in the pediatric population. Clinical guidelines that establish pre-emptive and postoperative pain-control protocols should be considered to determine safe and optimal pain control throughout the duration of care while minimizing opioid prescribing and consumption.

Purpose: The purpose of this study is to determine the safety of elective, outpatient orthopaedic sports procedures during the Coronavirus (COVID-19) pandemic at a high-volume orthopaedic practice. Methods: All patients who were scheduled for elective, outpatient orthopaedic sports medicine procedures at one of two of outpatient surgical centers between July 1, 2020 and December 31, 2020 were asked to complete a custom survey during a post-operative clinic visit or phone call at a minimum of two-weeks or were subject to a routine screening questionnaire and temperature screen at the time of the first post-operative follow-up visit. The survey questionnaire assessed for any COVID-19-related symptoms. Surgical case logs were retrieved to review for any cancelled surgeries due to a positive pre-operative COVID-19 test. Results: A total of 3.5% of patients (n=39/1119) scheduled for surgery were diagnosed with COVID-19 during preoperative testing, resulting in surgical cancellation. Patients with a positive pre-operative COVID-19 test were found to be significantly younger (46 ± 20 years) when compared to all other patients with a negative test (51 ± 21 years; p=0.002). No patient was diagnosed with COVID-19, reported symptoms concerning for COVID infection, underwent additional testing, or reported close contact with another individual with a positive test or possessed symptoms concerning for COVID-19 at a minimum of two-weeks post-operatively. Conclusion: This study found that 3.5% of patients tested positive for COVID-19 and were significantly younger when compared to patients testing negative. No patient investigated for potential infection post-operatively reported the development of any symptoms related to COVID-19 or reported a positive test post-operatively. Using current protocols for pre-operative screening, elective outpatient orthopaedic surgery performed in an ASC is safe with no documented cases of COVID-19 transmission in this cohort.

Orthoregeneration is defined as a solution for orthopedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include: drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electro-magnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the knee, including symptomatic osteoarthritis and chondral injuries, as well as injuries to tendon, meniscus, and ligament, including the anterior cruciate ligament. Promising and established treatment modalities include hyaluronic acid (HA) in liquid or scaffold form; platelet-rich plasma (PRP); bone marrow aspirate (BMA) comprising mesenchymal stromal cells (MSCs), hematopoietic stem cells, endothelial progenitor cells, and growth factors; connective tissue progenitor cells (CTPs) including adipose-derived mesenchymal stem cells (AD-MSCs) and tendon-derived stem cells (TDSCs); matrix cell-based therapy including autologous chondrocytes or allograft; vitamin D; and fibrin clot. Future investigations should standardize solution preparations, because inconsistent results reported may be due to heterogeneity of HA, PRP, BMAC, or MSC preparations and regimens, which may inhibit meaningful comparison between studies to determine the true efficacy and safety for each treatment.

Instability of the long head of the biceps brachii tendon is a recognized source of shoulder pain. However, this diagnosis is usually associated with concomitant pathology including subscapularis tendon tears. The appropriate diagnosis of biceps incarceration or instability remains challenging, with failure to address instability being likely to result in persistent pain and disability despite arthroscopic management of concomitant shoulder pathology. The objective of this article is to (1) describe a dynamic test performed both preoperatively and intraoperatively, termed the “biceps incarceration maneuver,” to help identify biceps instability; (2) reinforce the concept that biceps instability must be ruled out in young patients presenting with anterior shoulder pain; and (3) report that with proper diagnosis and treatment, patients with biceps instability will experience rapid symptomatic resolution after management., Technique Video Video 1 Patients with biceps incarceration generally complain of anterior shoulder pain with discomfort on palpation within the bicipital groove and when undergoing the biceps incarceration maneuver, in which the shoulder and elbow are flexed 90° and the arm is internally rotated. In the operating room, with the arthroscope in the standard posterior viewing portal, centered on the long head of the biceps tendon, the arm is released, and the incarceration maneuver is performed, resulting in subluxation or dislocation of the biceps tendon within the glenohumeral joint. Instability is eliminated through an arthroscopic biceps tenotomy followed by subsequent open biceps tenodesis. In many instances, a chondral print lesion may be appreciated as a result of articular cartilage wear from the biceps on the anterosuperior aspect of the humeral head.