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Background:Optimal treatment of meniscal pathology continues to evolve in orthopaedic surgery, with a growing understanding of which patients benefit from which procedure and which patients might be best treated nonsurgically. In 2002, Moseley et al found no difference between arthroscopic procedures, including meniscal debridement and sham surgery, in patients with osteoarthritis of the knee. This called into question the role of routine arthroscopic debridement in these patients. Additionally, an increased interest in understanding and maintaining the function of the meniscus has more recently resulted in a greater focus on meniscal preservation procedures.Study Design:Descriptive epidemiology study.Purpose/Hypothesis:The purpose was to evaluate the trends of arthroscopic meniscal debridement and repair and the characteristics of the patients receiving these treatments, compare the differences in practice between newly trained orthopaedic sports medicine specialists and those of other specialties, and analyze if there are differences in practice by region. It was hypothesized that the American Board of Orthopaedic Surgery (ABOS) database would evaluate practice patterns of recent graduates as a surrogate for current treatment and training and, consequently, demonstrate a decreased rate of meniscal debridement.Methods:Data from ABOS Part II examinees from 2001 to 2017 were obtained from the ABOS Case List. Current Procedure Terminology (CPT) codes related to arthroscopic meniscal treatment were selected. The examination year, age of the patient, practice region, and examinee subspecialty were analyzed. Patient age was stratified into 4 groups: 65 years. Examinee subspecialty was stratified into sports medicine and non–sports medicine. Statistical regression analysis was performed.Results:Between 2001 and 2017, ABOS Part II examinees submitted 131,047 cases with CPT codes 29880 to 29883. Meniscal debridement volume decreased for all age groups during the study period, while repair increased. Sports medicine subspecialists were more likely than their counterparts to perform repair over debridement in patients aged younger than 30 years ( P = .0004) and between 30 and 50 years ( P = .0005).Conclusion:This study provides insights into arthroscopic meniscal debridement and repair practice trends among ABOS Part II examinees. Meniscal debridement is decreasing and meniscal repair is increasing. Younger patient age and treatment by a sports medicine subspecialty examinee are associated with a higher likelihood of repair over debridement.

Background: Tears of the superior labrum (superior labrum anterior and posterior [SLAP] lesions) of the shoulder are uncommon injuries; however, the incidence of surgical correction seems to be increasing. Purpose: To report the findings of a review of a proprietary descriptive database that catalogs cases for the purpose of board certification on the demographics of SLAP lesion repair. It is the authors’ impression that the percentage of cases of SLAP lesion repairs reported by young orthopaedic surgeons is high and that complications associated with this are not insignificant. Study Design: Cohort study; Level of evidence, 3. Methods: We searched the American Board of Orthopedic Surgery (ABOS) Part II database to evaluate changes in treatment over time and to identify available outcomes and associated complications of arthroscopic repair of SLAP lesions. The database was searched for all SLAP lesions (ICD-9 code 840.7) and SLAP repairs (CPT code 29807) for the years 2003 through 2008. Utilization was analyzed by geographic region and was also obtained based on applicant subspecialty declaration. Results: There were 4975 SLAP repairs, representing 9.4% of all applicants’ shoulder cases. Mean follow-up was 8.9 weeks because of the time-limited case collection period. There were 78.4% who were men, and 21.6% of patients were women. The percentage of shoulder cases that were SLAP repairs increased over the study period from 9.4% to 10.1% by 2008 ( P = .0163). Mean age of male patients was 36.4 ± 13.0 years, with a maximum of 85 years. Mean age of female patients was 40.9 ± 14.0 years, with a maximum of 88 years. Pain was reported as absent in only 26.3% of patients at follow-up and function as normal in only 13.1%. There were 40.1% of applicants who self-reported their patients to have an excellent result. The self-reported complication rate was 4.4%. Declared sports medicine specialists had a higher percentage of SLAP repairs than did general orthopaedic surgeons: 12.4% versus 9.2%. Conclusion: The percentage of shoulder cases that are SLAP repairs reported by the candidates is 3 times the published incidence supported by the current literature. The large number of repairs in middle-aged and elderly patients is concerning. Focusing on educating young orthopaedic surgeons to appropriately recognize and treat symptomatic SLAP lesions may bring the rate of SLAP repairs down.

This article examines how organizations can better respond to the needs of individuals who are reexamining and changing their chosen career paths. The term, "career recycling ", reflects a new, growing segment of the workforce describing individuals who are reexamining and changing their career paths. Through exploratory interviews, we found that recylers were dissatisfied with their careers and willing to accept the risks associated with changing career direction. Recycling is generally triggered by organizational change, personal plateauing and/or personal crisis. Firms may need to reassess, redesign, and reevaluate key human resource activities, such as employee counseling, job sharing, and compensation benefits in the light of this new phenomenon.

Lower-extremity injuries are common among dancers and cause significant absences from rehearsals and performances. For this study of lower-extremity injuries in 101 ballet and 47 modern dance students, injuries requiring medical attention sustained over 1 academic year were associated with the following data obtained at the beginning of the school year: ankle flexibility, sex, dance discipline, previous injury, body mass in dex, and years of training. Eighty-three of the 148 students (age range, 12 to 28 years) reported prior lower-limb injuries, the most common being ankle sprains (28% of all dancers). Previous leg injuries cor related significantly with lower dorsiflexion meas urements and with more new injuries. Female students had greater ankle and first metatarsophalangeal flexi bility. Modern dancers had greater ankle inversion. Ninety-four students sustained 177 injuries during the study, including 75 sprains or strains and 71 cases of tendinitis. Thirty-nine percent ( N = 69) were ankle injuries; 18% ( N = 33) were knee injuries; 23% ( N = 40) were foot injuries; and 20% (N = 35) were either hip or thigh injuries. Sixty-seven percent (N = 78) of the injured students were ballet dancers. Age, years of training, body mass index, sex, and ankle range of motion measurement had no predictive value for injury; previous injury and dance discipline both correlated with increased risk of injury.

Seven cases of iliotibial band syndrome and the patho anatomic findings of each, as demonstrated by mag netic resonance imaging, are presented. These findings were compared with magnetic resonance imaging scans of 10 age- and sex-matched control knees with out evidence of lateral knee pain. Magnetic resonance imaging signal consistent with fluid was seen deep to the iliotibial band in the region of the lateral femoral epicondyle in five of the seven cases. Additionally, when compared with the control group, patients with iliotibial band syndrome demonstrated a significantly thicker ili otibial band over the lateral femoral epicondyle (P < 0.05). Thickness of the iliotibial band in the disease group was 5.49 ± 2.12 mm, as opposed to 2.52 ± 1.56 mm in the control group. Cadaveric dis sections were performed on 10 normal knees to further elucidate the exact nature of the area under the iliotibial band. A potential space, i.e., a bursa, was found between the iliotibial band and the knee capsule. This series suggests that magnetic resonance imag ing demonstrates objective evidence of iliotibial band syndrome and can be helpful when a definitive diag nosis is essential. Furthermore, correlated with ana tomic dissection, magnetic resonance imaging identi fies this as a problem within a bursa beneath the iliotibial band and not a problem within the knee joint.

Ankle arthroscopy has become an accepted procedure for the treatment of various intraarticular disorders. More than 100 ankle arthroscopies have been per formed at our institution since 1983. To better define the role of arthroscopic surgery in the treatment of ankle disorders, we evaluated the preoperative exami nation and indications, operative data, and radiographs of those patients with a minimum of 1 year of followup. Fifty-eight ankles in 57 patients were identified; their average follow-up period was 25 months (range, 12 to 49 months).Preoperative diagnoses were synovitis (26), trans chondral defects of the talus (17), degenerative joint disease (8), and osteophytes or loose bodies (7). Sub jective results were good or excellent in 64% of cases. The best overall results were achieved in patients with synovitis (77%) and transchondral defects of the talus (71 %). Degenerative joint disease patients did not do well. They had only 12% good or excellent results and a 43% rate of subsequent fusion. Complications in cluded superficial and deep infections, temporary and permanent paresthesias, and hemarthroses; the overall complication rate was 15%.In conclusion, operative ankle arthroscopy can be useful in selected patients. It is an effective surgical procedure in patients with synovitis and transchondral defects of the talus. The benefits and long-term results are less predictable with loose bodies and impinging osteophytes; the results are poor with degenerative joint disease. There appears to be a significant risk of complication with ankle arthroscopy; however, with proper indications, a thorough knowledge of anatomical landmarks, and meticulous technique, good results can be obtained.