Background: Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized. Purpose: To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM). Study Design: Cross-sectional study. Methods: Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally. Results: Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons ( P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women’s National Basketball Association (31.3%). Conclusion: Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.

Objectives: The purpose of this study was to evaluate the demographics of female representation among team physicians in the National Collegiate Athletic Association (NCAA) and professional sports organizations. We hypothesized that female team physicians are underrepresented at the collegiate and professional level despite controlling for the percentage of women in orthopaedics overall. Methods: Team physicians responsible for providing medical care to athletes in the “Power Five” conferences (Southeastern Conference [SEC], Atlantic Coast Conference [ACC], BIG-10, BIG-12, PAC-12) and select professional organizations [Major League Baseball(MLB), National Football League (NFL), National Basketball Association (NBA), Women’s National Basketball Association (WNBA)] were surveyed using the most current publicly available online information for both collegiate and professional organizations (range, 2012-2018). Demographic data was used to sort physicians by gender. Team physicians were further stratified into orthopaedic and primary care sports medicine (PCSM) categories. The proportion of females in each field was analyzed using univariate analysis, with statistical significance defined as p<0.05. Results: Analysis found that 100% of the teams in the NFL, NBA, and MLB as well as 82% of teams in the WNBA had male team physician representation, including either a male orthopaedic surgeon or male PCSM provider. Females (orthopaedic and PCSM) were represented among 13.3% of NBA teams, 55% of WNBA teams, 13.3% of MLB teams, and 6.3% of NFL teams. Specifically, female orthopaedic surgeons were represented in 3.33% of NBA, 45.45% of WNBA, 10% of MLB, and 3.13% of NFL teams. In the ”Power Five” conferences, female orthopaedic surgeons were represented in 7.14% of teams in the SEC, 8.33% in the ACC, 30.77% in the BIG-10, 0% in the BIG-12, and 50% in the PAC-12. The total number of male orthopaedic surgeons was significantly higher in the “Power Five” collegiate conferences, with team orthopaedic surgeons 1,483 times more likely to identify as male compared to female (p<0.001). The representation of female orthopaedic surgeons in the PAC 12 (p=0.004) and BIG 10 (p=0.005) was significantly higher as compared to female representation among physician members of the American Academy of Orthopaedic Surgeons (AAOS).The proportion of female orthopaedic surgeons in the AAOS was 5.4% (1568/28988) versus 94.6% male physicians (27420/28988) (AAOS 2016 Consensus Report). Conclusion: There is a paucity of data describing representation of female team physicians among major athletic organizations. This analysis found that male orthopaedic surgeons represent a significantly higher proportion of team or orthopaedic physicians in several Division I collegiate conferences and professional sports compared to female physicians. Interestingly, the overall representation of female orthopaedic surgeons in the PAC12 and BIG 10 conferences was higher than their representation in the AAOS. However, female representation among team physicians has not kept pace with increasing numbers of female participation in collegiate and professional athletics. Overall, female team physicians are underrepresented in sports medicine in the United States at both the collegiate and professional levels. Further exploration of educational pathways and hiring processes for team physicians may be warranted. [Table: see text]

Proximal tibiofibular joint (PTFJ) instability is a rare cause of lateral-sided knee pain. The authors present a case of bilateral, symptomatic PTFJ instability with peroneal nerve dysfunction in an active 16-year-old female athlete. This was addressed with peroneal nerve decompression and PTFJ stabilization using a suspensory button fixation system. This provides an alternative treatment from historical methods such as PTFJ fusion or re-approximation of the joint with tendon through bone tunnels. The surgical technique, as well as potential treatment challenges, is described in detail. The purpose of this report is to highlight PTFJ instability as a cause of lateral-sided knee pain to avoid misdiagnosis and delay in appropriate treatment. This patient had significant improvement in pain and decreased neurologic symptoms after the stabilization and nerve decompression. She was able to return to high-level activity. [Orthopedics. 2017; 40(6):e1107-e1111.].

In adolescents and young adults, instability is a common shoulder pathology with a myriad of coexisting soft tissue and bony lesions. When evaluating a patient for the cause of instability, care must be given to assess for the infrequent lesions, including glenoid avulsion of the glenohumeral ligaments. This case example illustrates key points in the diagnosis, surgical, and postsurgical management of this less common cause of anterior shoulder instability.

Background: Patients undergoing elective procedures often utilize online educational materials to familiarize themselves with the surgical procedure and expected postoperative recovery. While the Internet is easily accessible and ubiquitous today, the ability of patients to read, understand, and act on these materials is unknown. Purpose: To evaluate online resources about anterior cruciate ligament (ACL) surgery utilizing measures of readability, understandability, and actionability. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Using the term “ACL surgery,” 2 independent searches were performed utilizing a public search engine ( Google.com ). Patient education materials were identified from the top 50 results. Audiovisual materials, news articles, materials intended for advertising or medical professionals, and materials unrelated to ACL surgery were excluded. Readability was quantified using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index, and Gunning Fog Index. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) was utilized to assess the actionability and understandability of materials. For each online source, the relationship between its Google search rank (from first to last) and its readability, understandability, and actionability was calculated utilizing the Spearman rank correlation coefficient (ρS). Results: Overall, we identified 68 unique websites, of which 39 met inclusion criteria. The mean Flesch-Kincaid Grade Level was 10.08 ± 2.34, with no website scoring at or below the 6th-grade level. Mean understandability and actionability scores were 59.18 ± 10.86 (range, 33.64-79.17) and 34.41 ± 22.31 (range, 0.00-81.67), respectively. Only 5 (12.82%) and 1 (2.56%) resource scored above the 70% adequate PEMAT-P threshold mark for understandability and actionability, respectively. Readability (lowest P value = .103), understandability (ρS = –0.13; P = .441), and actionability (ρS = 0.28; P = .096) scores were not associated with Google rank. Conclusion: Patient education materials on ACL surgery scored poorly with respect to readability, understandability, and actionability. No online resource scored at the recommended reading level of the American Medical Association or National Institutes of Health. Only 5 resources scored above the proven threshold for understandability, and only 1 resource scored above it for actionability.