Prognostic level I. See instructions for authors for a complete description of levels of evidence.

Background Results of treatment for acute knee dislocations and multiligament knee injuries may be influenced by a multitude of patient-and injury-related factors, including neurologic function, vascular status, ipsilateral fractures, and joint stability. The development of heterotopic ossification (HO) may nullify any benefits of reconstruction, because it can cause stiffness and discomfort. Identifying factors associated with HO after knee dislocation may help identify patients who might benefit from prophylaxis. Questions/purposes The purposes of this study were (1) to identify specific risk factors for the development of HO in patients with knee dislocation; and (2) to elucidate the relationship between the presence of absence of HO and postoperative range of motion. Methods Between 2005 and 2010, we performed 101 multiligament reconstructions for patients with knee dislocations, of which 91 (90%) in 91 patients were available for followup at a minimum of 6 months (mean, 18 months; range, 6-44 months), and were reviewed here. AP and lateral radiographs were reviewed for all patients and HO was classified according to the Mills and Tejwani classification system. This knee dislocation cohort was separated into two groups based on the presence or absence of HO for comparison. Using a significance level of p \ 0.05 for factors in the univariate analyses, we identified potential variables for a multivariate logistic regression model to identify risk factors predicting development of HO in patients with multiligament knee injuries; multivariate analysis then was performed to mitigate the influence of potentially confounding variables. Thirty patients (34%) developed HO after multiligament knee injury in our series. Results Posterior cruciate ligament reconstruction was the only independent predictor of HO that we identified (odds ratio, 6.3; 95% confidence interval, 1.2-34.6). Patients who developed HO were more likely to develop stiff knees and undergo surgery (50%; 15 of 30 patients) versus those without HO (12%; seven of 58 patients) to attempt to restore functional range of motion (p \ 0.001). Conclusions HO is a common complication after knee dislocation and can diminish range of motion and cause patients to undergo further surgery. Posterior cruciate ligament reconstruction is an independent risk factor for the development of HO. Strategies to identify risk factors for, and safe prevention of, HO after multiple ligament injury and surgery should be investigated going forward.

Background: A prerequisite for a valuable surgical case log is the ability to perform an accurate self-assessment. Studies have shown mixed results when examining residents' ability to self-assess on varying tasks. We sought to examine the correlation between residents' self-assessment and staff surgeons' evaluation of surgical involvement and competence in performing primary total knee (TKA) and hip arthroplasty (THA). Methods:We used the intraclass correlation coefficient (ICC) to evaluate interobserver agreement between residents' self-perception and staff surgeons' assessment of involvement. An assessment of competency was performed using a categorical global scale and evaluated with the κ statistic. We piloted a structured surgical skills assessment form as an additional objective appraisal of resident involvement. Results:We analyzed assessment data from 65 primary TKA and THA cases involving 17 residents and 17 staff surgeons (93% response rate). The ICC for resident involvement between residents and staff surgeons was 0.80 (95% confidence interval [CI] 0.69-0.88), which represents substantial agreement. The agreement between residents and staff surgeons about residents' competency to perform the case had a κ value of 0.67 (95% CI 0.50-0.84). The ICC for resident, staff surgeon and thirdparty observer using the piloted skills assessment form was 0.82 (95% CI 0.75-0.88), which represents substantial agreement. Conclusion:This study supports the ability of orthopedic residents to perform selfassessments of their degree of involvement and competency in primary TKA and THA. Staff surgeons' assessment of resident involvement correlated highly with the surgical skills assessment form. Self-assessment is a valuable addition to the surgical case log.Contexte: Un préalable à la tenue d'un registre de cas chirurgicaux valable est la capacité de s'auto-évaluer correctement. Des études ont fait état de résultats mitigés quant à la capacité des résidents de s'auto-évaluer face à diverses tâches. Nous avons analysé la corrélation entre l'auto-évaluation des résidents et leur évaluation par des chirurgiens attachés à l'établissement pour ce qui est de la participation aux chirurgies et des compétences lors d'interventions pour prothèse totale primaire du genou (PTG) et de la hanche (PTH).Méthodes: Nous avons utilisé un coefficient de corrélation intraclasse (CCI) pour évaluer la concordance inter-examinateurs entre la perception des résidents et l'évaluation de leur participation par les chirurgiens. Nous avons évalué les compétences à l'aide d'une échelle nominale globale et à l'aide du test κ. Nous avons aussi administré un formulaire structuré d'évaluation des habiletés chirurgicales comme mesure objective additionnelle de la participation des résidents.Résultats: Nous avons étudié les données d'évaluation relatives à 65 cas de PTG et de PTH primaires, auxquels 17 résidents et 17 chirurgiens ont participé (taux de réponse 93 %). Le CCI afférent à la participation des résidents entre ces derniers et les chirurgiens a é...