AJSM - 2026-04-01 - Journal Article
Does Resident Involvement Affect Clinical Outcomes and Postoperative Complication Rates in Orthopaedic Sports Medicine Surgery?
Stokes DJ, Cram TR, Pasic N, McGinley BM, Felan NA, Lim JJ, Geraghty EH, Rakos S, Grassmeyer RP, Wharton BR, Keeter C, Frank RM
Topics
Key Takeaway
Trainee involvement in ACLR and RCR did not increase 100-day complication rates (4.6% and 3.6%, respectively) or worsen 2-year PROs, though operative time increased by 13–26 minutes depending on trainee type.
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Summary
This single-institution retrospective cohort examined whether resident or fellow involvement in primary ACLR and RCR (2014–2022) affected 100-day complication rates, operative time, and 2-year PROs across 3997 cases. Complication rates were equivalent regardless of trainee presence (ACLR 4.6%, RCR 3.6%; both P=0.4), and no PRO differences were detected at 2 years. Operative time was significantly longer with trainees: up to 15 minutes longer for fellows and 21 minutes longer when both resident and fellow were present in ACLR, and up to 26 minutes longer in RCR with both trainees.
Key Limitation
Non-randomized trainee assignment at a single institution likely introduces case-complexity selection bias, potentially underestimating the true effect of trainee involvement by concentrating trainees in more straightforward cases.
Original Abstract
BACKGROUND
The "July effect" suggests increased patient morbidity and mortality during the early academic year due to new resident involvement. Evidence specific to orthopaedic sports medicine is limited.
PURPOSE
To evaluate the effect of resident and fellow involvement on postoperative complication rates, surgical time, and patient-reported outcomes (PROs) in anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR).
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Patients who underwent primary ACLR or RCR between 2014 and 2022 at a single institution with a minimum 2-year follow-up were analyzed. Outcomes included operative time, postoperative complications within 100 days, and PROs (International Knee Documentation Committee Subjective Knee Form, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, Patient-Reported Outcomes Measurement Information System [PROMIS]-Physical Function, PROMIS-Pain Interference, Marx Activity Rating Scale, and visual analog scale). Trainee involvement was defined by resident or fellow presence in the operating room. Statistical analyses included analysis of variance, t tests, chi-square tests, and linear mixed models ( P < .05).
RESULTS
Of the 3997 cases (2065 RCR, 1932 ACLR), trainees were involved in 1537 RCR and 1529 ACLR cases. ACLR demographic characteristics (age, sex, body mass index [BMI], and smoking status) were similar across all groups ( P > .05), whereas RCR patients showed modest significant differences in sex ( P = .011), BMI ( P = .036), and smoking status ( P = .012) but not age ( P = .13). Postoperative complication rates were comparable with or without trainees (ACLR, 4.6%, P = .4; RCR, 3.6%, P = .4), although operative time was longer in cases with trainee involvement (ACLR, 97 minutes [no trainee] vs 110 minutes [fellow], 105 minutes [resident], and 112 minutes [both], P < .001; RCR, 91 minutes [no trainee] vs 106 minutes [fellow], 103 minutes [resident], and 117 minutes [both], P < .001). No significant differences in PROs were observed at 2 years.
CONCLUSION
Trainee involvement in ACLR and RCR did not increase postoperative complication rates or worsen PROs, despite longer operative times and RCR demographic variations, supporting the safety of trainee participation in sports medicine surgeries.