Background: The Centers for Disease Control defines work-related musculoskeletal disorders as disorders of the nerves, muscles, tendons, joints, spinal discs, and cartilage that are caused or exacerbated by the environment or nature of work. Previous meta-analyses have characterized work-related musculoskeletal disorders among interventionists, general surgeons, and other surgical subspecialties, but prevalence estimates, prognosis, and ergonomic considerations vary by study and surgical specialty. Questions/purposes: (1) What is the career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons? (2) What is the treatment prevalence associated with work-related musculoskeletal disorders in orthopaedic surgeons? (3) What is the disability burden of work-related musculoskeletal disorders in orthopaedic surgeons? (4) What is the scope of orthopaedic surgical ergonomic assessments and interventions? Methods: A systematic review of English-language studies from PubMed, MEDLINE, Embase, and Scopus was performed in December 2022 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that presented prevalence estimates of work-related musculoskeletal disorders or assessed surgical ergonomics in orthopaedic surgery were included. Reviews, case reports, gray literature (conference abstracts and preprints), and studies with mixed-surgeon (nonorthopaedic) populations were excluded. The search yielded 5603 abstracts; 24 survey-based studies with 4876 orthopaedic surgeons (mean age 48 years; 79% of surgeons were men) were included for an analysis of work-related musculoskeletal disorders, and 18 articles were included for a descriptive synthesis of ergonomic assessment. Quality assessment using the Joanna Briggs Institute Tool revealed that studies had a low to moderate risk of bias, largely because of self-reporting survey-based methodology. Because of considerable heterogeneity and risk of bias, prevalence outcomes were not pooled and instead are presented as ranges (mean I² = 91.3%). Results: The career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons ranged from 37% to 97%. By anatomic location, the prevalence of work-related musculoskeletal disorders in the head and neck ranged from 4% to 74%; back ranged from 9% to 77%; forearm, wrist, and hand ranged from 12% to 54%; elbow ranged from 3% to 28%; shoulder ranged from 3% to 34%; hip and thigh ranged from 1% to 10%; knee and lower leg ranged from 1% to 31%; and foot and ankle ranged from 4% to 25%. Of orthopaedic surgeons reporting work-related musculoskeletal disorders, 9% to 33% had a leave of absence, practice restriction or modification, or early retirement, and 27% to 83% received some form of treatment. Orthopaedic surgeons experienced biomechanical, cardiovascular, neuromuscular, and metabolic stress during procedures. Interventions to improve orthopaedic surgical ergonomics have been limited, but have included robotic assistance, proper visualization aids, appropriate use of power tools, and safely minimizing lead apron use. In hip and knee arthroplasty, robotic assistance was the most effective in improving posture and reducing caloric expenditure. In spine surgery, proper use of surgical loupes was the most effective in improving posture. Conclusion: Although the reported ranges of our main findings were wide, even on the low end of the reported ranges, work-related musculoskeletal disability among orthopaedic surgeons appears to be a substantial concern. We recommend that orthopaedic residency training programs incorporate surgical ergonomics or work injury lectures, workshops, and film review (alongside existing film review of surgical skills) into their curricula. We suggest hospitals engage in shared decision-making with surgeons through anonymous needs assessment surveys to implement wellness programs specific to surgeons’ musculoskeletal needs. We urge institutions to assess surgeon ergonomics during routine quality assessment of novel surgical instruments and workflows. Level of Evidence: Level III, prognostic study.

Background: Body protection compound-157 (BPC-157) is a naturally occurring gastric peptide that promotes mucosal integrity and homeostasis. Preclinical studies show its potential for promoting healing in musculoskeletal injuries such as fractures, tendon ruptures, ligament tears, and muscle injuries. Despite lacking US Food and Drug Administration approval and its use being banned in professional sports, it is increasingly used by clinicians and athletes. Purpose: We sought to (1) provide a comprehensive synthesis of the BPC-157 literature from an orthopedic sports medicine perspective and (2) elucidate the mechanism of action, musculoskeletal effects, metabolism, and safety profile. Methods. We conducted a systematic review of English-language literature, published from database inception to June 3, 2024, from PubMed, Cochrane, and Embase. We searched PROSPERO to identify any current or unpublished reviews. Studies reporting BPC-157’s mechanism, musculoskeletal outcomes, metabolism, and safety were included. Articles were screened in 3 phases by 2 reviewers. In cases of a disagreement between the 2 reviewers, blinding was removed, and eligibility was determined by group consensus, with a third author making the final decision. Results. A total of 544 articles from 1993 to 2024 were identified. After duplicates were removed, 36 studies were included (35 preclinical studies, 1 clinical study). The studies suggest that BPC-157 enhances growth hormone receptor expression and several pathways involved in cell growth and angiogenesis, while reducing inflammatory cytokines. In preclinical models, BPC-157 improved functional, structural, and biomechanical outcomes in muscle, tendon, ligament, and bony injuries. In a retrospective study of musculoskeletal pain following intraarticular injection of BPC-157 for unspecified chronic knee pain, 7 of 12 patients reported relief for >6 months. BPC-157 is metabolized in the liver, with a half-life of less than 30 minutes, and is cleared by the kidneys. Preclinical safety studies showed no adverse effects across several organ systems. No clinical safety data were found. Conclusion: This systematic review of level IV and level V studies suggests that BPC-157 shows promise for promoting recovery from musculoskeletal injuries. Adverse effects are possible due to unregulated manufacturing, contamination, or unknown clinical safety. We recommend that clinicians counsel athletes to understand their organizations’ rules to remain compliant with medication/supplement safety and testing standards.

Selective Androgen Receptor Modulators (SARMs) abuse and social media prevalence is rapidly growing. Despite the paucity of literature on the clinical effects and safety profile of SARMs, abuse by recreational and professional athletes increases annually. SARMs, a World Anti-Doping Agency (WADA) prohibited performance enhancing drug (PED), display stronger tissue-selective activation of androgen signaling as compared to anabolic steroids. Published case reports and anecdotal evidence suggest liver toxicity, cardiac injury, and other adverse effects are associated with SARMs consumption. However, social media misinformation may lead individuals to believe that SARMs are safe. With no established evidence-based guidelines, we propose that treatment for SARMs abuse should mimic treatment for anabolic-steroid abuse. Health care providers and sports team members must educate themselves on the SARMs literature and social media trends to promote open dialogue and prevent SARMs abuse.

Selective Androgen Receptor Modulators (SARMs) social media interest is at an all-time high. The aim of this study is to analyze the: (1) quality; (2) educational content; and (3) reliability of th...

Objectives: Many orthopedic surgeons experience work-related injury and musculoskeletal symptoms. The culture of orthopedics lends itself to surgeons and trainees operating through such injuries, which may jeopardize the health of orthopedic surgeons and impact their ability to provide exemplary patient care. The objective of this study was to present a comprehensive synthesis of the literature pertaining to occupational injuries among orthopedic surgeons, with particular emphasis on characterizing the predominant causes, treatments, and reported outcomes associated with these injuries. Methods: A systematic review of the English-language literature from PubMed, Embase, and Scopus was performed according to the PRISMA guidelines. All studies assessing MSK-injury/pain epidemiology, treatment, or outcomes among orthopedic surgeons and trainees were included. Studies primarily assessing ergonomics pertaining to specific manufacturers or devices were excluded. Reviews, meta- analyses, editorials and conference abstracts were excluded. Results: The literature search yielded 719 abstracts, and a total of 11 articles were identified for inclusion. All included studies were survey-based. A total of 2153 orthopedic surgeons, fellows, and residents were surveyed across several subspecialties (Table 1). 1547 orthopedic surgeons and trainees (71.9%) reported present or past work-related or work-exacerbated musculoskeletal injury/pain (Table 2). Four studies reported the back as the most commonly injured body part (Table 2). Four studies reported pain scores (Table 2). Three studies noted a greater prevalence of acute pain/injury as compared to chronic pain/injury (Table 2). Seven studies investigated the treatment of musculoskeletal injury/pain among orthopedic surgeons and trainees, including surgical, non-surgical, and pharmacological interventions (Table 3). A total of 605 of 1054 injured orthopedic surgeons/trainees (57.4%) received some form of treatment for musculoskeletal pain/injury. However, only 305 of 1054 injured orthopedic surgeons and trainees (28.9%) took time off from work due to pain/injury. Three studies compared the incidence of musculoskeletal injury/pain by orthopedic subspecialty and found no difference between subspecialties (Table 4). One study compared injury/pain incidence by training level and found no difference. Seven studies compared injury/pain incidence by sex and found no difference (Table 4). Nine studies assessed injury/pain incidence by number of years in practice; five of these studies reported a statistically significant association, where a higher number of years in practice correlated positively with a higher incidence of musculoskeletal injury/pain (Table 4). Conclusions: Many orthopedic surgeons and trainees experience musculoskeletal pain/injury and work through these symptoms. Many surgeons believe their injury/pain will have a deleterious impact on surgical performance and patient care. Thus, hospitals and other administrative programs should consider assessing orthopedic surgeons’ physical health and encourage paid rest time or other treatment modalities to promote surgeon well-being and optimize patient outcomes. [Table: see text][Table: see text][Table: see text][Table: see text]