Browsing by Author "Guiloff, Rodrigo"

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    4 Domain Sports PROM en español: adaptación transcultural en la población chilena y análisis de confiabilidad
    (2024) Figueroa, David; Guiloff, Rodrigo; Figueroa, Francisco; Stocker, Esteban; Rocha, Sergio
    Antecedentes y objetivo: Las medidas de resultado reportadas por el paciente (PROM) son herramientas de interés creciente en la población deportiva. El propósito de este estudio fue realizar la adaptación transcultural y análisis de confiabilidad del 4-Domain Sports Patient-Reported Outcome Measure (4DSP) al español. Métodos: Se ejecutó un protocolo de adaptación transcultural en seis etapas para obtener la versión en español del 4DSP (S-4DSP). Posteriormente, se aplicó el cuestionario a una población de 108 deportistas posoperados de reconstrucción de ligamento cruzado anterior (RLCA). Se aplicó nuevamente el cuestionario luego de 30 días. Se evaluó la aceptabilidad, efecto piso y techo, consistencia interna (alfa de Cronbach) y reproducibilidad (correlación intraclase). Resultados: La S-4DSP fue respondida completamente por 108 participantes (edad media 34 ± 10,75, 26% mujeres) alcanzando una aceptabilidad de 100%. No se detectó efecto piso. El análisis estadístico entregó un alfa de Cronbach global para el cuestionario de 0,65, y desagregado por dominios de 0,88, 0,72, 0,27, 0,68 para el primer, segundo, tercer y cuarto dominio, respectivamente. El estudio de correlación intraclase alcanzó un máximo de 0,94 y un mínimo de 0,48 en la primera y quinta preguntas, respectivamente. Conclusión:El S-4DSP es una herramienta confiable y útil para evaluar deportistas de habla hispana posterior a una RLCA. Abstract Background: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. Methods: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. Results: The S-4DSP was fully completed by 108 participants (mean age 34 ± 10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. Conclusions: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.
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    Ángulo de Convergencia de la Línea Articular después de la Artroplastia Total de Rodilla: Comparación entre Alineación Mecánica y Alineación Paciente Específica con Cirugía Asistida por Robot
    (2025) Figueroa, David; Gonzalez, Waldo; Isla, Jorge; Figueroa, Francisco; Figueroa, Loreto; Rodrigo Guiloff; Guiloff, Rodrigo
    Introducción Como un método para mejorar la satisfacción del paciente después de la artroplastia total de rodilla (ATR), se han realizado diferentes estrategias de alineación para restaurar las superficies femorales y tibiales a su estado preartrítico. Debido a este cambio de paradigma, la orientación de la línea articular de la rodilla (JLO), un componente esencial de la cinemática de la rodilla, ha despertado recientemente interés como parámetro clínico. Este estudio tuvo como objetivo evaluar la JLO de la rodilla, medida por el ángulo de convergencia de la línea articular (JLCA), después de la ATR en dos estrategias de alineación diferentes mientras se utiliza cirugía asistida por robots. Nuestra hipótesis fue que una estrategia de alineación específica para el paciente conduciría a más valores de JLCA considerados normales (0–2°). Métodos Se realizó una revisión retrospectiva de datos de 98 pacientes (100 rodillas) que se sometieron a ATR asistida por robots. El Grupo I consistió en 50 rodillas que se sometieron a ATR utilizando una estrategia de alineación mecánica, y el Grupo II consistió en 50 rodillas que se sometieron a ATR utilizando una estrategia de alineación específica para el paciente. El JLCA fue medido por dos observadores diferentes en radiografías preoperatorias y postoperatorias. Se realizó un análisis estadístico utilizando la prueba t de Student, la prueba de chi-cuadrado y la regresión lineal para análisis multivariable. Resultados No hubo diferencias demográficas estadísticamente significativas entre ambos grupos en cuanto a edad, género, lado, índice de masa corporal, clasificación de Kellgren-Lawrence, rango de movimiento preoperatorio y medición del ángulo de cadera-rodilla-tobillo (HKA). La edad promedio fue de 69 años y el 61,2 % de todos los pacientes eran mujeres. En el Grupo I, el JLCA promedio preoperatorio fue de 2,34° (1,49 DE), y el JLCA promedio postoperatorio fue de 0,35° (0,27 DE). En el Grupo II, el JLCA promedio preoperatorio fue de 2,43° (1,72 DE), y el JLCA promedio postoperatorio fue de 0,29° (0,24 DE). En el Grupo I, la diferencia media entre el JLCA preoperatorio y postoperatorio fue de 2,34 (1,48 DE), y en el Grupo II la diferencia media entre el JLCA preoperatorio y postoperatorio fue de 2,43 (1,72 DE). No hubo una diferencia estadísticamente significativa entre ambos grupos en cuanto a la mejora del JLCA (p = 0,285). Conclusiones El JLCA mejoró en el postoperatorio en ambas estrategias de alineación, mecánica y específica del paciente, después de la ATR asistida por robots, sin diferencias significativas entre las estrategias. Introduction Different alignment strategies have been used to restore the femoral and tibial surfaces to their pre-arthritic state after total knee arthroplasty (TKA), improving patient satisfaction. Due to this paradigm change, the knee joint line orientation (JLO), an essential component of knee kinematics, has recently garnered interest as a clinical parameter. This study aimed to evaluate the JLO measured by the joint line convergence angle (JLCA) after TKA using two different alignment strategies and robotic-assisted surgery. We hypothesized that a patient-specific alignment strategy would lead to more JLCA values considered normal (0–2°). Methods A retrospective review of data from 98 patients (100 knees) who underwent robotic-assisted TKA was performed. Group I consisted of 50 knees that underwent TKA using a mechanical alignment strategy, and Group II consisted of 50 knees that underwent TKA using a patient-specific alignment strategy. The JLCA was measured by two different observers in pre-operative and post-operative radiographs. Statistical analysis was performed using the T-Student test, chi-square test, and linear regression for multivariate analysis. Results There were no statistically significant demographic differences between both groups regarding age, gender, side, body mass index, Kellgren-Lawrence classification, pre-operative range of motion, and hip-knee-ankle (HKA) angle measurement. The mean age was 69 years and 61.2% of all patients were females. In Group I, the average pre-operative JLCA was 2.34° (1.49 SD), and the average post-operative JLCA was 0.35° (0.27 SD). In Group II, the average pre-operative JLCA was 2.43° (1.72 SD), and the average post-operative JLCA was 0.29° (0.24 SD). In Group I, the mean difference between the pre- and post-operative JLCA was 2.34 (1.48 SD), and in Group II, the mean difference between the pre- and post-operative JLCA was 2.43 (1.72 SD). There was no statistically significant difference between both groups regarding JLCA improvement (p = 0.285). Conclusions The JLCA improved post-operatively in both mechanical and patient-specific alignment strategies after robotic-assisted TKA, without significant differences between strategies.
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    Comparison of Muscular Power Between Dominant and Nondominant Legs in Healthy Young Adults Associated With Single-Leg-Dominant Sports
    (2017) Vaisman, Alex; Guiloff, Rodrigo; Rojas, Juan; Delgado, Iris; Figueroa, David; Calvo, Rafael
    Background: Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison. Purpose: To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population. Study Design: Controlled laboratory study. Methods: A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 ears; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test. Results: No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes (t ¼ –1.01, P ¼ .316) or single-leg-dominant professional soccer players (t ¼ –1.10, P ¼ .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities. Conclusion: Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15% difference in power seems to be a proper parameter to define symmetrical power performance assessed by vertical single-leg jump tests.
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    Cross-cultural adaptation and validation of the KOOS, JR questionnaire for assessing knee osteoarthritis in Spanish-speaking patients
    (2023) Guiloff, Rodrigo; Iñiguez, Magaly; Prado, Tomás; Figueroa, Francisco; Olavarría, Nicolás; Carrasco, Eduardo; Ergas, Enrique; Salgado, Martín; Lyman, Stephen
    Purpose The present study aims to translate, adapt and validate a Spanish version of the Knee Injury and OsteoarthritisOutcome Score, Joint Replacement (KOOS, JR), including a reliability and validity analysis in patients with knee osteoar-thritis (OA).Methods This study conducted a prospective validation study following the six stages of the “Guidelines for the Process ofCross-Cultural Adaptation of Self-Report Measures”. Psychometric testing was conducted in patients with knee osteoarthritis.Subjects answered the Spanish KOOS, JR (S-KOOS, JR) and a validated Spanish Oxford Knee Score (S-OKS). Retest wasconducted at 10 days. Acceptability, floor and ceiling effect, internal consistency (Cronbach’s α), reproducibility (mixed-effect model coefficient [MEMC]) and construct validity (Spearman’s correlation; p = 0.05) were assessed.Results Forty-one patients (mean age: 65.6 ± 5.39; 48.8% female) participated in the study. All patients (100%) answeredboth scores during the first assessment and 38 (92.7%) during the second assessment. All patient-reported outcomes measureswere answered completely (100%). The S-KOOS, JR resulted in 100% acceptability when answered. There were no ceilingor floor effects detected. The Cronbach’s α for the S-KOOS, JR was 0.927 and its MEMC was 0.852 (CI 95% 0.636–1.078).The Spearman’s correlation between the S-KOOS, JR and the S-OKS was 0.711 (CI 0.345–0.608; p < 0.001) and 0.870 (CI0.444–0.651; p < 0.001) for the first and second assessments, respectively.Conclusion The S-KOOS, JR has very high internal consistency and reproducibility, with a high correlation with the S-OKS;it is a reliable and valid instrument for characterising Spanish-speaking patients suffering from knee OA.Level of evidence IV.
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    Impact of burnout on turnover, medical errors, medical leave and a cross-sectional study of contributing factors among Chilean physicians
    (2025) Villalón López, Francisco; Mundt, Adrian P.; Hirmas, Alejandro; Rivera, Rita M.; Guiloff, Rodrigo
    Background During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies. Objective To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment. Design A cross-sectional online survey conducted from November 2020 to December 2020. Participants Physicians registered with the Medical College of Chile. Setting Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare. Primary outcomes Burnout was assessed using the Maslach Burnout Inventory for Human Services. Secondary outcomes Self-reported medical errors, medical leave and turnover. Independent variables Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied. Results Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p<0.01), turnover (ß=0.012, p<0.05) and perceived medical errors (ß=0.009, p<0.001). In contrast, burnout was inversely correlated with age (ß=−0.125, p<0.001), agreeableness as a personality trait (ß=−0.107, p<0.001), psychological well-being (ß=−0.248, p<0.001) and the mindfulness factor awareness (ß=−0.145, p<0.001). In the work environment, time pressure (ß=0.167, p<0.001) was positively associated with burnout among others. Conclusion Younger physicians may be prioritised for individual-level interventions, while addressing time pressure at the organisational level could help prevent burnout. However, longitudinal studies are needed to clarify the directionality of relationships with psychological factors.
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    Knee Iliotibial Band Z-Plasty Lengthening and Bursectomy Technique
    (2022) Vaisman, Alex; Guiloff, Rodrigo; Andreani, Domingo
    Multiple surgical techniques have been described to treat refractory iliotibial band syndrome. However, there is lacking evidence demonstrating superiority of one technique over the other and limited audiovisual resources. Most surgical procedures aim to release the iliotibial band; nevertheless, few focus on reducing concomitant inflammation. The present article illustrates a Z-plasty lengthening technique associated with local bursectomy for treating iliotibial band syndrome refractory to conservative treatment.
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    La infiltración pericapsular intraoperatoria estandarizada es superior a los bloqueos regionales anestésicos en artroplastia total de rodilla
    (2025) Vaisman, Alex; Braun, Hernan; Vial, Santiago; Guiloff, Rodrigo; Figueroa, David; Figueroa, Francisco
    Introducción La artroplastia total de rodilla (ATR) es el tratamiento de elección en artrosis avanzada; sin embargo, el dolor postoperatorio sigue siendo un desafío. Los bloqueos regionales anestésicos (BRA) son efectivos, aunque limitan la rehabilitación precoz y requieren de material y personal especializado. La infiltración pericapsular intraoperatoria estandarizada (IPIe), basada en estudios anatómicos previos, surge como alternativa eficaz y segura, con menor compromiso motor. Objetivo Comparar los resultados clínicos y funcionales postoperatorios entre IPIe y BRA en pacientes sometidos a ATR. Materiales y Métodos Se realizó un estudio retrospectivo en 41 pacientes con artrosis severa operados por un mismo cirujano en un mismo centro entre 2014 y 2024, distribuidos en tres grupos comparables: G1 (anestesia general (AG) + IPIe (n=17)), G2 (AG + IPIe + BRA (n=13)) y G3 (AG + BRA (n=11)). Se excluyó a pacientes con artroplastia parcial, revisión de prótesis, registros clínicos incompletos y técnicas anestésicas distintas al objeto de estudio. Los pacientes de G1 y G2 recibieron IPIe basada en estudios cadavéricos previos, con una combinación de anestésicos y técnica de infiltración predeterminada. Se evaluó dolor postoperatorio, requerimiento de opiáceos, complicaciones e hitos de rehabilitación. Resultados IPIe mostró menor dolor a las 12, 24 y 48 horas postoperatorias (p=0.022, 0.005, menos de 0.001), una estadía hospitalaria menor (G1: 2.3, G2: 3.1, G3: 3.7 días (p menor a 0.001)), mejores hitos en rehabilitación a las 12 y 24 horas (p menor a 0.001, 0.002) y menos retrasos en la rehabilitación por bloqueo motor (p=0.001). No hubo diferencias significativas en requerimientos de opiáceos, complicaciones, ni en dolor y funcionalidad a los 14 días postcirugía. Discusión La IPIe mejora la analgesia postoperatoria y rehabilitación funcional tras la ATR, comparada con BRA. Su fácil aplicación por el cirujano, sin requerir personal ni equipamiento adicional, y sin incrementar complicaciones, la postulan como una opción eficiente y segura. Conclusión La IPIe demostró mejores resultados clínicos y funcionales en comparación a BRA. Nivel de Evidencia: C (Estudio retrospectivo comparativo). Introduction Total knee arthroplasty (TKA) is the treatment of choice for advanced osteoarthritis; however, postoperative pain remains a significant challenge. Regional anesthetic blocks (RAB) are effective, but they limit early rehabilitation and require specialized personnel and equipment. Standardized intraoperative pericapsular injection (SIPI) has emerged as an alternative, based on previous anatomical studies, offering less motor impairment. Objective To compare postoperative clinical and functional outcomes between SIPI and RAB in patients undergoing TKA. Materials and Methods A retrospective study was conducted on 41 patients with severe osteoarthritis, all operated on by the same surgeon at a single center between 2014 and 2024. Patients were divided into three comparable groups: G1 (general anesthesia (GA) + SIPI, n=17), G2 (GA + SIPI + RAB, n=13), and G3 (GA + RAB, n=11). Patients undergoing partial arthroplasty, prosthetic revision, those with incomplete clinical records, or who received anesthetic techniques other than those under study were excluded. Patients in G1 and G2 received a standardized intraoperative injection protocol based on prior cadaveric studies, including a predefined combination of anesthetics and infiltration technique. Postoperative pain, opioid consumption, complications, and rehabilitation milestones were assessed. Results SIPI was associated with significantly lower pain levels at 12, 24, and 48 hours postoperatively (p=0.022, 0.005, less than 0.001), shorter hospital stays (G1: 2.3, G2: 3.1, G3: 3.7 days; p less than 0.001), earlier rehabilitation milestones at 12 and 24 hours (p less than 0.001, 0.002), and fewer delays in rehabilitation due to motor blockade (p=0.001). No significant differences were observed in opioid requirements, complications, or in pain and function at 14 days post-surgery. Discussion SIPI enhances postoperative analgesia and functional rehabilitation following TKA compared with RAB. Its straightforward application by the surgeon, without the need for additional personnel or equipment and without increasing complications, supports its role as an efficient and safe option. Conclusion SIPI demonstrated superior clinical and functional outcomes compared with RAB. Level of Evidence: C (Retrospective Comparative Study).
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    Ligament Lesions: Biologics
    (2022) Figueroa, David; Guiloff, Rodrigo; Figueroa, Francisco
    In terms of the latest clinical evidence, the use of PRP for ligament injuries remains controversial. There is insufficient evidence to recommend the use of PRP in ACL-R for improving graft maturation and donor site morbidity or improving functional outcomes. The use of PRP injections for the treatment of partial ACL injuries, MCL injuries, and ankle sprains cannot be recommended. Finally, there is no reported clinical evidence of the use of PRP in other knee ligament injuries such as posterior cruciate ligament, lateral collateral ligament, and posterolateral corner
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    Navigation in anterior cruciate ligament reconstruction: State of the art
    (2023) Figueroa, Francisco; Figueroa, David; Guiloff, Rodrigo; Putnis, Sven; Fritsch, Brett; Itriago, Minerva
    Computer navigation (CN) for anterior cruciate ligament (ACL) surgery has been used mainly for two purposes: to enhance the accuracy of tunnel position and to evaluate the kinematics of the ACL reconstruction (ACLR) and the stability achieved bydifferent surgical techniques.Many studies have shownthatnavigationmay improve the accuracy of anatomical tunnel orientation and position during ACL reconstructive surgery compared with normal arthroscopic tunnel placement, especially regarding the femoral side. At the same time, it has become the gold-standardmethod for intraoperative knee kinematic assessment, as it permits a quantitative multidirectional knee joint laxity evaluation. CN in ACL surgery has been associated with diverse problems. First, in most optic systems additional skin incisions and drill holes in the femoral bone are required for fixation of a reference frame to the femur. Second, additional radiation exposure and extra medical cost to the patient for preoperative planning are usually needed. Third, CN, due to additional steps, has more opportunities for error during preoperative planning, intraoperative registration, and operation. Fourth, soft tissues, including the skin and subcutaneous tissues, are usually not considered during the preoperative planning, which can be a problem for kinematic and stability assessment. Many studies have concluded that ACLR using a CN system is more expensive than conventional surgery, it adds extra time to the surgery and it is not mitigated by better clinical outcomes. This, combined with costs and invasiveness, has limited the use of CN to research-related cases. Future technology should prioritize less invasive intra-operative surgical navigation
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    Orthopedic Residency Programs: What are Our Current Goals? An International Society of Orthopedic Centers (ISOC) Delphi Consensus
    (2025) Figueroa, David; Moya, Luis; Arteaga, José; Alex Vaisman; Bostrom, Mathias; Acuña, Carolina; Alesi, Domenico; Radice, Fernando; Figueroa, Francisco; Toro, Felipe; Liebergall , Meir; Stegeman, Mark; Tagil, Magnus; Lenza, Mario; Sancheti, Parag; Ranawat, Amar; Calvo, Rafael; Guiloff, Rodrigo; Robbins, Laura; Irarrazaval, Sebastian; Zaffagnini, Stefano; Jung, Tobias; Winkler, Tobias
    This article presents an international consensus reached by the International Society of Orthopaedic Centers (ISOC) to establish recommendations on postgraduate orthopedic education. Using the Delphi technique, expert opinions from different regions of the world were collected and analyzed. Twenty statements were evaluated, of which 16 achieved strong consensus, 2 moderate consensus, and 2 did not reach consensus. Key recommendations include the implementation of objective metrics to assess competencies, the integration of ethical and professional standards into the curriculum, the use of high-fidelity simulations and advanced technologies such as virtual reality and telemedicine, the promotion of inclusive and non-discriminatory environments, and the establishment of quotas to ensure sufficient hands-on surgical training. The importance of balancing clinical demands with the mental health needs of residents and fostering interdisciplinary collaboration was also emphasized. The consensus aims to provide a framework for improving orthopedic residency programs, adapting them to current challenges and promoting innovation and better patient outcomes. Limitations such as variability in resources and needs between institutions are acknowledged, and it is proposed to continue with future research and adaptations to maintain the relevance of the recommendations.
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    Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors
    (2023) Vaisman, Alex; Guiloff, Rodrigo; Contreras, Martín; Casas, Juan; Calvo, Rafael; Figueroa, David
    Objective: Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons. Methods: This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p ​< ​0.05). Results: The survey's response rate was 20 ​% (n ​= ​358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 ​%) and 94 ​% were men. Of those surveyed, 50 ​% reported a burnout episode more than once per year, 60 ​% depersonalization when treating patients at least yearly, 13 ​% anhedonia, 11 ​% a depressive mood more than half of the month or almost every day, and 61 ​% weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p ​= ​0.012), fewer years as a specialist (p ​= ​0.037), fear of lawsuits (p ​< ​0.001), a non-healthy diet (p ​= ​0.003), non-doing recreational activities (p ​= ​0.004), depersonalization when treating their patients (p ​< ​0.001), weariness (p ​< ​0.001), anhedonia (p ​< ​0.001), depressive mood (p ​< ​0.001), and career dissatisfaction (p ​< ​0.001). The logistic regression demonstrated that fear of lawsuits (p ​< ​0.001), weariness at the end of a workday (p ​= ​0.016), and anhedonia (p ​= ​0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p ​< ​0.001). Conclusion: Over 50 ​% of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 ​% of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factor
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    Posterolateral corner knee injuries: a narrative review
    (2021) Figueroa, Francisco; Figueroa, David; Putnis, Sven; Guiloff, Rodrigo; Caro, Patricio; Espregueira-Mendes, João; Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
    Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis.
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    Specific considerations in female patients with patellar instability: current concepts
    (2024) Figueroa, Francisco; Guiloff, Rodrigo; Bolton, Sarah; Figueroa, David; Tapasvi, Sachin; Stocker, Esteban
    Prior literature suggests that patellofemoral instability (PFI) is significantly more prevalent in women than in men. This higher prevalence is commonly attributed to anatomical differences between sexes, particularly with patellofemoral alignment. These differences encompass a higher rate of trochlear dysplasia (TD), patella alta, an increased Q angle, and soft tissue imbalances. In recent years, worse outcomes have been reported in female patients after patellofemoral stabilization surgery using medial patellofemoral ligament reconstruction (MPFLr) alone or in combination with a tibial tubercle osteotomy (TTO), for this reason an "à la carte" plan (addressing the individuals anatomical risk factors) could be more appropriate for female patients.
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    Virtual reality training is associated with high satisfaction and self-perceived surgical confidence in anterior cruciate ligament reconstruction: Experience from an orthopedic residency pilot study
    (2026) Guiloff, Rodrigo; Pino, Ernesto; Armijo-Rivera, Soledad; Cabrolier, Jorge; Schulmeyer, Juan; Radkievich, Ruben; Vaisman, Alex; Rafael, Calvo; Figueroa, David
    Introduction/objective: Virtual reality (VR) is increasingly used in surgical education by enabling risk-free, immersive, and independent training. As orthopedic surgery residency programs increasingly integrate VR-based simulation, evidence regarding trainee satisfaction and self-perceived confidence remains scarce. This study aims to evaluate orthopedic surgery residents' satisfaction and self-perceived confidence following VR-based simulation training (VRT) in anterior cruciate ligament reconstruction (ACLR). The hypothesis is that VRT would result in high satisfaction and improve confidence in performing the procedure. Methods: A cross-sectional pilot study was conducted on 12 orthopedic surgery residents (4 per postgraduate year) from a three-year residency program. Residents with prior VR-based ACLR simulation experience were excluded. Each participant completed two VRT sessions using PrecisionOS software on the Oculus Quest 2 headset, practicing the inside-out ACLR technique. Pre- and post-training assessments included a validated five-point Likert scale and the net promoter score (NPS) to measure satisfaction and self-perceived confidence. Results: Eleven residents (91.7%) completed the study. Overall satisfaction with VRT was high, with most participants rating the experience as "agree" or "strongly agree" across all learning dimensions. The second session showed higher median satisfaction scores in five of six items. Participants valued VR training to improve procedural understanding, facilitate content application, and reinforce skills through immersive, tutor-independent learning. Overall, all sections achieved positive NPS values exceeding 40 (41-73), highlighting that VR training was an engaging way to learn. Third-year residents reported the greatest improvement regarding self-perceived confidence in executing the procedure, particularly to perform as the primary surgeon. First- and second-year residents showed increased confidence in assisting the procedure. Conclusion: This pilot study suggests that VR-based ACLR training is well accepted by orthopedic surgery residents and provides a highly satisfactory and immersive learning experience. Residents reported improved understanding of procedural steps and increased self-perceived confidence, with senior residents benefiting most in relation to the primary surgeon role and junior residents reporting greater confidence in assisting in the procedure. These findings support the feasibility and acceptability of VR simulation as a self-directed educational tool within orthopedic residency training programs

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