Trends in Adult Reconstruction Fellowship Applications and Match Outcomes: A Report From the American Association of Hip and Knee Surgeons Fellowship Committee.

BACKGROUND: This study investigated contemporary trends in hip and knee adult reconstruction (AR) fellowship applicant volumes, program changes, and match outcomes, including factors associated with successful matching.

METHODS: Characteristics of AR fellowship applicants and programs were assessed using 2021 to 2026 San Francisco (SF) Match data. Trends in the number of AR fellowship-offered positions, participating programs, applications, and percentage of positions filled/unfilled were reviewed. Further analysis of applicant demographics, including degree type and rank-list success, was also performed.

RESULTS: Over the current study period, AR fellowship positions have increased 17%, peaking at 236 for 114 programs in 2026. The mean number of applicants has been 267 (range, 251 to 281) and fluctuated approximately -8.5 to +7%. Applicants from the United States with medical degrees (MD) have significantly higher successful match rates than foreign medical graduates (FMG) (96 versus 15% annual average, respectively, P < 0.01). Despite a stable overall match rate of 75% (range: 74 to 77), unfilled positions rose sharply to a high of 38 of 236 (16%) in 2025. In 2025, 48% of matched AR fellowship applicants matched with their top-choice program, compared with 27% in 2021.

CONCLUSIONS: The hip and knee AR fellowship matching percentages and success for domestic MD and DO applicants have improved. However, the increasing number of unfilled positions may suggest growth outpacing interest. Ongoing AR fellowship match data surveillance is needed for strategic subspecialty fellowship training and planning.