Reference

ACGME orthopaedic surgery case log minimums, in plain text

The orthobro · 2026-08-26 · 7 min read

The ACGME publishes the orthopaedic case minimums as a two-page PDF. Which is fine, except that you never want it at a desk. You want it standing in a hallway, on a phone, deciding whether to fight for a case.

So here it is as text. Numbers below are from the October 2024 Review Committee list.

One warning before you use it: this page is a convenience copy, not the source of truth. Check the ACGME PDF before you make a decision that matters, and check with your program coordinator about your own cohort. The list is linked in the references at the bottom.

The 3C minimums

3C stands for core, common, competent. These are the procedures the Review Committee decided a graduating orthopaedic surgeon should be able to do independently.

These count toward the anatomic area totals as well, so a hip fracture is doing two jobs at once.

The two new ones

Two minimums were added that did not exist before:

Five each. Small numbers, and easy to assume will take care of themselves. They are also the two most likely to sneak up on you, because neither is elective and neither appears on a schedule you can plan around. If you are PGY-4 and have logged one fasciotomy, that is worth knowing now rather than in your chief year.

Totals by anatomic area

The 3C minimums count inside these totals. So the 50 primary TKAs are already part of your 300 femur/knee.

Look at the shape of that list. Femur/knee and pelvis/hip together are 585 of the required cases. Spine is 50 and oncology is 25 — and those two are the ones people scramble for in a final year, because they usually depend on a single rotation going well rather than on ordinary volume accumulating.

The ones that do not count toward your total

These have their own minimums, and the ACGME notes that items marked with an asterisk do not count toward total cases or the pediatric minimum.

The pediatric one has a logging catch worth reading twice: it requires the ADS "Pediatrics" box to be checked when you enter a case that satisfies an ortho minimum, and credit is given only for operative cases. Check the box or the case does not count. Nobody will tell you at the time.

What actually changed, and when it applies to you

The Review Committee rewrote these in 2024 to move away from a single total-case count toward a framework of specific competencies plus a breadth requirement across anatomic areas.

Three dates are worth knowing:

July 1, 2025. The ABOS Knowledge, Skills, and Behavior platform — KSB+ — interfaces with the ACGME ADS Case Log System for all residents from this date. You log the procedural encounter in KSB+, and the CPT codes transfer to ADS within a few business days.

Late spring 2025. The first look at a program's minimums status.

2025-2026 academic year. Data collected without risk of citation for programs.

And the one that matters if you are in the middle of training: the 2024-2025 PGY-3 residents are the first cohort held to the new minimum standards at graduation.

Logging is genuinely simpler now

This part is easy to miss because it is buried in a program-resources document rather than announced to residents.

The old system made you designate primary and secondary codes, which created an incentive to deconstruct a case into parts so that the parts would count. The Review Committee said so directly — previous standards led to ambiguity and an incentive to break cases up.

The new system drops that. There is no primary/secondary designation, multiple CPT codes can count in a single case entry, and there are fewer checkboxes. You log what happened, with every relevant code, and the system sorts out which minimums it satisfies.

The practical translation: log the whole case, with all the codes, and stop optimizing. The optimizing was an artifact of the old rules and it is now working against you.

The part nobody enforces

Case logging accuracy is poor in many instances. That is not a jab from me — it is the Review Committee's own characterization, citing a 2014 JBJS study of variability in how orthopaedic residents use the ACGME case log system.

Which points at the actual failure mode. Almost nobody misses a minimum because the cases were not there. They miss it because six weeks of cases went unlogged, then the memory of which codes applied went with it, and what got entered later was a guess.

The fix is not a better spreadsheet. It is logging the case the same day, while you still remember whether you did the approach or watched it. There is a longer version of that argument in how to log your cases without falling behind.

If you want a system for that, the honest version is short: write down the case, your role, and the codes before you leave the hospital. Everything else — the reflection, the technique notes, the attending's preferences for next time — can wait for the evening. The codes cannot, because they are the part you will fabricate if you delay.

Use the source

Again: numbers here are transcribed from the ACGME's October 2024 list and are a convenience copy. CPT code lists for each minimum are in that PDF and are long enough that reproducing them here would make this page worse, not better. If you are checking whether a specific code counts, go to the source.

And ask your program coordinator which cohort rules apply to you. That answer is local, and it is the one thing on this page nobody on the internet can tell you.