I applied from a lower-tier medical school, although we did have a home program. I had research, but was concerned that some of the prestigious research institutions wouldn't interview me. The biggest thing you can do to help yourself if you want to go to these places (ie Harvard, Rush, HSS, Jefferson, Penn, UCSF, UCLA, etc) is rotate there. A strong away rotation followed by a good letter from a famous orthopaedic surgeon at one of these places can also go a long way towards securing you interviews at that program as well as at other well-known programs. I will say that without a home program, you should spread your away rotations across different program sizes (ie 3 vs 6 vs 12 residents per year) and types (ie community vs academic, trauma-heavy vs subspecialty-heavy) to see what fits you best. Location also is a big factor in getting interviews, so I would recommend at least 1 rotation at a program nearby so your letter would come from a surgeon people in your region know. Good luck.
