When I said that they aren't considered by many as one of the top programs cause they don't have fellows, I didn't mean that you have to have a bunch of fellows to have a good program, just that most "top" programs that everyone seems to talk about happen to be known for their fellowships, including places like Harvard, Mayo, HSS, etc.
I agree that the best places to train probably don't have a bunch of fellows, none of my top five places have more than a couple of fellows each. I think that UTCC fully deserves to be considered as one of the best programs in the nation, I mean heck, they wrote the book that many consider the authority in orthopaedics and they have some of the top staff in the world of academic ortho. They didn't seem to have the research world by the horns, but that is also somewhat of a bonus in my book.
They also are certainly, as podtobe noted, not a well rounded program as far as their residents go. All male, all caucasian or mostly caucasian, most are really laid back, almost all from the South or Midwest, kinda a southern fraternity feel to the whole thing, which makes it very attractive to many.