This study was just published in the Arthroscopy: Little agreement between preoperative Kellgren and Lawrence classification and intraoperative Outerbridge score in patients undergoing arthroscopic partial meniscectomy And, well, the title says it all. Their study included over 400 middle-aged (average 49 years) obese patients (average BMI 30.2). Authors wrote: Understanding the degree of cartilage degeneration […]
Tag: arthroscopic partial meniscectomy
Shamanism and orthopaedics
Yes, we orthopedic surgeons are shamans or spiritual healers. And I don’t mean the magic of surgery. There is nothing magical about the majority of our operations. We are shamans because we trick ourselves and our patients with the same principles as shamans and spiritual leaders of the past. Firstly, Stuart Green wrote an excellent […]
How to recognize low-value treatments in orthopaedic research?
Low-value care is defined “as the use of a health service for which the harms or costs outweigh the benefits“. In other words, if a certain surgical procedure cannot be shown to result in superior results compared to nonoperative treatment or simple watchful waiting, this procedure can be labelled as low-value care. Randomized clinical trials […]
What was left out from our critical APM paper?
Early this year, we published a paper that I am incredibly proud of. For a long time, I have thought that arthroscopic partial meniscectomy in the treatment of degenerative meniscus tears “does not make sense.” I mean that there is no credible biological mechanism for removing the torn meniscus to make the knee any better […]
Resentment around arthroscopic surgery
Ardern and co-workers proposed five reasons which would explain the declining worldwide arthroscopic meniscectomy rates (see my previous post on this topic). Among other things they wrote: If one cannot congratulate the funders for limiting arthroscopy, perhaps a broad-based, international consensus on the need for medical reversal was responsible? One might expect such a consensus […]
The fallacy of “meniscal of symptoms”: part 2
I don´t have anything else to add to my post from yesterday, besides what MacFarlane conclude: “Meniscal symptoms” were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of “meniscal symptoms” in isolation should not inform clinical decisions surrounding APM vs. […]
The fallacy of “meniscal symptoms”
A long story short. Farina et al. conclude: Contrary to current dogma, this study demonstrates that traditionally defined “meniscal” and “mechanical” knee symptoms are strongly associated with the burden and severity of underlying cartilage damage rather than with specific meniscal pathology. It is only relevant to ask how could an arthroscopic partial meniscectomy be an […]
When we stop “treating” degeneration?
This is a second post about an excellent Invited Paper in the International Orthopaedics. Authors begin their paper as follows: The specialism of orthopaedic surgery covers many subdisciplines. Most of these deal with degenerative changes occurring as a result of the normal aging process. Some will follow trauma or are as a result of congenital […]
Improvement after APM?
Clinical improvement after certain surgical procedure is a fundamental aspect when evaluating success of a surgical treatment. The most important aspect is outlined in a question: “How would have this patient fared without the procedure?”. This is also major paradigm in the surgical and orthopaedic research. Our clinical experience is usually based on observations how […]
Conceptual replication and elbow osteoarthritis
Van Berkel and Crandal define conceptual replication as follows: Conceptual replication means that researchers re-test the same theoretical idea or hypothesis repeatedly, but use different populations, different ways of manipulating variables, different ways of measuring variables, or using different study designs. Surgical treatment of joint degeneration is an excellent topic in orthopedics where conceptual replication applies […]