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: evidence based medicine
Another Nail in the Coffin for PRP?
Platelet-rich plasma or PRP is probably the most popular orthobiologic treatment nowadays. Advocates of PRP claim that it can heal and promote healing of various orthopedic conditions. None of these claims are, however, backed by good clinical evidence. Some studies show that PRP is almost a miracle drug, but these studies often have major methodological […]
What do we need in orthopaedic research? – Case gluteal tendon tear
Orthobullets is an excellent educational platform. However, their case examples consistently seem to favor surgical treatment. This may, of course, stem from the generally surgery-oriented culture in the US. When compensation is tied to the number of operations performed, treatment preferences naturally reflect this. A recent Orthobullets case in X featured a 78-year-old female patient […]
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 […]
Quote from Mark Twain doesn’t mean good patient treatment
If you decide to quote a famous writer in your article, make sure the context is preferably fundamental. Sherman and Albersheim quote Mark Twain in their opinion piece. Age is an issue of mind over matter. If you don’t mind, it doesn’t matter. Their punchline is a criticism towards a dogma, saying, “‘older’ patients with […]
To my fellow orthopods 1 – Why do we oppose orthopaedic sham-controlled trials so aggressively?
Sometimes, I wonder if orthopaedics is a branch of modern medicine at all. While large, multicenter RCTs are common practice in other fields, in orthopaedics, we seem to rely on mechanical reasoning, biological plausibility, and uncontrolled before-after studies. This duality has become very visible with regard to orthopaedic sham-controlled trials. A recent research in the […]
Regress in orthopaedic science
What is it? I have example! Take a look at this study: Arthroscopic Subacromial Balloon Spacer for Massive Rotator Cuff Tears Demonstrates Improved Shoulder Functionality and High Revision-Free Survival Rates at Minimum 5-Year Follow-up. Authors concluded: “… subacromial balloon spacer placement in conjunction with biceps tenotomy and subacromial bursectomy for massive rotator cuff tears yielded […]
Apparently not all PRP is made equal
Orthobiologics have become increasingly popular in recent years. OrthoInfo defines orthobiologics as “therapies developed from biologic (natural) substances that can be used by orthopaedic specialists to relieve pain […], enhance the body’s ability to heal from a repetitive use injury […] and in some cases, improve healing after orthopaedic surgery.” One of the most popular […]
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 […]
Continues discourse about “level V evidence”
In my recent post I discussed about “Level V Guideline” for subacromial decompression. I naturally participated to the discussion Drs Poolman and van den Bekerom had started. We wrote in our letter: ‘Optimal patient selection’ can be considered a myth until evidence of effect modifiers arises. We argue that if there were subpopulations that benefit […]