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 […]
Why double placebo studies are so common in orthopaedics?
The title is slightly provocative, but I will explain it. On of the leading orthopaedic journals, Journal of Bone and Joint Surgery Am, referenced a study published in another leading orthopaedic journal under a Evidence-based orthopaedics section. This is somewhat controversial. The study, JBJS referenced, was published in September in the American Journal of Sports […]
We need to get better in contrafactual thinking
This probably also applies to other medical subspecialties, but we orthopaedic surgeons are very bad at contrafactual thinking. For the sake of our patients, we need to understand better a hypothetical situation in which we could have done otherwise. Once again, something like this was written: Extremely medialized repair of large and massive tears not […]
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 […]
Low-intensity pulsed ultrasound or LIPUS to improve injury healing?
LIPUS has been proposed to improve fracture healing but no evidence supports this proposal. Omer Ilahi writes in a recent editorial in the Arthroscopy: Still, the positive findings of animal investigations with LIPUS in the acute setting are intriguing. I therefore find myself in agreement with Lai et al. in that large, randomized, placebo-controlled human […]
Checklist for robust methodology and statistical analyses?
Recent editorial in the CORR was about EQUATOR guidelines and the editors write: Since reporting guidelines rely on consensual scientific principles and evidence-based research, consulting them before beginning a project will tend to cause clinician scientists to consider why an element of a checklist is included; doing so inevitably results in discussion and consideration of […]
Uncertainty – the uncomfortable companion in the decision making which you can´t rid of
Uncertainty related to a decision making is very interesting concept. It is poorly tolerated and it´s nature and extent is also not well understood. Medical decision making is never deterministic and hence uncertainty is present everywhere in medicine. Concept of probability is closely related to the uncertainty. Very crucial part in the patient-doctor communication is […]
Machine learning algorithm for correlation analysis – Yes!
I have a PubMed alert for studies involving search with “machine learning”. This study was included in the search list recently: “One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients“. That really stood out. But yes, they indeed used machine learning algorithm to investigate risk factors for treatment […]
Fragility Index – Why?
Fragility Index is a completely useless metric. Literature is filled with studies claiming that findings in some field in medicine are fragile. Maldano et al conclude: A systematic survey of hip arthroscopy RCTs resulted in a low FI, indicating that the findings tended to be fragile. What is the point to calculate FI for outcomes […]
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 […]