Our response to Sochacki et al. regarding sham-controlled RCTs

Sochacki et al. wrote in their study:

Randomized sham-controlled studies in orthopaedic sports medicine have significant methodologic deficiencies that may invalidate their conclusions.

High quality sham-controlled RCTs in the field of sports and arthroscopic surgery have met severe objection from people who are advocates of these common procedures. A study after another study show that common procedures, such as arthroscopic partial meniscectomy, lack any efficacy yet the common argument is that each and every study has “inherent biases”. I have blogged earlier about this certain publication in here and here.

I wrote a letter to editor with my colleagues and sent it to the Arthroscopy Journal. We argued many aspects claimed in the study by Sochacki et al. but the main comment we wanted to make was following:

Finally, authors state that “no patients underwent psychiatric or psychologic evaluation to test their competence to participate in a randomized sham surgery trial.” They seem to imply that consenting to a potentially harmful surgical procedure that has not been rigorously evaluated does not require psychiatric evaluation but consenting a study evaluating such a procedure does.

Indeed. Not a single study has shown that APM indeed works better compared to physiotherapy and observation. Yet around the world millions of patients annually undergo APM simply due to that fact that is seems to work in patients with meniscal tear. We need to do better.

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