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 Medicine. This study from Italy was titled “Microfragmented Adipose Tissue Versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Prospective Randomized Controlled Trial at 2-Year Follow-up“.

It does not matter what the overall result of this study was. My main concern is that this was one of the numerous trials which compare two active treatments, which either have yet to be proven to be better than a placebo. As Rudolf Poolman asked, is this a placebo vs. placebo study?

Someone can rightfully ask why this is an issue. My concern is that these sorts of studies give a false impression that these active treatments would somehow be beneficial, and such a study tries to clarify their superiority. Eventually, this could lead to broader use of low-value care. Before we can compare two active treatments, we need to clarify if these treatments even outperformed a placebo treatment. This is precisely the case for PRP: it is no better than a placebo in symptomatic knee osteoarthritis.

We need better orthopaedic science.

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