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 […]

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 […]

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 […]

Prediction is hard and prediction is even harder for postoperative infections

Deep infection after a major orthopaedic surgery is a devastating complication. A prediction model with excellent predictive performance for deep infections would be extremely valuable for example in joint replacement surgery. The problem is that a deep infection is (fortunely) very rare event. Overall infection rate is close to 1% in the modern total knee […]

More well developed orthopaedic prediction models

It seems that appropriate methodology in the development of prediction models is becoming more common in our field. These two recent studies caught my attention: Development of a model to predict the probability of incurring a complication during spine surgery and Prediction of 90-day mortality after total hip arthroplasty. Both studies report calibration performance and […]

Orthopaedic journals really stand out and not in a good way

Preprint policy of majority of academic journals can be found in the Wikipedia: https://en.wikipedia.org/wiki/List_of_academic_journals_by_preprint_policy. Some 130 journals can be found in the list. Large majority of journals allow preprints prior to submission. Few journals have restrictions. Four journals glow in red since journal policy does not allow preprints. Which journals would they be? These journals […]

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 […]

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