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 […]

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 […]

When we stop “treating” degeneration?

This is a second post about an excellent Invited Paper in the International Orthopaedics. Authors begin their paper as follows: The specialism of orthopaedic surgery covers many subdisciplines. Most of these deal with degenerative changes occurring as a result of the normal aging process. Some will follow trauma or are as a result of congenital […]

Improvement after APM?

Clinical improvement after certain surgical procedure is a fundamental aspect when evaluating success of a surgical treatment. The most important aspect is outlined in a question: “How would have this patient fared without the procedure?”. This is also major paradigm in the surgical and orthopaedic research. Our clinical experience is usually based on observations how […]

Conceptual replication and elbow osteoarthritis

Van Berkel and Crandal define conceptual replication as follows: Conceptual replication means that researchers re-test the same theoretical idea or hypothesis repeatedly, but use different populations, different ways of manipulating variables, different ways of measuring variables, or using different study designs. Surgical treatment of joint degeneration is an excellent topic in orthopedics where conceptual replication applies […]

No APM study should go without citing sham or physiotherapy controlled RCTs

Beletsky et al. conclude in their study: The majority of patients undergoing APM achieve benefit within 6 months of surgery, with diminishing proportions at later timepoints. This should not come as a surprise considering that arthroscopic partial meniscectomy (APM) has no proven efficacy as shown by numerous high quality RCTs which have included even sham-surgery […]