How to investigate “novel techniques”?

I liked the study by Lapner et al. very much. Their study was titled “Preoperative bone marrow stimulation does not improve functional outcomes in arthroscopic cuff repair: a prospective randomized controlled trial”. They proposed a new concept to improve healing of rotator cuff repair. Authors hypothesized that preoperative ultrasound-guided bone channeling in the footprint 5-7 […]

Continues discourse about “level V evidence”

In my recent post I discussed about “Level V Guideline” for subacromial decompression. I naturally participated to the discussion Drs Poolman and van den Bekerom had started. We wrote in our letter: ‘Optimal patient selection’ can be considered a myth until evidence of effect modifiers arises. We argue that if there were subpopulations that benefit […]

Three-to-one response to our letter

In my previous blog post I told about our letter to editor concerning a study criticizing sham-controlled studies in orthopaedics. Another letter was also submitted and accepted at the same time by Harris, Poolman and Buchbinder. They had also very important aspects regarding the criticism towards sham-controlled RCTs: We agree that there are other methods […]

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 […]

Role of sisu, a special form of courage, grit, and determination in orthopaedics

Sochacki et al. write as follows in recent study criticizing sham-controlled studies in orthopaedics: Additionally, two studies in this systematic review were performed in Finland. Unfortunately, any study investigating an intervention (e.g. surgery) on individuals born and raised in Finland cannot be extrapolated to the rest of the world. Finns embrace sisu, a special form […]

When you thought you had seen it all… Part 2

Sham-surgery or surgical placebo is increasingly used in orthopaedic randomized controlled trials. Most notable studies include comparison between sham-surgery and arthroscopic partial meniscectomy in knee and arthoscopic subacromial decompression in shoulder. These studies have truly challenged the traditional treatment guidelines in degenerative knee and shoulder conditions. I have previously posted about population level changes in […]