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Congratulations and Condemnations: Level I Evidence Prize for Femoral Tunnel Position in ACL Reconstruction, and AAOS Clinical Practice Guidelines Miss the Mark—Again

2014; Elsevier BV; Volume: 30; Issue: 1 Linguagem: Inglês

10.1016/j.arthro.2013.11.008

1526-3231

James H. Lubowitz, Matthew T. Provencher, Gary G. Poehling,

Knee injuries and reconstruction techniques

We are always excited by a new year,1Lubowitz J.H. Poehling G.G. Two on the fast track: Arthroscopic rotator cuff repair and subacromial decompression with coracoacromial ligament excision.Arthroscopy. 2009; 25: 2-3Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 2Lubowitz J.H. Poehling G.G. Old school: Arthroscopy's 25th anniversary.Arthroscopy. 2010; 26: 2-4Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 3Lubowitz J.H. Poehling G.G. Technology and innovation in arthroscopic and related surgery.Arthroscopy. 2011; 27: 2-4Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 4Lubowitz J.H. Provencher M.T. Poehling G.G. Arthroscopy Techniques: Aims and scope.Arthroscopy. 2012; 28: 1Abstract Full Text Full Text PDF Scopus (5) Google Scholar, 5Lubowitz J.H. Provencher M.T. Poehling G.G. Journalism and the new social media.Arthroscopy. 2012; 29: 1Abstract Full Text Full Text PDF Scopus (10) Google Scholar and on behalf of the Associate Editors we are excited to announce the winner of the 2013 Arthroscopy Journal Prize for best Level I Evidence. Table 1 lists the articles published in Arthroscopy in 2013 of this highest level of evidence.6Ruiz-Moneo P. Molano-Muñoz J. Prieto E. Algorta J. Plasma rich in growth factors in arthroscopic rotator cuff repair: A randomized, double-blind, controlled clinical trial.Arthroscopy. 2013; 29: 2-9Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 7Krych A.J. Thompson M. Knutson Z. Scoon J. Coleman S.H. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: A prospective randomized study.Arthroscopy. 2013; 29: 46-53Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar, 8Bourke H.E. Salmon L.J. Waller A. et al.Randomized controlled trial of osteoconductive fixation screws for anterior cruciate ligament reconstruction: A comparison of the Calaxo and Milagro screws.Arthroscopy. 2013; 29: 74-82Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 9Sheibani-Rad S. Giveans M.R. Arnoczky S.P. Bedi A. Arthroscopic single-row versus double-row rotator cuff repair: A meta-analysis of the randomized clinical trials.Arthroscopy. 2013; 29: 343-348Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 10Yoon K.H. Park S.W. Lee S.H. Kim M.H. Park S.Y. Oh H. Does cast immobilization contribute to posterior stability after posterior cruciate ligament reconstruction?.Arthroscopy. 2013; 29: 500-506Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 11Shen J. Zhang H. Lv Y. et al.Validity of a novel arthroscopic test to diagnose posterolateral rotational instability of the knee joint: The lateral gutter drive-through test.Arthroscopy. 2013; 29: 695-700Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 12Ko S.H. Kang B.S. Hwang C.H. Ultrasonography- or electrophysiology-guided suprascapular nerve block in arthroscopic acromioplasty: A prospective, double-blind, parallel-group, randomized controlled study of efficacy.Arthroscopy. 2013; 29: 794-801Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 13Milano G. Saccomanno M.F. Careri S. Taccardo G. De Vitis R. Fabbriciani C. Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: A prospective randomized study.Arthroscopy. 2013; 29: 802-810Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 14Noh J.H. Roh Y.H. Yang B.G. Yi S.R. Lee S.Y. Femoral tunnel position on conventional magnetic resonance imaging after anterior cruciate ligament reconstruction in young men: Transtibial technique versus anteromedial portal technique.Arthroscopy. 2013; 29: 882-890Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 15Merivirta R. Äärimaa V. Aantaa R. et al.Postoperative fentanyl patch versus subacromial bupivacaine infusion in arthroscopic shoulder surgery.Arthroscopy. 2013; 29: 1129-1134Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 16Lubowitz J.H. Schwartzberg R. Smith P. Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel.Arthroscopy. 2013; 29: 1195-1200Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 17Vaquerizo V. Plasencia M.A. Arribas I. et al.Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: A randomized controlled trial.Arthroscopy. 2013; 29: 1635-1643Abstract Full Text Full Text PDF PubMed Scopus (163) Google ScholarTable 1Level I Studies Published in Arthroscopy in 2013TitleAuthorsIssuePagePlasma Rich in Growth Factors in Arthroscopic Rotator Cuff Repair: A Randomized, Double-Blind, Controlled Clinical TrialRuiz-Moneo, Molano-Muñoz, Prieto, AlgortaJanuary2Arthroscopic Labral Repair Versus Selective Labral Debridement in Female Patients With Femoroacetabular Impingement: A Prospective Randomized StudyKrych, Thompson, Knutson, Scoon, ColemanJanuary46Randomized Controlled Trial of Osteoconductive Fixation Screws for Anterior Cruciate Ligament Reconstruction: A Comparison of the Calaxo and Milagro ScrewsBourke, Salmon, Waller, Winalski, Williams, Linklater, Vasanji, Roe, PinczewskiJanuary74Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair: A Meta-analysis of the Randomized Clinical TrialsSheibani-Rad, Giveans, Arnoczky, BediFebruary343Does Cast Immobilization Contribute to Posterior Stability After Posterior Cruciate Ligament Reconstruction?Yoon, Park, Lee, Kim, Park, OhMarch500Validity of a Novel Arthroscopic Test to Diagnose Posterolateral Rotational Instability of the Knee Joint: The Lateral Gutter Drive-Through TestShen, Zhang, Lv, Hong, Wang, Zhang, FengApril695Ultrasonography- or Electrophysiology-Guided Suprascapular Nerve Block in Arthroscopic Acromioplasty: A Prospective, Double-Blind, Parallel-Group, Randomized Controlled Study of EfficacyKo, Kang, HwangMay794Efficacy of Marrow-Stimulating Technique in Arthroscopic Rotator Cuff Repair: A Prospective Randomized StudyMilano Saccomanno, Careri, Taccardo, De Vitis, FabbricianiMay802Femoral Tunnel Position on Conventional Magnetic Resonance Imaging After Anterior Cruciate Ligament Reconstruction in Young Men: Transtibial Technique Versus Anteromedial Portal TechniqueNoh, Roh, Yang, Yi, LeeMay882Postoperative Fentanyl Patch Versus Subacromial Bupivacaine Infusion in Arthroscopic Shoulder SurgeryMerivirta, Äärimaa, Aantaa, Koivisto, Leino, Liukas, KuusniemiJuly1,129Randomized Controlled Trial Comparing All-Inside Anterior Cruciate Ligament Reconstruction Technique With Anterior Cruciate Ligament Reconstruction With a Full Tibial TunnelLubowitz, Schwartzberg SmithJuly1,195Comparison of Intra-Articular Injections of Plasma Rich in Growth Factors (PRGF-Endoret) Versus Durolane Hyaluronic Acid in the Treatment of Patients With Symptomatic Osteoarthritis: A Randomized Controlled TrialVaquerizo, Plasencia, Arribas, Seijas, Padilla, Orive, AnituaOctober1,635 Open table in a new tab Seriously? Only 12 articles in 12 months? Research is challenging, but as editors we relish original scientific articles of the highest levels of evidence, so we strongly urge authors to bring it on.18Lubowitz J.H. Poehling G.G. Controversy in Arthroscopy: Bring it on.Arthroscopy. 2010; 26: 573-574Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Please send us your reports of studies of the highest levels of evidence and, in the future, please attempt to pursue higher level research. On the other hand, level of evidence is but one measure of the quality of a scientific study, and randomized controlled trials represent Level II evidence if the quality is low or follow-up is less than stellar.19Lubowitz J.H. Provencher M.T. Poehling G.G. Climbing the level of evidence ladder: Prospective, comparative-effectiveness knee ACL and PCL research.Arthroscopy. 2013; 29: 399-400Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 20Lubowitz J.H. Understanding evidence-based arthroscopy.Arthroscopy. 2004; 20: 1-3Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar It gives us great pleasure to announce that “Femoral Tunnel Position on Conventional Magnetic Resonance Imaging After Anterior Cruciate Ligament Reconstruction in Young Men: Transtibial Technique Versus Anteromedial Portal Technique” by Noh, Roh, Yang, Yi, and Lee14Noh J.H. Roh Y.H. Yang B.G. Yi S.R. Lee S.Y. Femoral tunnel position on conventional magnetic resonance imaging after anterior cruciate ligament reconstruction in young men: Transtibial technique versus anteromedial portal technique.Arthroscopy. 2013; 29: 882-890Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar is our 2013 Level I Evidence prize winner. We congratulate the authors, who will receive a check for $5,000, certificates suitable for framing, and everlasting glory. We also acknowledge “Comparison of Intra-Articular Injections of Plasma Rich in Growth Factors (PRGF-Endoret) Versus Durolane Hyaluronic Acid in the Treatment of Patients With Symptomatic Osteoarthritis: A Randomized Controlled Trial” by Vaquerizo, Plasencia, Arribas, Padilla, Orive, and Anitua17Vaquerizo V. Plasencia M.A. Arribas I. et al.Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: A randomized controlled trial.Arthroscopy. 2013; 29: 1635-1643Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar as a particularly well performed study. In fact, one reason it did not achieve first prize in 2013 was that this same group won this prize for related research in 2012.21Sánchez S. Fiz N. Azofra J. et al.A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis.Arthroscopy. 2012; 28: 1070-1078Abstract Full Text Full Text PDF PubMed Scopus (270) Google Scholar We also recognize Level I work by editors who, according to the rules, were excluded from the competition.13Milano G. Saccomanno M.F. Careri S. Taccardo G. De Vitis R. Fabbriciani C. Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: A prospective randomized study.Arthroscopy. 2013; 29: 802-810Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 16Lubowitz J.H. Schwartzberg R. Smith P. Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel.Arthroscopy. 2013; 29: 1195-1200Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Editorial controversy…again?18Lubowitz J.H. Poehling G.G. Controversy in Arthroscopy: Bring it on.Arthroscopy. 2010; 26: 573-574Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 22Lubowitz J.H. Provencher M.T. Poehling G.G. Single-row versus double-row rotator cuff repair: The controversy continues.Arthroscopy. 2011; 27: 880-882Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar In our opinion, Louis McIntyre and his colleagues have a lot of guts for speaking up, yet again, and proclaiming that the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines miss the mark.23Bannuru R.R. Vaysbrot E.E. McIntyre L.F. Did the American Academy of Orthopaedic Surgeons osteoarthritis guidelines miss the mark?.Arthroscopy. 2014; 30: 86-89Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar To be honest, your editors felt uncomfortable when we and Dr. McIntyre first proclaimed that an AAOS CPG missed the mark, way back in 2012.24Lubowitz J.H. McIntyre L.F. Provencher M.T. Poehling G.G. AAOS rotator cuff clinical practice guideline misses the mark.Arthroscopy. 2012; 28: 589-592Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar (“Does anybody remember 2012?”) Here is the background: in 2008, AAOS published a “Clinical Practice Guideline on the Treatment of Osteoarthritis of the Knee” by Richmond, Hunter, Irrgang, et al.25Richmond J. Hunter D. Irrgang J. et al.American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee.J Bone Joint Surg Am. 2010; 92: 990-993Crossref PubMed Scopus (133) Google Scholar to guide management of patients with knee OA. These CPGs were revised this year.26American Academy of Orthopaedic Surgeons. Clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. Evidence-based guideline. Ed 2. 2013. Available at: http://www.aaos.org/research/guidelines/guidelineoaknee.asp. Accessed 5 November, 2013.Google Scholar Simply put, Bannuru, Vaysbrot, McIntyre state that the 2013 AAOS CPG “recommended against the use of viscosupplementation, for failing to meet the new criterion of Minimum Clinically Important Improvement (MCII). However, the AAOS's methodology contained numerous flaws…[and] the current state of research on MCII allows it to be used only as a supplementary instrument, not a basis for clinical decision making.”23Bannuru R.R. Vaysbrot E.E. McIntyre L.F. Did the American Academy of Orthopaedic Surgeons osteoarthritis guidelines miss the mark?.Arthroscopy. 2014; 30: 86-89Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar In the opinion of your editors, the use of knee hyaluronate viscosupplementation may be clinically insignificant for some patients, but it can be of significant benefit for others, as Bannuru, Vaysbrot, and McIntyre make clear in this issue. This opinion is based on our own extensive clinical experience, and this opinion is also evidence-based, as it is reported in the same 2013 AAOS CPG,26American Academy of Orthopaedic Surgeons. Clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. Evidence-based guideline. Ed 2. 2013. Available at: http://www.aaos.org/research/guidelines/guidelineoaknee.asp. Accessed 5 November, 2013.Google Scholar that some published literature does show clear and statistically significant improvement of knee OA symptoms after viscosupplementation treatment. The bottom line is that there are many criteria for evaluating the quality and importance and clinical relevance and generalizability of medical research, and no research is perfect. Furthermore, we are shocked that an institution as eminent as the American Academy of Orthopaedic Surgeons, of which we are proud members, would publish guidelines that seem so inconsistent with the mission of the AAOS, which states: “AAOS will champion the interests of all patients, serve our members and the profession, and advance the highest quality musculoskeletal health.”27American Academy of Orthopaedic Surgeons. Mission statement. Available at: http://www.aaos.org/about/mission.asp. Accessed November 5, 2013.Google Scholar In our opinion, it is not in the interests of all patients to recommend against a treatment that is of significant benefit for some patients, especially when that treatment is for a disease (knee OA) that is not preventable, and for which there is no cure. In our opinion, it does not serve AAOS members and our profession to recommend against a treatment that AAOS members provide their own patients, many of whom demand such treatment because viscosupplementation decreases their knee OA pain and limitations of function with a risk-to-benefit profile they prefer to alternative treatments, including no treatment at all. Again, in our opinion, it does not advance the highest quality of musculoskeletal health to publish CPGs based on methods that are controversial, insofar as there are other ways to assess the medical literature.23Bannuru R.R. Vaysbrot E.E. McIntyre L.F. Did the American Academy of Orthopaedic Surgeons osteoarthritis guidelines miss the mark?.Arthroscopy. 2014; 30: 86-89Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar We believe that the AAOS should seek the counsel of independent experts to review the AAOS CPG methods and alternatives and, in the interim, refrain from CPG activity and publication in accordance with the AAOS Mission that additionally states that AAOS's “major activities” require “defensible criteria against which all goals are established.”27American Academy of Orthopaedic Surgeons. Mission statement. Available at: http://www.aaos.org/about/mission.asp. Accessed November 5, 2013.Google Scholar It takes guts to say it: “Cease and desist.” Your editors do not have all the answers to clinical questions,28Lubowitz J.H. Poehling G.G. Clinically relevant articles of high levels of evidence are required to change surgical practice.Arthroscopy. 2007; 23: 803Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 29D'Agostino Jr., R.B. Lubowitz J.H. Provencher M.T. Poehling G.G. A modest proposal for a clinical trial on single-bundle versus double-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2012; 28: 301-304Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar because science and medicine continue to evolve.30Lubowitz J.H. Poehling G.G. Shoulder arthroscopy: Evolution of the revolution.Arthroscopy. 2009; 25: 823-824Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 31Lubowitz J.H. Provencher M.T. Poehling G.G. Two steps forward, one step back.Arthroscopy. 2011; 27: 1453-1455Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar In the past, we have shared the humble words of Donald H. Johnson, M.D., member emeritus of the Arthroscopy Journal Board of Trustees: “Based on past experience, it is likely that half of what we today believe to be correct arthroscopic knowledge or treatment is wrong. The problem is. . .I don't know which half.”32Lubowitz J.H. Poehling G.G. Medical literature ahead: Proceed with caution.Arthroscopy. 2007; 23: 1255-1256Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Future research may find that there are more effective treatments for knee OA than viscosupplementation. On the other hand, in the future, we may find that viscosupplementation is a routinely recommended treatment for knee OA. It may be for good reason that Dhawan, Mather Karas, Ellman, Young, Bach, and Cole report in this issue of Arthroscopy that, “…significant gaps exists between CPGs established by the AAOS in 2008 and current practice patterns in the non-arthroplasty treatment of knee OA in the United States.”33Dhawan A. Mather III, R.C. Karas V. et al.An epidemiologic analysis of clinical practice guidelines for non-arthroplasty treatment of osteoarthritis of the knee.Arthroscopy. 2014; 30: 65-71Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar Perhaps, for now, it could be better were the AAOS to be less dogmatic.