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Arthroscopy Techniques Achieves PubMed Central Citation, Yet Knee and Shoulder Outcome Failures Represent a Challenge, and a Presidential Address Prepares Us for Adversity

2013; Elsevier BV; Volume: 29; Issue: 9 Linguagem: Inglês

10.1016/j.arthro.2013.06.012

1526-3231

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

Shoulder and Clavicle Injuries

At the April 2013 Arthroscopy Association of North America annual meeting in San Antonio, Nick Sgaglione shared “a story about getting knocked down and getting back up.” If you missed Nick's inspirational presidential address at the AANA meeting, and if you missed reading it in last month's issue, be sure go back and find Past President Sgaglione's speech, or check it out at www.arthroscopyjournal.org. “Leadership in the Face of the Adversity” includes a message that can benefit each and every one of us.1Sgaglione N.A. Presidential address: Leadership in the face of the adversity.Arthroscopy. 2013; 29 (August issue): 1387-1391Abstract Full Text Full Text PDF PubMed Scopus (1) Google ScholarEqually inspiring at the annual meeting was presidential Guest Speaker Eric Greitens, who related insights and experiences from his Navy Seal training to his community service with the Mission Continues Foundation (www.missioncontinues.org). Greitens shared anecdotes from his best-selling book, “The Heart and the Fist.”2Greitens E. The heart and the fist. Houghton Mifflin Harcourt, Boston2011Google ScholarRegarding our present challenges, orthopaedic surgeons and their patients are facing issues of adversity—emphasizing our need for leadership—because of health economic issues that are acute in the United States and throughout most parts of the world.3Lubowitz J.H. Poehling G.G. Comparative effectiveness research: We must lead (so as not to be misled).Arthroscopy. 2009; 25: 455-456Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 4Lubowitz J.H. Poehling G.G. Access to arthroscopy: Ethical imperatives and economic challenges.Arthroscopy. 2009; 25: 1363-1364Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 5Lubowitz J.H. Provencher M.T. Poehling G.G. Lower price high volume better outcome maximum efficiency minimally invasive: A developing model for health care delivery.Arthroscopy. 2011; 27: 599-600Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar We editors are thankful to the leadership of AANA for helping us to face difficult times in all areas by providing education that prepares us for clinical challenges, and leadership helping us to face issues in the area of health care delivery.As above, orthopaedic surgeons and their patients presently face clinical challenges, as there is strong evidence in the current issue suggesting that knee ACL and cartilage and shoulder arthroscopy outcomes have room for improvement.Crawford, Waterman, and Lubowitz6Crawford S.N. Waterman B.R. Lubowitz J.H. Long-term failure of anterior cruciate ligament reconstruction.Arthroscopy. 2013; 29: 1566-1571Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar present the knee ACL clinical challenge—a significant failure rate. Many published studies report ACL outcome after excluding the adverse outcome of graft failure requiring reoperation, which is obviously biased. When we also consider publication bias (surgeons with below average outcomes are less likely to publish their results7Lubowitz J.H. Poehling G.G. Publication bias.Arthroscopy. 2006; 22: 1031-1032PubMed Scopus (5) Google Scholar), the overall ACL failure rate likely exceeds 12%. Thus, we are challenged and we must improve our ACL outcomes.More adversity in the current issue is noted by Abouali, Hatzantoni, Holtby, Veillette, and Theodoropoulos who emphasize the shoulder Bankart repair clinical challenge—a significant failure rate (again). These authors also report high revision Bankart failure rates.8Abouali J.A.K. Hatzantoni K. Holtby R. Veillette C. Theodoropoulos J. Revision arthroscopic Bankart repair.Arthroscopy. 2013; 29: 1572-1578Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar When we consider publication bias, the overall Bankart and revision Bankart failure rate may exceed 15%.Additional challenge in the current issue is reported by Goyal, Keyhani, Lee, and Hui, who systematically review knee cartilage microfracture. Again, the clinical challenge is a high rate of failure and osteoarthritis (OA).9Goyal D. Keyhani S. Lee E.H. Hui J.H.P. Evidence-based status of microfracture technique: A systematic review of level I and II studies.Arthroscopy. 2013; 29: 1579-1588Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar In this case, when we consider transfer bias and publication bias, the overall knee microfracture failure or OA rate may exceed 33%.Clearly, there is a huge need for continued arthroscopic and related research in the areas of knee ACL, shoulder instability, and cartilage.And finally with regard to the current issue, the challenges keep coming, because when it comes to surgery, risks range from glove perforation as described by Martinez, Han, Sardar, Beckman, Steffen, Miller, and Martineau10Martinez A. Han Y. Sardar Z.M. et al.Risk of glove perforation with arthroscopic knot tying using different surgical gloves and high-tensile strength sutures.Arthroscopy. 2013; 29: 1552-1558Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar to iatrogenic surgical tool metal particles and possible joint damage reported by Pedowitz, Billi, Kavanaugh, Colbert, Liu, Savoie, and You.11Pedowitz R.A. Billi F. Kavanaugh A. et al.Arthroscopic surgical tools: A source of metal particles and possible joint damage.Arthroscopy. 2013; 29: 1559-1565Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar As if we didn't have enough to worry about! Fortunately, in the experience of the editors, while the appearance of metal fragments can be observed from products manufactured by any company, we have not observed adverse clinical outcomes as a result. In addition, biomaterials continue to evolve.While the current issue challenges readers in all manners as described, we should remember that, despite difficulties, the opportunity for research could not be more fertile. The current issue also encourages; we were speaking of evolution, so what could be more timely than respected expert opinion (Level V evidence)12Lubowitz J.H. Poehling G.G. A new year.Arthroscopy. 2008; 24: 2-3Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 13Lubowitz J.H. Poehling G.G. Rotator cuff repair: Obviously. Arthroscopy. 2010; 26: 293-294Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar on the topic of the evolution of suture anchors in arthroscopic rotator cuff repair by Denard and Burkhart.14Denard P.J. Burkhart S.S. The evolution of suture anchors in arthroscopic rotator cuff repair.Arthroscopy. 2013; 29: 1589-1595Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar The figures and video accompanying this article are truly compelling. If you perform arthroscopic rotator cuff repair and you've never watched an Arthroscopy journal video, this is the video to watch. Burkhart and Denard have wowed us with their videos in the past,15Lubowitz J.H. Provencher M.T. Poehling G.G. Let us go to the video: Part II.Arthroscopy. 2011; 27: 743Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar and they have done it again!Speaking of video, our new online journal, Arthroscopy Techniques (www.arthroscopytechniques.org) is now listed on PubMed Central as Arthrosc Tech and its content is searchable on PubMed. We are proud to share that this significant editorial goal has been accomplished.16Lubowitz J.H. Provencher M.T. Poehling G.G. Award winning research and a new journal.Arthroscopy. 2011; 27: 1599-1601Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 17Lubowitz J.H. Provencher M.T. Poehling G.G. Our new journal: Arthroscopy Techniques.Arthroscopy. 2012; 28: 149-150Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 18Lubowitz J.H. Provencher M.T. Poehling G.G. Arthroscopy Techniques: Aims and scope.Arthroscopy. 2013; 29: 1Abstract Full Text Full Text PDF Scopus (10) Google Scholar After you enjoy the Burkhart video at www.arthroscopyjournal.org, please also check out the listed content of Arthroscopy Techniques at http://www.ncbi.nlm.nih.gov/pmc/journals/2115/. Each published article includes educational figures and video. The topics are broad and the techniques may amaze.We again feel fortunate for the examples set by our leaders and the opportunities afforded by our organizations, including peer-reviewed scholarship that provides us with education and the motivation to continue to face our arthroscopic and related challenges. At the April 2013 Arthroscopy Association of North America annual meeting in San Antonio, Nick Sgaglione shared “a story about getting knocked down and getting back up.” If you missed Nick's inspirational presidential address at the AANA meeting, and if you missed reading it in last month's issue, be sure go back and find Past President Sgaglione's speech, or check it out at www.arthroscopyjournal.org. “Leadership in the Face of the Adversity” includes a message that can benefit each and every one of us.1Sgaglione N.A. Presidential address: Leadership in the face of the adversity.Arthroscopy. 2013; 29 (August issue): 1387-1391Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Equally inspiring at the annual meeting was presidential Guest Speaker Eric Greitens, who related insights and experiences from his Navy Seal training to his community service with the Mission Continues Foundation (www.missioncontinues.org). Greitens shared anecdotes from his best-selling book, “The Heart and the Fist.”2Greitens E. The heart and the fist. Houghton Mifflin Harcourt, Boston2011Google Scholar Regarding our present challenges, orthopaedic surgeons and their patients are facing issues of adversity—emphasizing our need for leadership—because of health economic issues that are acute in the United States and throughout most parts of the world.3Lubowitz J.H. Poehling G.G. Comparative effectiveness research: We must lead (so as not to be misled).Arthroscopy. 2009; 25: 455-456Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 4Lubowitz J.H. Poehling G.G. Access to arthroscopy: Ethical imperatives and economic challenges.Arthroscopy. 2009; 25: 1363-1364Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 5Lubowitz J.H. Provencher M.T. Poehling G.G. Lower price high volume better outcome maximum efficiency minimally invasive: A developing model for health care delivery.Arthroscopy. 2011; 27: 599-600Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar We editors are thankful to the leadership of AANA for helping us to face difficult times in all areas by providing education that prepares us for clinical challenges, and leadership helping us to face issues in the area of health care delivery. As above, orthopaedic surgeons and their patients presently face clinical challenges, as there is strong evidence in the current issue suggesting that knee ACL and cartilage and shoulder arthroscopy outcomes have room for improvement. Crawford, Waterman, and Lubowitz6Crawford S.N. Waterman B.R. Lubowitz J.H. Long-term failure of anterior cruciate ligament reconstruction.Arthroscopy. 2013; 29: 1566-1571Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar present the knee ACL clinical challenge—a significant failure rate. Many published studies report ACL outcome after excluding the adverse outcome of graft failure requiring reoperation, which is obviously biased. When we also consider publication bias (surgeons with below average outcomes are less likely to publish their results7Lubowitz J.H. Poehling G.G. Publication bias.Arthroscopy. 2006; 22: 1031-1032PubMed Scopus (5) Google Scholar), the overall ACL failure rate likely exceeds 12%. Thus, we are challenged and we must improve our ACL outcomes. More adversity in the current issue is noted by Abouali, Hatzantoni, Holtby, Veillette, and Theodoropoulos who emphasize the shoulder Bankart repair clinical challenge—a significant failure rate (again). These authors also report high revision Bankart failure rates.8Abouali J.A.K. Hatzantoni K. Holtby R. Veillette C. Theodoropoulos J. Revision arthroscopic Bankart repair.Arthroscopy. 2013; 29: 1572-1578Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar When we consider publication bias, the overall Bankart and revision Bankart failure rate may exceed 15%. Additional challenge in the current issue is reported by Goyal, Keyhani, Lee, and Hui, who systematically review knee cartilage microfracture. Again, the clinical challenge is a high rate of failure and osteoarthritis (OA).9Goyal D. Keyhani S. Lee E.H. Hui J.H.P. Evidence-based status of microfracture technique: A systematic review of level I and II studies.Arthroscopy. 2013; 29: 1579-1588Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar In this case, when we consider transfer bias and publication bias, the overall knee microfracture failure or OA rate may exceed 33%. Clearly, there is a huge need for continued arthroscopic and related research in the areas of knee ACL, shoulder instability, and cartilage. And finally with regard to the current issue, the challenges keep coming, because when it comes to surgery, risks range from glove perforation as described by Martinez, Han, Sardar, Beckman, Steffen, Miller, and Martineau10Martinez A. Han Y. Sardar Z.M. et al.Risk of glove perforation with arthroscopic knot tying using different surgical gloves and high-tensile strength sutures.Arthroscopy. 2013; 29: 1552-1558Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar to iatrogenic surgical tool metal particles and possible joint damage reported by Pedowitz, Billi, Kavanaugh, Colbert, Liu, Savoie, and You.11Pedowitz R.A. Billi F. Kavanaugh A. et al.Arthroscopic surgical tools: A source of metal particles and possible joint damage.Arthroscopy. 2013; 29: 1559-1565Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar As if we didn't have enough to worry about! Fortunately, in the experience of the editors, while the appearance of metal fragments can be observed from products manufactured by any company, we have not observed adverse clinical outcomes as a result. In addition, biomaterials continue to evolve. While the current issue challenges readers in all manners as described, we should remember that, despite difficulties, the opportunity for research could not be more fertile. The current issue also encourages; we were speaking of evolution, so what could be more timely than respected expert opinion (Level V evidence)12Lubowitz J.H. Poehling G.G. A new year.Arthroscopy. 2008; 24: 2-3Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 13Lubowitz J.H. Poehling G.G. Rotator cuff repair: Obviously. Arthroscopy. 2010; 26: 293-294Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar on the topic of the evolution of suture anchors in arthroscopic rotator cuff repair by Denard and Burkhart.14Denard P.J. Burkhart S.S. The evolution of suture anchors in arthroscopic rotator cuff repair.Arthroscopy. 2013; 29: 1589-1595Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar The figures and video accompanying this article are truly compelling. If you perform arthroscopic rotator cuff repair and you've never watched an Arthroscopy journal video, this is the video to watch. Burkhart and Denard have wowed us with their videos in the past,15Lubowitz J.H. Provencher M.T. Poehling G.G. Let us go to the video: Part II.Arthroscopy. 2011; 27: 743Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar and they have done it again! Speaking of video, our new online journal, Arthroscopy Techniques (www.arthroscopytechniques.org) is now listed on PubMed Central as Arthrosc Tech and its content is searchable on PubMed. We are proud to share that this significant editorial goal has been accomplished.16Lubowitz J.H. Provencher M.T. Poehling G.G. Award winning research and a new journal.Arthroscopy. 2011; 27: 1599-1601Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 17Lubowitz J.H. Provencher M.T. Poehling G.G. Our new journal: Arthroscopy Techniques.Arthroscopy. 2012; 28: 149-150Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 18Lubowitz J.H. Provencher M.T. Poehling G.G. Arthroscopy Techniques: Aims and scope.Arthroscopy. 2013; 29: 1Abstract Full Text Full Text PDF Scopus (10) Google Scholar After you enjoy the Burkhart video at www.arthroscopyjournal.org, please also check out the listed content of Arthroscopy Techniques at http://www.ncbi.nlm.nih.gov/pmc/journals/2115/. Each published article includes educational figures and video. The topics are broad and the techniques may amaze. We again feel fortunate for the examples set by our leaders and the opportunities afforded by our organizations, including peer-reviewed scholarship that provides us with education and the motivation to continue to face our arthroscopic and related challenges.