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Summertime Blues: ACL Rupture, Rotator Cuff Tear, and Meniscus Tear Seem Epidemic

2008; Elsevier BV; Volume: 24; Issue: 7 Linguagem: Inglês

10.1016/j.arthro.2008.05.009

1526-3231

James H. Lubowitz, Gary G. Poehling,

Total Knee Arthroplasty Outcomes

In our home towns of Taos, New Mexico, and Winston-Salem, North Carolina, it seems that ACL rupture, rotator cuff tear, and meniscus tear are epidemic. We suppose that the epidemic has reached your home towns also. And this being July, the epidemic brings to mind the title of the 1958 blues standard song “Summertime Blues.”1WikipediaSummertime blues.http://en.wikipedia.org/wiki/Summertime_BluesGoogle Scholar Fortunately, we offer this green-covered journal as an antidote. While Cochran and Capehart write that “There ain't no cure for the Summertime Blues,” we believe that a tonic of clinical relevance mixed with a large dose of controversy may help.2Lubowitz 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, 3Lubowitz J.H. Poehling G.G. A new year.Arthroscopy. 2008; 24: 2-3Abstract Full Text Full Text PDF Scopus (20) Google Scholar Let's get to it. Notably in this issue, Fabricant, Rosenberger, Jokl, and Ickovics4Fabricant P.D. Rosenberger P.H. Jokl P. Ickovics J.R. Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy.Arthroscopy. 2008; 24: 769-778Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar show that, with regard to short-term recovery after partial meniscectomy, surgeons should be aware and patients may be counseled that female patients and patients with more advanced osteoarthritis can have a short-term recovery that may not be as short as they might expect or desire. This is clinically relevant because, when patients are informed of this, realistic expectations should result in greater patient satisfaction. Billante, Diduch, Lunardini, Treme, Miller, and Hart5Billante M.J. Diduch D.R. Lunardini D.J. Treme G.P. Miller M.D. Hart J. Meniscal repair using an all-inside, rapidly absorbing, tensionable device.Arthroscopy. 2008; 24: 779-785Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar report that patients having meniscal repair (concomitant with ACL reconstruction) generally do well after all-inside repair. Furthermore, Kalliakmanis, Zourntos, Bousgas, Pantelis, and Nikolaou6Kalliakmanis A.G. Zourntos S. Bousgas D. Nikolaou P. Comparison of arthroscopic meniscal repair results using three different meniscal repair devices in an anterior cruciate ligament reconstruction population.Arthroscopy. 2008; 24: 810-816Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar found nearly identical results. Unfortunately, both groups of authors also report that more than 10% of their patients do not do well. While the studies have limitations that are well acknowledged by the authors, what is clear is that, although results of meniscal repair using the all-inside technique have improved, additional research is required to solve the problem of failure. As above, meniscus tears are epidemic. The all-inside technique makes meniscal repair easier; however, in our opinion, a 10% failure rate is “good,” but too many patients will be dissatisfied until we are able to achieve “better.” With regard to the epidemic of rotator cuff tear, minimally invasive arthroscopic repair may be the ideal solution for massive tears; however, some massive tears may be irreparable. This is discouraging—it would be ideal if all tears could be fixed. Reassuringly, Liem, Lengers, Dedy, Poetzl, Steinbeck, and Marquardt7Liem D. Lengers N. Dedy N. Poetzl W. Steinbeck J. Marquardt B. Arthroscopic debridement of massive irreparable rotator cuff tears.Arthroscopy. 2008; 24: 743-748Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar confirmed that minimally invasive arthroscopic debridement and biceps tenotomy resulted in substantial pain relief for massive, irreparable tears in elderly, low-demand patients. Faced with the alternative of an open surgical repair requiring tendon transfer, the benefits of a lower-morbidity arthroscopic procedure seem an appealing alternative for the correct patient. Finally, from the esteemed UCLA Biomechanics Laboratories,8Markolf K.L. Park S. Jackson S.R. McAllister D.R. Contributions of the posterolateral bundle of the anterior cruciate ligament to anterior-posterior knee laxity and ligament forces.Arthroscopy. 2008; 24: 805-809Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Markolf, Park, Jackson, and McAllister demonstrate that cutting the posterolateral bundle of the ACL results in minimal increases in knee anterior translation. While proponents of double-bundle ACL reconstruction may argue that it is rotation rather than translation that matters, until rotation can be measured, do readers believe that there is a need for posterolateral bundle (and thus double-bundle) ACL reconstruction? In keeping with the theme of this editorial, ACL rupture is epidemic, and double-bundle reconstruction may lead to greater morbidity than single-bundle techniques, so this is a clinically relevant question. Corresponding author David McAllister,8Markolf K.L. Park S. Jackson S.R. McAllister D.R. Contributions of the posterolateral bundle of the anterior cruciate ligament to anterior-posterior knee laxity and ligament forces.Arthroscopy. 2008; 24: 805-809Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar a member of the Arthroscopy Editorial Board, appreciates the importance of presenting a controversy and offers a clinically relevant challenge by calling into question the need for posterolateral bundle (and thus double-bundle) ACL reconstruction. As we've queried regarding basic science research in the past,9Lubowitz J.H. Poehling G.G. Do basic science articles have clinical relevance?.Arthroscopy. 2008; 24: 249-250Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar do readers believe that biomechanics data are clinically relevant? As always, we await your letters. So in summary, in both the knee and the shoulder, low-morbidity arthroscopic techniques take the day as we fight the epidemics of ACL rupture, rotator cuff tear, and meniscus tear. We think this is good news. Like the Summertime Blues, there ain't no 100% cure, but the reward of lower patient morbidity is a clinically relevant strong tonic that we aren't afraid to mix with a large dose of controversy.