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Arthroscopy, Anatomy, and Translational Research

2007; Elsevier BV; Volume: 23; Issue: 3 Linguagem: Inglês

10.1016/j.arthro.2007.01.002

1526-3231

James H. Lubowitz, Gary G. Poehling,

Shoulder Injury and Treatment

“Don’t know much about history.” Although some surgeons might even admit that they don’t know much biology, it is recognized that when it comes to anatomy, a well-prepared surgeon devotes a lifetime of learning. The initial study of anatomy may be rote, exhausting, and full of formalin, but presurgical mastery of our next patient’s anatomic pathology results in the immediate reward and satisfaction of a case well performed. The study of anatomy dates to the Egyptians as shown in the Edwin Smith papyrus of 1600 bc. Thus, it seems rather surprising that today, over 3,600 years later, research continues to elucidate more thorough understanding of our body’s design. In this issue of Arthroscopy, we publish no fewer than 6 original scientific research articles reporting on, you guessed it, anatomy. Before we highlight these anatomic studies, we introduce readers to a concept that, even if previously unfamiliar, is one about which they will likely hear more in coming years: translational research. Basic science research must be translated into practical applications. Perhaps nowhere is this more pressing than in health care, where it is of the ultimate benefit when research is translated from the bench top to the clinic. Increasingly, this is a 2-way street. Scientists provide clinicians with new tools, whereas clinicians and particularly arthroscopic surgeons develop new techniques, often based on an improved understanding of anatomy, which in turn stimulate additional basic science investigation.1Re-engineering the clinical research enterprise: Translational research. National Institutes of Health (NIH) roadmap for medical research. NIH Office of Portfolio Analysis and Strategic Initiatives. Available at http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp. Accessed January 6, 2006.Google Scholar On review of the anatomic studies in the current issue, we observe 2 phenomena. First, we observe that the metaphor of the 2-way street has merit. Clinical advances in the areas of hip, knee, and shoulder arthroscopy seem to provide the impetus for the in-depth anatomic studies that follow. Second, we observe that when it comes to translational research, the study of anatomy results in a very rapid clinical translation. Whereas it may take years for a new biomaterial to become ready for implantation, improved understanding of arthroscopic anatomy may be applied in our practices tomorrow. Our readers should thus note the report by Vieira et al., “Anatomic Study of the Iliotibial Tract,” when considering arthroscopic treatment from the greater trochanteric bursa of the hip to the posterolateral corner of the knee.2Vieira E.L.C. Vieira E.A. da Silva R.T. Berlfein P.Ad.S. Abdalla R.J. Cohen M. Anatomic study of the iliotibial tract.Arthroscopy. 2007; 23: 269-274Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar The work of Edward et al.3Edwards A. Bull A.M.J. Amis A.A. The attachments of the fiber bundles of the posterior cruciate ligament: An anatomic study.Arthroscopy. 2007; 23: 284-290Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar on attachment of the fiber bundles of the posterior cruciate ligament may aid as an immediate reference for graft tunnel placement and in future design of posterior cruciate ligament guides. Understanding the fetal anterior cruciate ligament as elucidated by Ferretti et al.4Ferretti M. Levicoff E.A. Macpherson T.A. Moreland M.S. Cohen M. Fu F.H. The fetal anterior cruciate ligament: An anatomic and histologic study.Arthroscopy. 2007; 23: 278-283Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar provides a basis of ontogeny for consideration of double-bundle reconstruction of the anterior cruciate ligament. Research into the subscapularis footprint as reported by Richards et al.5Richards D.P. Burkhart S.S. Tehrany A.M. Wirth M.A. The subscapularis footprint: An anatomic description of its insertion site.Arthroscopy. 2007; 23: 251-254Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar will aid surgeons attempting to perform accurate arthroscopic rotator cuff repair. Further, an appreciation that “The Superior-Medial Shoulder Arthroscopic Portal Is Safe” as described by Woolf et al.6Woolf S.K. Guttmann D. Karch M.M. Graham R.D. Reid J.B. Lubowitz J.H. The superior-medial shoulder arthroscopic portal is safe.Arthroscopy. 2007; 23: 247-250Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar allows surgeons performing arthroscopic rotator cuff repair, superior labrum repair, and acromioclavicular joint excision to consider use of superior-medial shoulder arthroscopic portal with confidence. Finally, an understanding of the anterior meniscofemoral ligament as described by Ranalletta et al.7Ranalletta M. Rossi W. Paterno M. Brigatti N.A. Ranalletta A. Incidence of the anterior meniscofemoral ligament: An arthroscopic study in anterior cruciate ligament deficient knee.Arthroscopy. 2007; 23: 275-277Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar suggests that this is a structure that requires additional study and, pending future research, may perhaps be a structure worthy of identifying and preserving during arthroscopic knee surgery. So (with apologies to Sam Cooke) we know that 1 and 1 is 2, and we know that, with anatomy true, what a wonderful world this would be.