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Controversy in Arthroscopy: Bring It On
Editorial
Controversy in Arthroscopy: Bring It On
C
onsider these opinions:
“Sometimes the obvious is obscured by irrelevant or by poorly understood facts. . . . A critical examination yields . . . a fatal flaw [that] essentially prevents one from deriving a valid conclusion. [The] study . . . offers little to our knowledge. . . . Is that level [what] we want for evaluating our [outcomes]? Surely not! Unfortunately, recent studies . . . are being used by some to justify the use of less expensive and easier procedures that are inferior. . . . The path of least resistance in orthopaedics is not always the best way.” Or these: “A Myth Busted? A myth founded on poor scientific practice and affected by commercial bias. As for preclinical studies . . . serious hazards lie in declaring them a sufficient scientific basis for new research, or (worse) for clinical standards of care. There is no excuse for poor scientific practice, whether it be in the form of methodologic compromises or neglect of the unpleasant truth. Why do we have no trouble reprimanding our children when they justify their bad deeds . . . while we fail to uphold such a level of morality in our own work? Despite the massive commercially supported research interest . . . virtually no evidence exists. . . . We should be very wary.” Now consider: Are these arguments overheard after drinking too much alcohol in a bar? Are these excerpts from a shouting match on a late-night television show? A political rally? A university debate? No, dear reader, no. Well, then, were these affronts uttered in a back room brawl at an Academy meeting? Again, dear reader, no. Believe it or not, these paragraphs represent the
© 2010 by the Arthroscopy Association of North America 0749-8063/10/2605-10205$36.00/0 doi:10.1016/j.arthro.2010.04.001
strong opinions of leading international experts in shoulder and knee arthroscopy, and we have dared to publish these words, and more, right here in your May 2010 issue of Arthroscopy. The first quotation is from Burkhart and Cole, “Bridging self-reinforcing double-row rotator cuff repair: We really are doing better.”1 The second is from Järvinen, Alami, and our very own, mild-mannered former Associate Editor, Jón Karlsson, “Anterior cruciate ligament graft fixation—A myth busted?”2 Dear reader, let us not confuse honesty with impropriety. Level V evidence is expert opinion, and our quoted experts are entitled to express their honest thoughts. Let us not confuse passion with venom, for we believe the writers of these opinions have benevolent intentions—they believe that only by questioning established thought, might they advance our knowledge. We editors have the highest level of respect for our readers, as do these authors. As a show of this respect, we believe that these authors share with our readers the opinions that they truly believe, and not merely what they think readers wish to hear. In the 1992 film, A Few Good Men, Jack Nicholson uttered a now famous quip: “You can’t handle the truth.” We disagree. That said, Burkhart and Cole, and Järvinen, Alami, and Karlsson may not have the last word. As they challenge previous studies, they may also be challenged. Just because the authors believe their opinions to be true does not prove them so. Time may show that these experts are, in fact, incorrect. So may your research, or your letters to the editor. In a recent personal communication, Peter Millett, whose notably well-organized and wellillustrated Current Concepts review3 is another clear highlight in this current issue, shared that “There’s nothing wrong with controversy.” We have heeded his words. Despite graying hair, your editors try to keep up with the latest in lexicography, as well as arthroscopic and related surgery. As such, we declare, “Controversy in Arthroscopy: Bring it on,” where “bring it on”
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 26, No 5 (May), 2010: pp 573-574
573
574
EDITORIAL
is defined as “a direct challenge,” an “invitation to perform an action,” an invitation “to come forth.”4 Therefore, today, we invite controversy. Level V evidence is opinion. We expect that some of you may disagree with the opinions we publish. Once again, we solicit your letters in response. Controversy: Bring it on! JAMES H. LUBOWITZ, M.D. Assistant Editor-in-Chief GARY G. POEHLING, M.D. Editor-in-Chief
REFERENCES 1. Burkhart SS, Cole BJ. Bridging self-reinforcing double-row rotator cuff repair: We really are doing better. Arthroscopy 2010;26:677-680. 2. Järvinen TLN, Alami GB, Karlsson J. Anterior cruciate ligament graft fixation—A myth busted? Arthroscopy 2010;26:681684. 3. Elser F, Braun S, Dewing CB, Millett PJ. Glenohumeral joint preservation: Current options for managing cartilage lesions in young, active patients. Arthroscopy 2010;26:685-696. 4. Urban dictionary definition. Available at http://www .urbandictionary.com/define.php?term⫽bring⫹it⫹. Accessed April 5, 2010.
Controversy in Arthroscopy: Bring It On
C
onsider these opinions:
“Sometimes the obvious is obscured by irrelevant or by poorly understood facts. . . . A critical examination yields . . . a fatal flaw [that] essentially prevents one from deriving a valid conclusion. [The] study . . . offers little to our knowledge. . . . Is that level [what] we want for evaluating our [outcomes]? Surely not! Unfortunately, recent studies . . . are being used by some to justify the use of less expensive and easier procedures that are inferior. . . . The path of least resistance in orthopaedics is not always the best way.” Or these: “A Myth Busted? A myth founded on poor scientific practice and affected by commercial bias. As for preclinical studies . . . serious hazards lie in declaring them a sufficient scientific basis for new research, or (worse) for clinical standards of care. There is no excuse for poor scientific practice, whether it be in the form of methodologic compromises or neglect of the unpleasant truth. Why do we have no trouble reprimanding our children when they justify their bad deeds . . . while we fail to uphold such a level of morality in our own work? Despite the massive commercially supported research interest . . . virtually no evidence exists. . . . We should be very wary.” Now consider: Are these arguments overheard after drinking too much alcohol in a bar? Are these excerpts from a shouting match on a late-night television show? A political rally? A university debate? No, dear reader, no. Well, then, were these affronts uttered in a back room brawl at an Academy meeting? Again, dear reader, no. Believe it or not, these paragraphs represent the
© 2010 by the Arthroscopy Association of North America 0749-8063/10/2605-10205$36.00/0 doi:10.1016/j.arthro.2010.04.001
strong opinions of leading international experts in shoulder and knee arthroscopy, and we have dared to publish these words, and more, right here in your May 2010 issue of Arthroscopy. The first quotation is from Burkhart and Cole, “Bridging self-reinforcing double-row rotator cuff repair: We really are doing better.”1 The second is from Järvinen, Alami, and our very own, mild-mannered former Associate Editor, Jón Karlsson, “Anterior cruciate ligament graft fixation—A myth busted?”2 Dear reader, let us not confuse honesty with impropriety. Level V evidence is expert opinion, and our quoted experts are entitled to express their honest thoughts. Let us not confuse passion with venom, for we believe the writers of these opinions have benevolent intentions—they believe that only by questioning established thought, might they advance our knowledge. We editors have the highest level of respect for our readers, as do these authors. As a show of this respect, we believe that these authors share with our readers the opinions that they truly believe, and not merely what they think readers wish to hear. In the 1992 film, A Few Good Men, Jack Nicholson uttered a now famous quip: “You can’t handle the truth.” We disagree. That said, Burkhart and Cole, and Järvinen, Alami, and Karlsson may not have the last word. As they challenge previous studies, they may also be challenged. Just because the authors believe their opinions to be true does not prove them so. Time may show that these experts are, in fact, incorrect. So may your research, or your letters to the editor. In a recent personal communication, Peter Millett, whose notably well-organized and wellillustrated Current Concepts review3 is another clear highlight in this current issue, shared that “There’s nothing wrong with controversy.” We have heeded his words. Despite graying hair, your editors try to keep up with the latest in lexicography, as well as arthroscopic and related surgery. As such, we declare, “Controversy in Arthroscopy: Bring it on,” where “bring it on”
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 26, No 5 (May), 2010: pp 573-574
573
574
EDITORIAL
is defined as “a direct challenge,” an “invitation to perform an action,” an invitation “to come forth.”4 Therefore, today, we invite controversy. Level V evidence is opinion. We expect that some of you may disagree with the opinions we publish. Once again, we solicit your letters in response. Controversy: Bring it on! JAMES H. LUBOWITZ, M.D. Assistant Editor-in-Chief GARY G. POEHLING, M.D. Editor-in-Chief
REFERENCES 1. Burkhart SS, Cole BJ. Bridging self-reinforcing double-row rotator cuff repair: We really are doing better. Arthroscopy 2010;26:677-680. 2. Järvinen TLN, Alami GB, Karlsson J. Anterior cruciate ligament graft fixation—A myth busted? Arthroscopy 2010;26:681684. 3. Elser F, Braun S, Dewing CB, Millett PJ. Glenohumeral joint preservation: Current options for managing cartilage lesions in young, active patients. Arthroscopy 2010;26:685-696. 4. Urban dictionary definition. Available at http://www .urbandictionary.com/define.php?term⫽bring⫹it⫹. Accessed April 5, 2010.