Jefferson C. Brand

The Effect of a Geographic Lateral Bone Bruise on Knee Inflammation after Acute Anterior Cruciate Ligament Rupture

We prospectively evaluated 40 patients who had knee inflammation after isolated anterior cruciate ligament rupture with or without an associated “geographic” bone bruise/subchondral fracture of the lateral femoral condyle. All patients with acute ruptures documented by magnetic resonance imaging within 1 week of injury were evaluated for a geographic bone bruise/subchondral fracture of the lateral femoral condyle. Two groups of 20 patients each (bone bruise versus no bone bruise) were then enrolled. Variables measured at 1, 2, 3, and 4 weeks after injury included pain, range of motion, effusion, and number of days with an antalgic gait. Patients with a bone bruise had increased size and duration of effusion, increased number of days required to nonantalgic gait without external aids, increased days to achieve normal range of motion, and increased pain scores at measured time intervals. This study confirms results of previous clinical and histologic studies showing an associated articular cartilage lesion, otherwise known as bone bruise/subchondral fracture, is clinically significant. There appears to be an association between a geographic bone bruise and increased disability in patients with acute anterior cruciate ligament ruptures. Patients with a geographic bone bruise may require longer to reach normal homeostasis (range of motion, pain, neuromuscular control) before undergoing anterior cruciate ligament reconstruction.

Making the Right Treatment Decision Requires Consideration of Utility and Reconsideration of Value

To achieve a good clinical outcome, arthroscopic and related surgeons must choose the proper treatment, and the basis of this choice is accurate diagnosis. Generally, our clinical focus is on outcome, but outcome is achieved after the fact. While this seems obvious, arthroscopic and related surgeons-and our patients who participate in shared decision making-evaluate the utility, or usefulness, of potential treatments based on desired and expected benefits versus potential risks. Today, cost is frequently considered as a determinant of value in medicine and may be applied to the decision analysis, but if an individual patient perceives health to be priceless, cost becomes irrelevant. In the end, an individual patients satisfaction is determined on a case-by-case basis. Proper choice of treatment cannot be formulaic.

Thirty Years Brings Major Change

appy New Year. We hang a banner to celebrate Hour 30th anniversarydthe new cover is festooned. A year has passed. The passage of time is always notable. We reflect in the New Year that time is fleeting. Moreover, we find it hard to believe it has been a full 5 years since “Old School: Arthroscopy’s 25 Anniversary.” An anniversary is worthy of recognition, but at the same time represents a challenge, because 30 years brings major change. In the last year, we have named a new associate editor, new deputy editors, a new assistant editor-in-chief, a new Editorial Board, a new Journal Board of Trustees (JBOT), a new JBOT Chairman, and our number one, Hank Hackett, Managing Editor, will be retiring June 30, 2015. On top of this, we recall the big news from 2014 is that Gary G. Poehling, M.D. is newly the editor-in-chief emeritus. Dr. Poehling joins the 30-year club; his name has been associated with the journal since Volume 1, Issue 1 in 1985. Finally, our new editor-in-chief, James Lubowitz, M.D., assumed the responsibility in May of this year. Leadership during times of change entails a fast learning curve, and Arthroscopy journal and Arthroscopy Techniques are in prime position to be forward looking, innovative, and nimble, because our foundation is based on 3 decades of rock-solid arthroscopic and related research. A major task in 2015 will be to continue to adapt to disruptive change in the publishing industry from innovation in technology and social media. Our solution is Arthroscopy Techniques, andwehavededicated significant manpower toward development of a greatly improved electronic platform for www.arthroscopytechniques.org. Stay tuned for the imminent launch, which will be well announced.Weareoptimistic thatoncewe launch thenew platform, the enriched utility of Arthroscopy Techniqueswill be most notable. With major change at the Green Journal, we greatly appreciate our reviewers and editorial board, on whom we rely absolutely. Journal metrics indicate that the number of submissions toArthroscopy is exploding (Fig 1). As a result, we are recruiting new reviewers: Please sign up as a reviewer, first by viewing the Journal Review Course PowerPoint at www.arthroscopyjournal. org, and then submitting your contact information and

Learning the Language of Copernicus.

The Copernicus Initiative was a bold and important undertaking by the Arthroscopy Association of North America to help further our learning the art of arthroscopy in a controlled setting. Understanding arthroscopic learning, training, and simulation research requires mastery of a lexicon of new terms, which AANA Copernicus researchers define in a glossary. Learning requires practice to develop proficiency. Developing new ability is a rewarding challenge. Metrics may be used to quantitatively measure objective performance, and is a key component of the Copernicus Initiative. A dedicated group of AANA researchers and educators have taken on an important and challenging task to help us improve in the realm of surgical education.

Shoulder Arthroscopy Complication and Readmission Rates: Impact on Value

In medicine, value is defined as outcome divided by cost. Adverse events after medical treatment result in diminished outcomes and increased costs. As we evolve toward value-driven care, we must quantify the incidence of and risk factors for adverse events in order to minimize this dual-and multiplicative-effect.

Are Orthopaedic Systematic Reviews Overly Prevalent

Systematic Reviews (SRs) are becoming an increasingly utilized resource for readers that aims to answer a specific question by critically analyzing multiple research studies or papers on a topic. Although an SR can be extremely helpful to find an answer to a question, it may also be scrutinized, as the methodology is often not robust enough to adequately determine the outcome. This editorial serves to highlight the benefits of an SR, the methodology of a high-caliber SR, and some common pitfalls that may reduce the impact of an SR.

The Expectation Game: Patient Comprehension Is a Determinant of Outcome

Patient comprehension of orthopaedic procedures is low and their expectations for successful outcomes are often unrealistic. Surgeons need to understand this and guide patients toward sensible expectations.

Acromioclavicular joint reconstruction: complications and innovations.

Minimally invasive anatomic reconstruction of the acromioclavicular joint is a technically challenging procedure. The repair must be sufficiently strong and reconstitute the joint as closely as possible. This includes restoration of both superior-inferior stability, and the often overlooked anterior-posterior stability, of the acromioclavicular joint. There is no gold standard treatment for acromioclavicular joint separation.

News You Can Use: The Knee Anterolateral Ligament and the ISAKOS Journal

The knee anterolateral ligament may be fiction, but we thought it fact. As true anatomic restoration of the anterior cruciate ligament (ACL) may not be possible today, we are open to the possibility that lateral augmentation of ACL reconstruction could be of benefit in some patients.

Arthroscopy Journal Prizes Are Major Decisions

According to the Harvard Business Review, the optimal number of people in a decision-making group is no more than 8. Thus, it is no surprise that 18 Arthroscopy journal associate editors had difficulty making a major decision. In the end, 18 editors did successfully select the 2015 winner of the Best Comparative Study Prize. All studies have limitations, but from a statistical standpoint, the editors believe that the conclusions of the winning study are likely correct.