Michael J. Rossi

The Knee Anterolateral Ligament

hen we woke on November 6, 2013, Time Wmagazine reported: “In an age filled with advanced medical techniques like MRIs, artificial hearts, and laser eye surgery, one could be forgiven for believing doctors are also at least vaguely familiar with every one of your body parts. However, a new discovery by Belgian physicians has proved this assumption wrong.two surgeons at University Hospitals Leuven have located a new ligament in the human knee, and their findings may mean a revolution in how we treat ACL injuries.” A new knee ligament? It was hard for us to believe this was true. However, “A press release, issued by the university (University Hospitals Leuven in Belgium) and picked up by numerous media outlets around the world, claimed the ligament was previously unknown.” Thus began the media hype. By the next week, the story had gone viral. By November 13, 2014, the headline in The New York Times announced: “Doctors Identify a New Knee Ligament,” and reported that the “new ligament” was “one that had not previously been specifically identified despite untold numbers of past knee dissections and scans.” The Times quoted Dr. Steven Claes, who published his dissection of the knee anterolateral ligament (ALL) in the Journal of Anatomy. According to Claes, after study of the work of French surgeon Paul Segond, who in 1879 described a “‘pearly, resistant fibrous band’ originating at the outside, front portion of the thighbone and continuing to the shinbone,” Claes had an innovative hypothesis. According to Claes, “I know it probably sounds crazy to say that we thought there might be this new ligament.” As Arthroscopy editors and academic ACL surgeons, we viewed the media frenzy without judgment and with thoughtful consideration, but many arthroscopic and related surgeons and sports medicine specialists found

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.

Research Pearls: The Significance of Statistics and Perils of Pooling

A series of articles on statistics are intended for an audience of clinicians, as well as statisticians and authors. Statistical significance is different than clinical significance. Understanding of clinical outcomes, value, quality, or generalizability requires critical analysis of medical research literature to ensure that statistical analyses have been properly applied and interpreted.

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.