To Operate or Not to Operate? That Is (Still) the Question (JBJS)
Commentary on an article by Hege Grindem, PT, PhD, et al.: “Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury. The Delaware-Oslo ACL Cohort Study”
Donald C. Fithian, MD
J Bone Joint Surg Am, 2014 Aug 06;96(15):e133. http://dx.doi.org/10.2106/JBJS.N.00340
COMMENTARY
It need hardly be said that the decision whether to operate is the most critical step in treating a patient with a torn anterior cruciate ligament (ACL). So why are there only a handful of studies to support an evidence-based approach to this important decision? One reason may be that such studies are so difficult to do well. Randomization is expensive, and it is a considerable undertaking to recruit and retain a representative sample of subjects about whom valid, generalizable conclusions might be drawn. However, without randomization, treatment allocations and outcomes can be confounded by so many sources of bias, on the part of investigators, treating physicians, and subjects alike, that it can be very difficult to sort out fact from fallacy, or valid inference from statistical artifact.
Grindem...
