Letter to the Editor: Editorial: The New AAOS Guidelines on Knee Arthroscopy for Degenerative Meniscus Tears Are a Step in the Wrong Direction

Abstract

To the Editor,The American Academy of Orthopaedic Surgeons (AAOS) has developed and funds a considerable quality program managed by its Evidence-based Quality and Value Committee. The AAOS is invested in this process and takes the effort very seriously. The output of the committee includes various evidence-based guidelines that are meant to aid member surgeons in choosing the best treatment for their patients.

Letter to the Editor: Editor’s Spotlight/Take 5: Has Arthroscopic Meniscectomy Use Changed in Response to the Evidence? A Large-database Study from Spain

“…David Sackett [34], who many consider the father of evidence-based medicine (EBM), defined EBM as integrating: (1) the best available clinical evidence from systematic research; (2) individual clinical expertise; and (3) the thoughtful identification of "individual patients' predicaments, rights, and preferences." We find ourselves in agreement with an earlier letter to CORR that states surgeon experience is important when selecting appropriate nonoperative and operative treatments [12]. Until we have prognostic evidence from large, prospective, observational studies that define key positive and negative prognostic factors for knee OA treatments, we will need to rely on surgeon experience to treat individual patients.…”

Editorial: Chance Encounters, Overdiagnosis, and Overtreatment

“…And they’re correct. But when I suggest to knee surgeons that we’re doing too much arthroscopy for the wrong reasons [11], I get some fairly pointed comments back [7]. (In fairness, same goes, more or less, when asking my friends in spine surgery about fusions, shoulder surgeons about subacromial decompressions, and so on.)…”

Reply to the Letter to the Editor: Editorial: The New AAOS Guidelines on Knee Arthroscopy for Degenerative Meniscus Tears Are a Step in the Wrong Direction

“…Getelman and colleagues [4] are correct that practicing high-quality orthopaedic surgery involves marrying experienced-based good judgment with a discerning eye for integrating the best-available evidence. And when it comes to the indications for some of the procedures we perform, must make decisions in the absence of strong evidence.…”

“…The bedrock principle of science that undergirds modern medicine is the falsifiable hypothesis. If the mountain of highquality evidence on this topic is insufficient to convince surgeons that As for attending to the specific arguments in their letter [4], while it's true that randomized trials have shortcomings, vague concepts about how the patients in those studies might not look like yours or mine should not cause one to disqualify them. By contrast, "experience" has several disqualifying problems in this context.…”