Editorials
Thirty Years Brings Major Change
H
appy New Year. We hang a banner to celebrate our 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 25th Anniversary.”1 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.2 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.3-5 Our solution is Arthroscopy Techniques,6-9 and we have dedicated 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. We are optimistic that once we launch the new platform, the enriched utility of Arthroscopy Techniques will 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 to Arthroscopy 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 Ó 2015 by the Arthroscopy Association of North America 0749-8063/14942/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.11.007
specialty interests. We ask Fellowship Directors to please encourage their Fellows, who will now be eligible to join AANA as Resident/Fellow members. Arthroscopy journal editors will be recruiting reviewers and presenting top tips for writers and reviewers at the 2015 AANA Annual Meeting in Los Angeles, including the Fellows Symposia, and at the 2015 ISAKOS Biennial Congress in Lyon. Continuing, in 2014, the number of Level I evidence submissions is decreasing,10,11 continuing last year’s trend. This raises a number of issues, and results in more major change at the Green Journal. We will consider how to address this change below, but first we are proud to name the finalists of the 2014 Arthroscopy Journal Prize for Best Level I Evidence Study (Table 1).12-15 Before we announce the winner, we recognize one particular paper, a systematic review, by Harris et al., “Current Status of Evidence-Based Sports Medicine.”12 Harris et al. measure and report that Level I Evidence and randomized controlled trials are rare in contemporary sports medicine, and especially rare in Arthroscopy. This is in concordance with our finding above, that Level I evidence submissions are decreasing. This comes somewhat as a surprise, since we’ve been promoting Level I evidence since 2004.16 However, in the surgical subspecialties, we have to look beyond the level of evidence for now,10 because in order to determine the best methods for treating patients, other fundamental research methods, including comparative trials, case series, and expert opinion, inform our opinions.17-19 In fact, we have recognized and supported the importance of all levels of evidence since publicizing the importance of Level V evidence in 2006.20 At Arthroscopy, and in AANA, ISAKOS, and ISHA, we continue to always highly value and regard expert opinion from experienced authors. A risk of a decreasing number of Level I evidence submissions is that our Journal Prize for Level I evidence could become so restrictive as to miss some of the best or most clinically relevant articles published in the journal. Therefore, it is time for additional transformation. It was decided at our recent annual meeting of editors and associate editors that, starting in 2015, a major change is that we will open up the inclusion criteria for the Arthroscopy Journal Prize to comparative studies of Level I, or II, or III evidence. Clinically relevant comparative studies of Level I, II, and III evidence are all critical in determining a best method of treating patients
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 31, No 1 (January), 2015: pp 1-6
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EDITORIALS
Fig 1. Submissions statistics from 2004 to the present show a dramatic rise in submissions over the past several years, and particularly this year through November (red arrow). Most of the increase this year is original scientific articles.
in clinical practice, when comparing diverse treatment options. Examples of Level I studies include: Arthroscopic versus mini-open rotator cuff repair: An up-to-date meta-analysis of randomized controlled trials,21 and Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: A prospective randomized trial,22 and Surgeon-determined visualization in shoulder arthroscopy: A randomized, blinded, controlled trial comparing irrigation fluid with and without epinephrine.23 Table 1. The Four Level I Studies Published in 2014 in Arthroscopy Current Status of Evidence-Based Sports Medicine by Joshua D. Harris, Gregory Cvetanovich, Brandon J. Erickson, Geoffrey D. Abrams, Jaskarndip Chahal, Anil K. Gupta, Frank M. McCormick, and Bernard R. Bach Arthroscopy 2014;30:362-371. Efficacy of Periarticular Multimodal Drug Injection After Medial Opening-Wedge High Tibial Osteotomy: A Randomized Controlled Study by Woon-Hwa Jung, Ryohei Takeuchi, Chung-Woo Chun, Jung-Su Lee, Jae-Hun Ha, Ji-Hyae Kim, and Jae-Heon Jeong Arthroscopy 2014;30:1-8. Effect of Ultrasonographically Guided Axillary Nerve Block Combined With Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial by Jae Jun Lee, Do-Young Kim, JungTaek Hwang, Sang-Soo Lee, Sung Mi Hwang, Gi Ho Kim, and Yoon-Geol Jo Arthroscopy 2014;30:906-914. Warmed Irrigation Fluid Does Not Decrease Perioperative Hypothermia During Arthroscopic Shoulder Surgery by Joo Han Oh, Joon Yub Kim, Seok Won Chung, Ji Soon Park, Do Hun Kim, Sung Hoon Kim, and Mi Ja Yun Arthroscopy 2014;30:159-164.
Examples of Level II studies include: Platelet-rich plasma in arthroscopic rotator cuff repair: A meta-analysis of randomized controlled trials,24 and Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: A randomized controlled trial,25 and Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis,26 and Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: A cadaveric and prospective clinical observational study.27 Examples of Level III studies include: The association of tibial slope and anterior cruciate ligament rupture in skeletally immature patients,28 and Effect of femoral anteversion on clinical outcomes after hip arthroscopy,29 and Comparison of femoral tunnel geometry using an in vivo 3-dimensional computed tomography during transportal and outside-in single-bundle anterior cruciate ligament reconstruction techniques,30 and Validity, reproducibility and responsiveness of the Oxford Hip Score in patients undergoing surgery for femoroacetabular impingement.31 Your editors hope that readers find the cited examples to be clinically relevant, because all of these investigations are published in the January 2015 issue you are about to read. Our aim is to start the year productively, and we
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EDITORIALS
hope readers agree that with expansion of the prize, we are starting well, and in 2015 we expect a raised level of competition for the best study. It may be of additional interest to note that sometimes level of evidence is technically difficult or controversial to assign or determine, and sometimes authors or editors get it wrong. Harris et al. report that Level I evidence is rare. Therefore, it is ironic that Harris et al., published as a Level I study, may not be Level I after all. A concern regarding the level of evidence of Harris et al. is that the level of evidence chart16 includes footnotes stating that a Level I systematic review is to be based on a combination of the results of two or more prior studies that have consistent results. It is not enough to simply review Level I studies. The results of Harris et al. are not based on actual quantitative synthesis of the combined Level I results. Technically, as above, level of evidence can be difficult to assign. Finally, we congratulate the winner of the 2014 Arthroscopy Journal Prize for Best Level I Evidence Study: Effect of Ultrasonographically Guided Axillary Nerve Block Combined With Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial by Jae Jun Lee, Do-Young Kim, Jung-Taek Hwang, Sang-Soo Lee, Sung Mi Hwang, Gi Ho Kim, Yoon-Geol Jo.14 These investigators from Hallym University found that the effect of the combination of axillary nerve block with suprascapular nerve block is favorable. A major area of change in our field, but solidly rooted in the annals of Arthroscopy, is the growing interest in biologics. We have been paying close attention to biologics since at least 2008,32 but in 2014 we were surprised that rather suddenly, a leader among our “hot” topics, was platelet-rich plasma.33-39 We look forward to trials evaluating platelet-rich plasma for knee osteoarthritis, because knee arthritis is common, and in our travels, we have heard anecdotal descriptions of promising results. We invite authors investigating hot topics including, but not limited, to orthobiologics including plateletrich plasma, to please submit their research to Arthroscopy. What are the current hot topics? Those who wish to review one list can check out the September 2014 editorial, where we tabulated the top 20 Arthroscopy articles by number of citations in the last 5 years.40 We anticipate that platelet-rich plasma is just the tip of the biologics iceberg.41-43 We remain enticed by the prospect of orthopaedic tissue engineering44,45 using arthroscopic implantation, and our view is to keep an eye on the international picture. We continue to observe, with deference to caution and safety but with regret in support of rapid innovation, that the United States Food and Drug Administration
still restricts product development in orthopaedic biologics.42,46 We therefore invite international tissue engineers and cell biologists to submit articles sharing their cutting-edge research in orthobiologics development. Our resolution for the New Year is to continue to strive to improve by recruiting new reviewers, pursuing top authors, soliciting hot topics, and publishing the best submissions of all levels of evidence. In other words, we resolve to lead, during a time of change, by maintaining stability. As we enter our fourth decade, editors will carry on editing, authors will carry on writing, readers will carry on reading, and all of us will continue to make every effort toward advancing our field. In a world of disruptive innovation, our view is that our New Year’s resolution, diverse thoughts, and prescribed agenda represent an ambitious but balanced approach. James H. Lubowitz, M.D. Editor-in-Chief Matthew T. Provencher, M.D. Assistant Editor-in-Chief Jefferson C. Brand, M.D. Deputy Editor Michael J. Rossi, M.D. Deputy Editor
References 1. Lubowitz JH, Poehling GG. Old School: Arthroscopy’s 25th anniversary. Arthroscopy 2010;26:2-4. 2. Lubowitz JH, Provencher MT, Rossi MJ, Hackett HP, VanNoy DT. Gary G. Poehling, M.D., Editor-in-Chief Emeritus. Arthroscopy 2014;30:5. 3. Lubowitz JH, Provencher MT, Poehling GG. Journalism and the new social media. Arthroscopy 2013;29:1. 4. Lubowitz JH, Provencher MT, Poehling GG. Follow us on Twitter. Arthroscopy 2012;28:1747-1748. 5. Wetzler MJ. “I found it on the internet:” How reliable and readable is patient information? Arthroscopy 2013;29: 967-968. 6. Lubowitz JH, Provencher MT, Poehling GG. Our new journal: Arthroscopy Techniques. Arthroscopy 2012;28: 149-150. 7. Lubowitz JH, Provencher MT, Poehling GG. Arthroscopy Techniques: Aims and scope. Arthroscopy 2012;28:1. 8. Lubowitz JH, Provencher MT, Poehling GG. Arthroscopy Techniques achieves PubMed Central citation, yet knee and shoulder outcome failures represent a challenge, and a presidential address prepares us for adversity. Arthroscopy 2013;29:1461-1462. 9. Lubowitz JH, Provencher MT, Poehling GG. Looking forward and back: The value of arthroscopy, shoulder controversies, hip advancements, cartilage cutting edge, and Arthroscopy Techniques. Arthroscopy 2013;29:1897-1899. 10. Lubowitz JH, Provencher MT, Poehling GG. Arthroscopic and sports medicine science: Looking beyond the
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EDITORIALS level of evidence (for now). Arthroscopy 2014;30: 281-282. Lubowitz JH, Provencher MT, Poehling GG. Congratulations and condemnations: Level I evidence prize for femoral tunnel position in ACL reconstruction, and AAOS Clinical Practice Guidelines miss the markdAgain. Arthroscopy 2014;30:2-5. Harris JD, Cvetanovich G, Erickson BJ, et al. Current status of evidence-based sports medicine. Arthroscopy 2014;30:362-371. Jung W-H, Takeuchi R, Chun C-W, et al. Efficacy of periarticular multimodal drug injection after medial opening-wedge high tibial osteotomy: A randomized, controlled study. Arthroscopy 2014;30:1-8. Lee JJ, Kim D-Y, Hwang J-T, et al. Effect of ultrasonographically guided axillary nerve block combined with suprascapular nerve block in arthroscopic rotator cuff repair: A randomized controlled trial. Arthroscopy 2014;30: 906-914. Oh JH, Kim JY, Chung SW, et al. Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery. Arthroscopy 2014;30: 159-164. Lubowitz JH. Understanding evidence-based arthroscopy. Arthroscopy 2004;20:1-3. Lubowitz JH, Provencher MT, Poehling GG. Appropriate use criteria get orthopaedic sports medicine and arthroscopy back on track. Arthroscopy 2013;29:1125-1126. Lubowitz JH, Provencher MT, Poehling GG. Climbing the level of evidence ladder: Prospective, comparativeeffectiveness knee ACL and PCL research. Arthroscopy 2013;29:399-400. Lubowitz JH, McIntyre LF, Provencher MT, Poehling GG. AAOS Rotator Cuff Clinical Practice Guideline misses the mark. Arthroscopy 2012;28:589-592. Lubowitz JH. Introducing Level V evidence to Arthroscopy journal. Arthroscopy 2006;22:237. Xiaoxi Ji X, Chun Bi C, Fang Wang F, Qiugen Wang Q. Arthroscopic versus mini-open rotator cuff repair: An upto-date meta-analysis of randomized controlled trials. Arthroscopy 2015;31:118-124. Faunø PZ, Lund B, Christiansen SE, Gjøderum O, Lind M. Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: A prospective randomized trial. Arthroscopy 2015;31: 63-68. Avery D, Gibson B, Carolan G. Surgeon-rated visualization in shoulder arthroscopy: A randomized blinded controlled trial comparing irrigation fluid with and without epinephrine. Arthroscopy 2015;31:12-18. Zhao J-G, Zhao L, Jiang Y-X, Wang Z-L, Wang J, Zhang P. Platelet-rich plasma in arthroscopic rotator cuff repair: A meta-analysis of randomized controlled trials. Arthroscopy 2015;31:125-135. Koga H, Muneta T, Yagishita K, et al. Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: Randomized controlled trial. Arthroscopy 2015;31:69-76. Gilmer B, DeMers AM, Guerrero D, Reid JB, Lubowitz JH, Guttmann D. Arthroscopic versus open comparison of
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long head of biceps tendon visualization and pathology in patients requiring tenodesis. Arthroscopy 2015;31:29-34. Yoo JC, Rhee YG, Shin SJ, et al. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: A cadaveric and prospective clinical observational study. Arthroscopy 2015;31:19-28. O’Malley MP, Milewski M, Solomito M, Erwteman A, Nissen C. The association of tibial slope and anterior cruciate ligament rupture in skeletally immature patients. Arthroscopy 2015;31:77-82. Jackson TJ, El Bitar YF, Lindner D, Domb BG. Effect of femoral anteversion on clinical outcomes after hip arthroscopy. Arthroscopy 2015;31:35-41. Park JS, Park JH, Wang JH, et al. Comparison of femoral tunnel geometry using an in vivo 3-dimensional computed tomography during transportal and outside-in singlebundle anterior cruciate ligament reconstruction techniques. Arthroscopy 2015;31:83-91. Impellizzeri FM, Mannion AF, Naal FD, Leunig M. Validity, reproducibility and responsiveness of the Oxford Hip Score in patients undergoing surgery for femoroacetabular impingement. Arthroscopy 2015;31:42-50. Lubowitz JH, Poehling GG. Don’t know much biology: Redux. Arthroscopy 2008;24:127-129. Dragoo J, Braun H, Kim HJ, Chu C. The effect of platelet rich plasma formulations and blood products on human synoviocytes. Arthroscopy 2014;30:e34 (suppl, abstr SS-64). Smyth N, Ross K, Haleem A, et al. The effect of platelet rich plasma and hyaluronic acid on autologous osteochondral transplantation: An in vivo rabbit model. Arthroscopy 2014;30:e29 (suppl, abstr SS-54). Magalon J, Bausset O, Serratrice N, et al. Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy 2014;3: 629-638. Beitzel K, McCarthy MB, Cote MP, et al. Properties of biologic scaffolds and their response to mesenchymal stem cells. Arthroscopy 2014;30:289-298. Kaniki N, Willits K, Mohtadi NGH, Fung V, Bryant D. A retrospective comparative study with historical control to determine the effectiveness of platelet-rich plasma as part of nonoperative treatment of acute achilles tendon rupture. Arthroscopy 2014;30: 1139-1145. Charousset C, Zaoui A, Bellaïche L, Piterman M. Does autologous leukocyte-plateleterich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears? Arthroscopy 2014;30: 428-435. Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J. Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: A prospective study. Arthroscopy 2014;30:1453-1460. Lubowitz JH, Provencher MT, Rossi MJ, Brand JC. The fall classic. Arthroscopy 2014;30:1045-1048. Lubowitz JH, Provencher MT, Poehling GG. Cartilage treatment and biologics current research. Arthroscopy 2013;29:1597-1598.
EDITORIALS 42. Lubowitz JH, Provencher MT, Poehling GG. Stem cells in the knee. Arthroscopy 2013;29:609-610. 43. Lubowitz JH, Provencher MT, Poehling GG. Stem cells in arthroscopy. Arthroscopy 2012;28:891-892. 44. Lubowitz JH, Poehling GG. Saving our cells: advances in tissue engineering for focal cartilage defects. Arthroscopy 2009;25:115-116.
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45. Lubowitz JH, Poehling GG. Tissue engineering: A call for manuscripts. Arthroscopy 2008;24:623-624. 46. Lubowitz JH, Provencher MT, Poehling GG. ISAKOS Upper Extremity Committee shoulder rotator cuff consensus, plus chondrocyte implantation and ACL systematic reviews. Arthroscopy 2013;29: 1733-1734.
Aman Dhawan, M.D., Associate Editor
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lease join me in welcoming Dr. Aman Dhawan to our Arthroscopy editorial team. He replaces Vipool K. Goradia who has completed his term. Aman is an Assistant Professor in the Department of Orthopaedics and Rehabilitation at Penn State College of Medicine and Penn State Hershey Bone and Joint Institute. He earned his bachelor’s of science degree at Union College in New York and graduated from Albany Medical College. He completed his residency in orthopaedic surgery at Walter Reed Army Medical Center and then a Sports Medicine and Shoulder Surgery Fellowship at Rush University Medical Center. In 2008 Aman was selected for the AANA Advanced Arthroscopy Traveling Fellowship. He was an active duty officer in the U.S. Army for 11 years, which included deployment to Iraq during Operation Iraqi Freedom in 2006.
Dr. Dhawan began reviewing for Arthroscopy in 2008 and was appointed to the Editorial Board in 2011. He is an Associate Team Physician for the AHL Hershey Bears and the Double A Harrisburg Senators baseball team, as well as several other area colleges and high schools. He is actively involved in research and his main interests include biomechanics and mechanobiology of soft tissue fixation to bone. He serves on several committees including the AANA Research Committee, AOSSM Self Assessment Committee, and AOA 2015 Emerging Leaders Program Webinar Workgroup. He lives in Hummelstown, Pennsylvania with his wife Denise and their children Ryan, Alexis, Lauren, and Caitlin. Aman enjoys playing golf and recently developed a passion for the noble sport of croquet.
Ó 2015 by the Arthroscopy Association of North America 0749-8063/14887/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.10.004
James H. Lubowitz, M.D. Editor-in-Chief
Erik Hohmann, M.D., Ph.D., Associate Editor
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am very pleased to announce that Dr. Erik Hohmann of Rockhampton, Australia, has been appointed an Associate Editor of Arthroscopy, replacing Dr. Jae Chul Yoo who has completed his term. Erik is a Consultant Orthopaedic and Trauma Surgeon and Senior Staff Specialist at Rockhampton Hospital. He holds two academic posts: Associate Professor of Orthopaedic Surgery, Division of Surgery, University of Queensland Medical School; and Professor, School of Medical and Applied Sciences, Central Queensland University. Dr. Hohmann completed his undergraduate and medical school in his native Germany at Johann Wolfgang Goethe University in Frankfort. He earned his medical doctorate at the Department of Orthopaedic Ó 2015 by the Arthroscopy Association of North America 0749-8063/14888/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.10.003
Sports Medicine, University Technology of Munich, and his Doctorate of Philosophy at Queensland Central University. He did his internship and residency at the University of the Witwatersrand, Johannesburg, South Africa, as well as two Fellowships, in orthopaedic sports medicine in Munich with Andreas Imhoff, and shoulder surgery in Heidelberg. Erik is Board Certified as an orthopaedic surgeon, a sports physician, and a trauma surgeon. Somehow Erik has also found the time to be a triathlon and marathon runner and compete at an international level in karate. He has reviewed for Arthroscopy since 2007, joining the Editorial Board in 2009. Please join me in welcoming Erik Hohmann to our editorial team. James H. Lubowitz, M.D. Editor-in-Chief
Thirty Years Brings Major Change
H
appy New Year. We hang a banner to celebrate our 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 25th Anniversary.”1 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.2 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.3-5 Our solution is Arthroscopy Techniques,6-9 and we have dedicated 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. We are optimistic that once we launch the new platform, the enriched utility of Arthroscopy Techniques will 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 to Arthroscopy 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 Ó 2015 by the Arthroscopy Association of North America 0749-8063/14942/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.11.007
specialty interests. We ask Fellowship Directors to please encourage their Fellows, who will now be eligible to join AANA as Resident/Fellow members. Arthroscopy journal editors will be recruiting reviewers and presenting top tips for writers and reviewers at the 2015 AANA Annual Meeting in Los Angeles, including the Fellows Symposia, and at the 2015 ISAKOS Biennial Congress in Lyon. Continuing, in 2014, the number of Level I evidence submissions is decreasing,10,11 continuing last year’s trend. This raises a number of issues, and results in more major change at the Green Journal. We will consider how to address this change below, but first we are proud to name the finalists of the 2014 Arthroscopy Journal Prize for Best Level I Evidence Study (Table 1).12-15 Before we announce the winner, we recognize one particular paper, a systematic review, by Harris et al., “Current Status of Evidence-Based Sports Medicine.”12 Harris et al. measure and report that Level I Evidence and randomized controlled trials are rare in contemporary sports medicine, and especially rare in Arthroscopy. This is in concordance with our finding above, that Level I evidence submissions are decreasing. This comes somewhat as a surprise, since we’ve been promoting Level I evidence since 2004.16 However, in the surgical subspecialties, we have to look beyond the level of evidence for now,10 because in order to determine the best methods for treating patients, other fundamental research methods, including comparative trials, case series, and expert opinion, inform our opinions.17-19 In fact, we have recognized and supported the importance of all levels of evidence since publicizing the importance of Level V evidence in 2006.20 At Arthroscopy, and in AANA, ISAKOS, and ISHA, we continue to always highly value and regard expert opinion from experienced authors. A risk of a decreasing number of Level I evidence submissions is that our Journal Prize for Level I evidence could become so restrictive as to miss some of the best or most clinically relevant articles published in the journal. Therefore, it is time for additional transformation. It was decided at our recent annual meeting of editors and associate editors that, starting in 2015, a major change is that we will open up the inclusion criteria for the Arthroscopy Journal Prize to comparative studies of Level I, or II, or III evidence. Clinically relevant comparative studies of Level I, II, and III evidence are all critical in determining a best method of treating patients
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 31, No 1 (January), 2015: pp 1-6
1
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EDITORIALS
Fig 1. Submissions statistics from 2004 to the present show a dramatic rise in submissions over the past several years, and particularly this year through November (red arrow). Most of the increase this year is original scientific articles.
in clinical practice, when comparing diverse treatment options. Examples of Level I studies include: Arthroscopic versus mini-open rotator cuff repair: An up-to-date meta-analysis of randomized controlled trials,21 and Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: A prospective randomized trial,22 and Surgeon-determined visualization in shoulder arthroscopy: A randomized, blinded, controlled trial comparing irrigation fluid with and without epinephrine.23 Table 1. The Four Level I Studies Published in 2014 in Arthroscopy Current Status of Evidence-Based Sports Medicine by Joshua D. Harris, Gregory Cvetanovich, Brandon J. Erickson, Geoffrey D. Abrams, Jaskarndip Chahal, Anil K. Gupta, Frank M. McCormick, and Bernard R. Bach Arthroscopy 2014;30:362-371. Efficacy of Periarticular Multimodal Drug Injection After Medial Opening-Wedge High Tibial Osteotomy: A Randomized Controlled Study by Woon-Hwa Jung, Ryohei Takeuchi, Chung-Woo Chun, Jung-Su Lee, Jae-Hun Ha, Ji-Hyae Kim, and Jae-Heon Jeong Arthroscopy 2014;30:1-8. Effect of Ultrasonographically Guided Axillary Nerve Block Combined With Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial by Jae Jun Lee, Do-Young Kim, JungTaek Hwang, Sang-Soo Lee, Sung Mi Hwang, Gi Ho Kim, and Yoon-Geol Jo Arthroscopy 2014;30:906-914. Warmed Irrigation Fluid Does Not Decrease Perioperative Hypothermia During Arthroscopic Shoulder Surgery by Joo Han Oh, Joon Yub Kim, Seok Won Chung, Ji Soon Park, Do Hun Kim, Sung Hoon Kim, and Mi Ja Yun Arthroscopy 2014;30:159-164.
Examples of Level II studies include: Platelet-rich plasma in arthroscopic rotator cuff repair: A meta-analysis of randomized controlled trials,24 and Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: A randomized controlled trial,25 and Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis,26 and Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: A cadaveric and prospective clinical observational study.27 Examples of Level III studies include: The association of tibial slope and anterior cruciate ligament rupture in skeletally immature patients,28 and Effect of femoral anteversion on clinical outcomes after hip arthroscopy,29 and Comparison of femoral tunnel geometry using an in vivo 3-dimensional computed tomography during transportal and outside-in single-bundle anterior cruciate ligament reconstruction techniques,30 and Validity, reproducibility and responsiveness of the Oxford Hip Score in patients undergoing surgery for femoroacetabular impingement.31 Your editors hope that readers find the cited examples to be clinically relevant, because all of these investigations are published in the January 2015 issue you are about to read. Our aim is to start the year productively, and we
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EDITORIALS
hope readers agree that with expansion of the prize, we are starting well, and in 2015 we expect a raised level of competition for the best study. It may be of additional interest to note that sometimes level of evidence is technically difficult or controversial to assign or determine, and sometimes authors or editors get it wrong. Harris et al. report that Level I evidence is rare. Therefore, it is ironic that Harris et al., published as a Level I study, may not be Level I after all. A concern regarding the level of evidence of Harris et al. is that the level of evidence chart16 includes footnotes stating that a Level I systematic review is to be based on a combination of the results of two or more prior studies that have consistent results. It is not enough to simply review Level I studies. The results of Harris et al. are not based on actual quantitative synthesis of the combined Level I results. Technically, as above, level of evidence can be difficult to assign. Finally, we congratulate the winner of the 2014 Arthroscopy Journal Prize for Best Level I Evidence Study: Effect of Ultrasonographically Guided Axillary Nerve Block Combined With Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial by Jae Jun Lee, Do-Young Kim, Jung-Taek Hwang, Sang-Soo Lee, Sung Mi Hwang, Gi Ho Kim, Yoon-Geol Jo.14 These investigators from Hallym University found that the effect of the combination of axillary nerve block with suprascapular nerve block is favorable. A major area of change in our field, but solidly rooted in the annals of Arthroscopy, is the growing interest in biologics. We have been paying close attention to biologics since at least 2008,32 but in 2014 we were surprised that rather suddenly, a leader among our “hot” topics, was platelet-rich plasma.33-39 We look forward to trials evaluating platelet-rich plasma for knee osteoarthritis, because knee arthritis is common, and in our travels, we have heard anecdotal descriptions of promising results. We invite authors investigating hot topics including, but not limited, to orthobiologics including plateletrich plasma, to please submit their research to Arthroscopy. What are the current hot topics? Those who wish to review one list can check out the September 2014 editorial, where we tabulated the top 20 Arthroscopy articles by number of citations in the last 5 years.40 We anticipate that platelet-rich plasma is just the tip of the biologics iceberg.41-43 We remain enticed by the prospect of orthopaedic tissue engineering44,45 using arthroscopic implantation, and our view is to keep an eye on the international picture. We continue to observe, with deference to caution and safety but with regret in support of rapid innovation, that the United States Food and Drug Administration
still restricts product development in orthopaedic biologics.42,46 We therefore invite international tissue engineers and cell biologists to submit articles sharing their cutting-edge research in orthobiologics development. Our resolution for the New Year is to continue to strive to improve by recruiting new reviewers, pursuing top authors, soliciting hot topics, and publishing the best submissions of all levels of evidence. In other words, we resolve to lead, during a time of change, by maintaining stability. As we enter our fourth decade, editors will carry on editing, authors will carry on writing, readers will carry on reading, and all of us will continue to make every effort toward advancing our field. In a world of disruptive innovation, our view is that our New Year’s resolution, diverse thoughts, and prescribed agenda represent an ambitious but balanced approach. James H. Lubowitz, M.D. Editor-in-Chief Matthew T. Provencher, M.D. Assistant Editor-in-Chief Jefferson C. Brand, M.D. Deputy Editor Michael J. Rossi, M.D. Deputy Editor
References 1. Lubowitz JH, Poehling GG. Old School: Arthroscopy’s 25th anniversary. Arthroscopy 2010;26:2-4. 2. Lubowitz JH, Provencher MT, Rossi MJ, Hackett HP, VanNoy DT. Gary G. Poehling, M.D., Editor-in-Chief Emeritus. Arthroscopy 2014;30:5. 3. Lubowitz JH, Provencher MT, Poehling GG. Journalism and the new social media. Arthroscopy 2013;29:1. 4. Lubowitz JH, Provencher MT, Poehling GG. Follow us on Twitter. Arthroscopy 2012;28:1747-1748. 5. Wetzler MJ. “I found it on the internet:” How reliable and readable is patient information? Arthroscopy 2013;29: 967-968. 6. Lubowitz JH, Provencher MT, Poehling GG. Our new journal: Arthroscopy Techniques. Arthroscopy 2012;28: 149-150. 7. Lubowitz JH, Provencher MT, Poehling GG. Arthroscopy Techniques: Aims and scope. Arthroscopy 2012;28:1. 8. Lubowitz JH, Provencher MT, Poehling GG. Arthroscopy Techniques achieves PubMed Central citation, yet knee and shoulder outcome failures represent a challenge, and a presidential address prepares us for adversity. Arthroscopy 2013;29:1461-1462. 9. Lubowitz JH, Provencher MT, Poehling GG. Looking forward and back: The value of arthroscopy, shoulder controversies, hip advancements, cartilage cutting edge, and Arthroscopy Techniques. Arthroscopy 2013;29:1897-1899. 10. Lubowitz JH, Provencher MT, Poehling GG. Arthroscopic and sports medicine science: Looking beyond the
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EDITORIALS level of evidence (for now). Arthroscopy 2014;30: 281-282. Lubowitz JH, Provencher MT, Poehling GG. Congratulations and condemnations: Level I evidence prize for femoral tunnel position in ACL reconstruction, and AAOS Clinical Practice Guidelines miss the markdAgain. Arthroscopy 2014;30:2-5. Harris JD, Cvetanovich G, Erickson BJ, et al. Current status of evidence-based sports medicine. Arthroscopy 2014;30:362-371. Jung W-H, Takeuchi R, Chun C-W, et al. Efficacy of periarticular multimodal drug injection after medial opening-wedge high tibial osteotomy: A randomized, controlled study. Arthroscopy 2014;30:1-8. Lee JJ, Kim D-Y, Hwang J-T, et al. Effect of ultrasonographically guided axillary nerve block combined with suprascapular nerve block in arthroscopic rotator cuff repair: A randomized controlled trial. Arthroscopy 2014;30: 906-914. Oh JH, Kim JY, Chung SW, et al. Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery. Arthroscopy 2014;30: 159-164. Lubowitz JH. Understanding evidence-based arthroscopy. Arthroscopy 2004;20:1-3. Lubowitz JH, Provencher MT, Poehling GG. Appropriate use criteria get orthopaedic sports medicine and arthroscopy back on track. Arthroscopy 2013;29:1125-1126. Lubowitz JH, Provencher MT, Poehling GG. Climbing the level of evidence ladder: Prospective, comparativeeffectiveness knee ACL and PCL research. Arthroscopy 2013;29:399-400. Lubowitz JH, McIntyre LF, Provencher MT, Poehling GG. AAOS Rotator Cuff Clinical Practice Guideline misses the mark. Arthroscopy 2012;28:589-592. Lubowitz JH. Introducing Level V evidence to Arthroscopy journal. Arthroscopy 2006;22:237. Xiaoxi Ji X, Chun Bi C, Fang Wang F, Qiugen Wang Q. Arthroscopic versus mini-open rotator cuff repair: An upto-date meta-analysis of randomized controlled trials. Arthroscopy 2015;31:118-124. Faunø PZ, Lund B, Christiansen SE, Gjøderum O, Lind M. Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: A prospective randomized trial. Arthroscopy 2015;31: 63-68. Avery D, Gibson B, Carolan G. Surgeon-rated visualization in shoulder arthroscopy: A randomized blinded controlled trial comparing irrigation fluid with and without epinephrine. Arthroscopy 2015;31:12-18. Zhao J-G, Zhao L, Jiang Y-X, Wang Z-L, Wang J, Zhang P. Platelet-rich plasma in arthroscopic rotator cuff repair: A meta-analysis of randomized controlled trials. Arthroscopy 2015;31:125-135. Koga H, Muneta T, Yagishita K, et al. Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: Randomized controlled trial. Arthroscopy 2015;31:69-76. Gilmer B, DeMers AM, Guerrero D, Reid JB, Lubowitz JH, Guttmann D. Arthroscopic versus open comparison of
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long head of biceps tendon visualization and pathology in patients requiring tenodesis. Arthroscopy 2015;31:29-34. Yoo JC, Rhee YG, Shin SJ, et al. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: A cadaveric and prospective clinical observational study. Arthroscopy 2015;31:19-28. O’Malley MP, Milewski M, Solomito M, Erwteman A, Nissen C. The association of tibial slope and anterior cruciate ligament rupture in skeletally immature patients. Arthroscopy 2015;31:77-82. Jackson TJ, El Bitar YF, Lindner D, Domb BG. Effect of femoral anteversion on clinical outcomes after hip arthroscopy. Arthroscopy 2015;31:35-41. Park JS, Park JH, Wang JH, et al. Comparison of femoral tunnel geometry using an in vivo 3-dimensional computed tomography during transportal and outside-in singlebundle anterior cruciate ligament reconstruction techniques. Arthroscopy 2015;31:83-91. Impellizzeri FM, Mannion AF, Naal FD, Leunig M. Validity, reproducibility and responsiveness of the Oxford Hip Score in patients undergoing surgery for femoroacetabular impingement. Arthroscopy 2015;31:42-50. Lubowitz JH, Poehling GG. Don’t know much biology: Redux. Arthroscopy 2008;24:127-129. Dragoo J, Braun H, Kim HJ, Chu C. The effect of platelet rich plasma formulations and blood products on human synoviocytes. Arthroscopy 2014;30:e34 (suppl, abstr SS-64). Smyth N, Ross K, Haleem A, et al. The effect of platelet rich plasma and hyaluronic acid on autologous osteochondral transplantation: An in vivo rabbit model. Arthroscopy 2014;30:e29 (suppl, abstr SS-54). Magalon J, Bausset O, Serratrice N, et al. Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy 2014;3: 629-638. Beitzel K, McCarthy MB, Cote MP, et al. Properties of biologic scaffolds and their response to mesenchymal stem cells. Arthroscopy 2014;30:289-298. Kaniki N, Willits K, Mohtadi NGH, Fung V, Bryant D. A retrospective comparative study with historical control to determine the effectiveness of platelet-rich plasma as part of nonoperative treatment of acute achilles tendon rupture. Arthroscopy 2014;30: 1139-1145. Charousset C, Zaoui A, Bellaïche L, Piterman M. Does autologous leukocyte-plateleterich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears? Arthroscopy 2014;30: 428-435. Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J. Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: A prospective study. Arthroscopy 2014;30:1453-1460. Lubowitz JH, Provencher MT, Rossi MJ, Brand JC. The fall classic. Arthroscopy 2014;30:1045-1048. Lubowitz JH, Provencher MT, Poehling GG. Cartilage treatment and biologics current research. Arthroscopy 2013;29:1597-1598.
EDITORIALS 42. Lubowitz JH, Provencher MT, Poehling GG. Stem cells in the knee. Arthroscopy 2013;29:609-610. 43. Lubowitz JH, Provencher MT, Poehling GG. Stem cells in arthroscopy. Arthroscopy 2012;28:891-892. 44. Lubowitz JH, Poehling GG. Saving our cells: advances in tissue engineering for focal cartilage defects. Arthroscopy 2009;25:115-116.
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45. Lubowitz JH, Poehling GG. Tissue engineering: A call for manuscripts. Arthroscopy 2008;24:623-624. 46. Lubowitz JH, Provencher MT, Poehling GG. ISAKOS Upper Extremity Committee shoulder rotator cuff consensus, plus chondrocyte implantation and ACL systematic reviews. Arthroscopy 2013;29: 1733-1734.
Aman Dhawan, M.D., Associate Editor
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lease join me in welcoming Dr. Aman Dhawan to our Arthroscopy editorial team. He replaces Vipool K. Goradia who has completed his term. Aman is an Assistant Professor in the Department of Orthopaedics and Rehabilitation at Penn State College of Medicine and Penn State Hershey Bone and Joint Institute. He earned his bachelor’s of science degree at Union College in New York and graduated from Albany Medical College. He completed his residency in orthopaedic surgery at Walter Reed Army Medical Center and then a Sports Medicine and Shoulder Surgery Fellowship at Rush University Medical Center. In 2008 Aman was selected for the AANA Advanced Arthroscopy Traveling Fellowship. He was an active duty officer in the U.S. Army for 11 years, which included deployment to Iraq during Operation Iraqi Freedom in 2006.
Dr. Dhawan began reviewing for Arthroscopy in 2008 and was appointed to the Editorial Board in 2011. He is an Associate Team Physician for the AHL Hershey Bears and the Double A Harrisburg Senators baseball team, as well as several other area colleges and high schools. He is actively involved in research and his main interests include biomechanics and mechanobiology of soft tissue fixation to bone. He serves on several committees including the AANA Research Committee, AOSSM Self Assessment Committee, and AOA 2015 Emerging Leaders Program Webinar Workgroup. He lives in Hummelstown, Pennsylvania with his wife Denise and their children Ryan, Alexis, Lauren, and Caitlin. Aman enjoys playing golf and recently developed a passion for the noble sport of croquet.
Ó 2015 by the Arthroscopy Association of North America 0749-8063/14887/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.10.004
James H. Lubowitz, M.D. Editor-in-Chief
Erik Hohmann, M.D., Ph.D., Associate Editor
I
am very pleased to announce that Dr. Erik Hohmann of Rockhampton, Australia, has been appointed an Associate Editor of Arthroscopy, replacing Dr. Jae Chul Yoo who has completed his term. Erik is a Consultant Orthopaedic and Trauma Surgeon and Senior Staff Specialist at Rockhampton Hospital. He holds two academic posts: Associate Professor of Orthopaedic Surgery, Division of Surgery, University of Queensland Medical School; and Professor, School of Medical and Applied Sciences, Central Queensland University. Dr. Hohmann completed his undergraduate and medical school in his native Germany at Johann Wolfgang Goethe University in Frankfort. He earned his medical doctorate at the Department of Orthopaedic Ó 2015 by the Arthroscopy Association of North America 0749-8063/14888/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.10.003
Sports Medicine, University Technology of Munich, and his Doctorate of Philosophy at Queensland Central University. He did his internship and residency at the University of the Witwatersrand, Johannesburg, South Africa, as well as two Fellowships, in orthopaedic sports medicine in Munich with Andreas Imhoff, and shoulder surgery in Heidelberg. Erik is Board Certified as an orthopaedic surgeon, a sports physician, and a trauma surgeon. Somehow Erik has also found the time to be a triathlon and marathon runner and compete at an international level in karate. He has reviewed for Arthroscopy since 2007, joining the Editorial Board in 2009. Please join me in welcoming Erik Hohmann to our editorial team. James H. Lubowitz, M.D. Editor-in-Chief
