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Siegel MG, Rossi MJ, Lubowitz JH. Artificial Intelligence and Machine Learning May Resolve Health Care Information Overload. Arthroscopy 2024; 40:1721-1723. [PMID: 38218231 DOI: 10.1016/j.arthro.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
Biomedical information doubles almost every 2 months, and this very rate is expected to double by 2025. The result is information overload for clinicians and researchers. Today, artificial intelligence (AI) and machine learning (ML) research contribute to the deluge of information. In addition, AI large language models, although capable of automating scientific writing, are flawed. They hallucinate (make things up), are trained primarily on non-peer-reviewed content, raise ethical and legal issues, and lack human empathy. Still, when it comes to AI including ML, we are optimistic. The technology is improving rapidly. In the future, AI will help us manage unwieldy information by processing data, determining diagnoses, recommending treatments, and predicting outcomes. In research, AI and ML similarly promise efficient data analysis and literature review and will create new content in response to our instructions. Human touch will be required, and we will disclose use of AI proactively, including rationale for its use, our data input, our level of confidence in the output, and the patients or populations to whom the output may be applied. In addition, we will ensure data quality is high and bias is minimized. Most of all, we will provide essential reasoning, clinical and research guidance, and diligent oversight. Humans will remain accountable.
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Korolev AV, Afanasyev AP, Il'in DO, Gerasimov DO, Ryazantsev MS, Kadantsev PM, Zaripov AR. [Damage of the knee posterior cruciate ligament: biomechanics, basic diagnostics, treatment and secondary osteoarthritis prevention directions]. Khirurgiia (Mosk) 2020:130-136. [PMID: 33030014 DOI: 10.17116/hirurgia2020091130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The analysis of literature data was performed on the pathogenesis, diagnosis and treatment of injuries of the posterior cruciate ligament (PCL) of the knee joint. PCL is the largest intra-articular ligament of the knee joint, can withstand the maximum loads compared with other ligaments. It was noted that, in general, in cases of damage to the PCL, it is necessary to use a set of diagnostic methods, and the basic principles for the choice of optimal treatment plan for this patient. It considered the results of the conservative treatment of PCL partial ruptures, and it is indicated that this approach increases the risk of degenerative anatomical structures and functional disorders of the joint. It was noted that it is advisable to conduct surgical treatment to restore the stability of the knee joint and normalize function, while a number of methods for the reconstruction of PCL have been proposed to date. The usage of chondroprotectors for prevention of the secondary osteoarthrosis of the knee joint affected by posterior cruciate ligament rupture was analyzed in the literature data.
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Affiliation(s)
- A V Korolev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
- Peoples Friendship University of Russia, Moscow, Russia
| | - A P Afanasyev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - D O Il'in
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - D O Gerasimov
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - M S Ryazantsev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - P M Kadantsev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
- Peoples Friendship University of Russia, Moscow, Russia
| | - A R Zaripov
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
- Peoples Friendship University of Russia, Moscow, Russia
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Houck DA, Kraeutler MJ, Belk JW, Goode JA, Mulcahey MK, Bravman JT. Primary Arthroscopic Repair of the Anterior Cruciate Ligament: A Systematic Review of Clinical Outcomes. Arthroscopy 2019; 35:3318-3327. [PMID: 31785765 DOI: 10.1016/j.arthro.2019.06.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the clinical outcomes after primary arthroscopic anterior cruciate ligament (ACL) repair. METHODS A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the PRISMA guidelines. All English-language literature published from 2000 to 2018 that reported the clinical outcomes after primary arthroscopic repair (AR) of complete tear of the ACL (without augmentation) with a minimum 2-year follow-up was reviewed by 2 independent reviewers. Outcomes included repair failure, reoperation, postoperative knee stability, and patient-reported outcomes. Descriptive statistics are presented. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Nonrandomized Studies (MINORS) score. RESULTS Six studies (2 level III, 4 level IV) were included. The mean MCMS was 62.2. The mean MINORS score for noncomparative studies was 11.8, and for comparative studies, 18. Six studies reported outcomes of 89 patients who underwent AR of the ACL from 2007 to 2016 (age, 8 to 67 years; follow-up, 24 to 110 months). All 6 studies included exclusively proximal avulsion tears. Overall, 0% to 25.0% of patients experienced repair failure (I2 = 23.7%; 95% confidence interval, 0% to 67.6%), and 0% to 20.0% of patients had a subsequent reoperation (I2 = 12.1%; 95% confidence interval, 0% to 77.7%). Similar inconsistent results were shown for postoperative knee stability measures and patient-reported outcomes. CONCLUSIONS The literature on clinical outcomes of primary arthroscopic ACL repair is limited. The reported rates of repair failure and reoperation are highly inconsistent. Most studies report relatively high failure rates. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
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Affiliation(s)
- Darby A Houck
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A..
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, New Jersey, U.S.A
| | - John W Belk
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Joshua A Goode
- Department of Sociology, Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, U.S.A
| | - Mary K Mulcahey
- Department of Orthopedics, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Cote MP, Lubowitz JH, Rossi MJ, Brand JC. Reviews Pooling Heterogeneous, Low-Evidence, High-Bias Data Result in Incorrect Conclusions: But Heterogeneity is an Opportunity to Explore. Arthroscopy 2018; 34:3126-3128. [PMID: 30509420 DOI: 10.1016/j.arthro.2018.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023]
Abstract
Systematic Review submissions to our journal commonly pool heterogeneous studies of low levels of evidence and a high risk of bias. Pooling, or quantitative synthesis, of such study data regularly results in incorrect conclusions. We reject these submissions without peer-review (desk rejection), and typically invite authors to submit a new, subjective synthesis without pooling and to report ranges of the results of included studies rather than pooled values. Generally, quantitative synthesis, or meta-analysis, should restrict included studies to randomized controlled trials. However, systematic review with exploration of heterogeneity can result in valuable information toward determining strengths and deficiencies of current literature, and thus guide future research.
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Siegel MG, Brand JC, Rossi MJ, Lubowitz JH. "Publish or Perish" Promotes Medical Literature Quantity Over Quality. Arthroscopy 2018; 34:2941-2942. [PMID: 30392678 DOI: 10.1016/j.arthro.2018.08.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
When it comes to medical research, incentives align to promote "publish or perish." This results in quantity over quality. A solution is to change the goal of medical scientist and clinician training from bolstering a curriculum vitae to mastering scientific research methods. In addition, the metric for scholarly authorship should be quality, for which validated measurement tools exist, rather than number of publications.
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Editorial Commentary: Hype, Hope and Everything in Between. What Produces the Real Effect for Blood-derived Products Including Platelet-Rich Plasma? Arthroscopy 2018; 34:1976-1978. [PMID: 29804615 DOI: 10.1016/j.arthro.2018.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 02/02/2023]
Abstract
Biological approaches have a promising future in the orthopaedic field because of their potential benefits that include their minimal invasiveness, potential for accelerated healing, and promise for rapid recovery. However, as the initial hype for these therapies starts to fade, it should be replaced by solid basic and clinical science research to tailor each compound to a determined patient/pathology. Blood contains several products that can be both beneficial and detrimental for every specific tissue, and therefore a one-fits-all approach should be avoided. Although beneficial effects have been consistently reported for certain pathologies such as lateral elbow tendinopathy, as an adjunct for rotator cuff repairs and the symptomatic treatment of osteoarthritis, other conditions' outcomes with biologic treatment remain nebulous such as for Achilles tendinopathy. To determine the real effect of these therapies, it is important to maintain strict inclusion criteria in an attempt to isolate the effect of one biologic product that already has many inherent intrinsic variables per se.
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Where Do Arthroscopy Editors Stand on Systematic Reviews of the Literature? Arthroscopy 2017; 33:1753-1754. [PMID: 28969810 DOI: 10.1016/j.arthro.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Abstract
Systematic reviews seem overly prevalent and often inconclusive. Yet, well-performed reviews provide powerful answers to clinical questions, whereas the results of a single clinical trial may not be reliably reproducible. Thus, in balance, we rest highly in favor of rigorously performed synthetic studies that stand at the top of the evidence-based medicine hierarchy.
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Harris JD, Brand JC, Cote MP, Dhawan A. Research Pearls: The Significance of Statistics and Perils of Pooling. Part 3: Pearls and Pitfalls of Meta-analyses and Systematic Reviews. Arthroscopy 2017; 33:1594-1602. [PMID: 28457677 DOI: 10.1016/j.arthro.2017.01.055] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 02/02/2023]
Abstract
Within the health care environment, there has been a recent and appropriate trend towards emphasizing the value of care provision. Reduced cost and higher quality improve the value of care. Quality is a challenging, heterogeneous, variably defined concept. At the core of quality is the patient's outcome, quantified by a vast assortment of subjective and objective outcome measures. There has been a recent evolution towards evidence-based medicine in health care, clearly elucidating the role of high-quality evidence across groups of patients and studies. Synthetic studies, such as systematic reviews and meta-analyses, are at the top of the evidence-based medicine hierarchy. Thus, these investigations may be the best potential source of guiding diagnostic, therapeutic, prognostic, and economic medical decision making. Systematic reviews critically appraise and synthesize the best available evidence to provide a conclusion statement (a "take-home point") in response to a specific answerable clinical question. A meta-analysis uses statistical methods to quantitatively combine data from single studies. Meta-analyses should be performed with high methodological quality homogenous studies (Level I or II) or evidence randomized studies, to minimize confounding variable bias. When it is known that the literature is inadequate or a recent systematic review has already been performed with a demonstration of insufficient data, then a new systematic review does not add anything meaningful to the literature. PROSPERO registration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines assist authors in the design and conduct of systematic reviews and should always be used. Complete transparency of the conduct of the review permits reproducibility and improves fidelity of the conclusions. Pooling of data from overly dissimilar investigations should be avoided. This particularly applies to Level IV evidence, that is, noncomparative investigations. With proper technique, systematic reviews and meta-analyses have the potential to be powerful investigations that efficiently assist clinicians in decision making.
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Affiliation(s)
- Joshua D Harris
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, U.S.A..
| | | | - Mark P Cote
- UConn Musculoskeletal Institute, Human Soft Tissue Research Laboratory, UConn Health, Farmington, Connecticut, U.S.A
| | - Aman Dhawan
- Penn State Hershey Bone and Joint Institute, Hershey, Pennsylvania, U.S.A
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Dhawan A, Brand JC, Provencher MT, Rossi MJ, Lubowitz JH. Research Pearls: The Significance of Statistics and Perils of Pooling. Arthroscopy 2017; 33:1099-1101. [PMID: 28578761 DOI: 10.1016/j.arthro.2017.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 02/02/2023]
Abstract
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.
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Mitchell JJ, Chahla J, LaPrade RF. Editorial Commentary: Limited Data Shows How Little We Know. Arthroscopy 2016; 32:2148-2150. [PMID: 27697189 DOI: 10.1016/j.arthro.2016.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 02/02/2023]
Abstract
Lateral compartment osteoarthritis of the knee can be a challenging problem to address in the younger, active population. The challenge is compounded by limited treatment options and high patient expectations, with patients often desiring a return to impact high intensity activity. Distal femoral osteotomy has been reported to be one potential treatment option; however, a highly heterogeneous literature exists for both opening and closing wedge distal femoral osteotomies for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. The literature does not provide significant direction for surgeons on the appropriate surgical approach; however, opening wedge osteotomies allow for fine adjustment and maintain leg length and joint alignment, and are our preferred approach.
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Abstract
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.
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