Page 44 - ISAKOS 2019 Newsletter Vol II
P. 44

Mark A. Heard MD, FRCS
Banff Sport Medicine Canmore, CANADA
The Stability Study Group was recently honored to receive the Jan I. Gillquist award for best Scientific Paper at the 2019 ISAKOS Congress in Cancun, Mexico. The paper was entitled “Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-Articular Tenodesis: Analysis of Complications from the ISAKOS-Sponsored Stability Study.” The purpose of this study was to answer the following questions: (1) “In the high-risk ACL patient, does the addition of a lateral extra- articular tenodesis (LET) decrease the rate of re-rupture or clinical failure of a hamstring ACL reconstruction?” and (2) “Are the complications associated with this additional procedure sufficiently frequent or severe to deter a surgeon from performing this additional procedure?” The research did, in fact, show that performing a LET decreased the relative risk of ACL graft rupture by 66%. Furthermore, the complications were not substantial and should not dissuade the surgeon from performing this technique at the time of ACL reconstruction.
This award was earned thanks to the contributions of the entire team of researchers who participated in this 600-patient, multicenter study. Dr. Alan Getgood, along with his research team and colleagues at Fowler Kennedy Sport Medicine in London, are to be applauded for taking the lead on this logistically challenging trial. Surgeons and research staff at Banff Sport Medicine, Fraser Health Authority, University of Calgary, McMaster University, Queens University, and Pan Am Clinic in Canada, as well as at centers in Coventry, U.K., and Antwerp, Belgium, collaborated in the quest to answer these questions. The significant efforts put in by each center of recruitment, from randomization and consistent surgical technique to ensuring that patients returned for follow- up appointments, cannot be overstated. The human and financial resources that are required to perform this type of study are enormous and, in that regard, the support of an ISAKOS grant was greatly appreciated by the Stability Study Group.
Answering these types of questions via robust scientific research can change the practice of surgeons, ultimately improving patient outcomes worldwide. This type of international collaboration is where ISAKOS can play a major role as an incubator, facilitator, supporter, and disseminator of this high-quality research.
There was a time in the not-too-distant-past when many orthopaedic papers were mostly retrospective, had low numbers of patients, and described results that were suspected of being “too good to be true.” Authors were often trying to satisfy publishing obligations, and high-quality study methods were not standard practice. We have evolved to a period in which well scrutinized scientific study is becoming the norm. Study power and recruitment are being statistically driven, and study results are broader in terms of the type and number of outcomes being measured. Collaboration by surgeons with statistical and research specialists in many fields of expertise is now a common and healthy practice. In general, the entire orthopaedic community is realizing and responding to the value of excellent research.
While single-center and single-surgeon studies are valuable to the advancement of orthopaedic knowledge, their results do not always reflect patient outcomes on a global basis. Multicenter studies, especially those with global recruitment, are more likely to reflect comprehensive patient outcomes. As an international society, ISAKOS brings people together to generate truly global perspectives and questions and facilitates prospective and randomized multicenter trials that carry tremendous value for advancing patient care. These studies are also of tremendous value from the perspective of health- care economics through the evaluation of the outcomes of procedures, which is becoming increasingly important and, in fact, is being mandated worldwide as health care spending continues to spiral out of control as a percentage of GDP in many nations.
The Stability Study group gratefully accepts the support of ISAKOS, and we encourage ISAKOS to continue to foster an international environment of collegiality, education, and research and to actively participate in stimulating multicenter and multinational studies.

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