The Future of Orthopaedic Sports Medicine by Brian M. Devitt & Mustafa Karahan & João Espregueira-Mendes

Author:Brian M. Devitt & Mustafa Karahan & João Espregueira-Mendes
Language: eng
Format: epub
ISBN: 9783030289768
Publisher: Springer International Publishing

© ISAKOS 2020

B. M. Devitt et al. (eds.)The Future of Orthopaedic Sports Medicine https://doi.org/10.1007/978-3-030-28976-8_28

28. There Are No Facts, Only Interpretations

John M. O’Byrne1

(1)Royal College of Surgeons in Ireland, Dublin, Ireland

John M. O’Byrne

Email: [email protected]

My concerns with regard to sports medicine and its future is the discrepancy between the sophistication and quality and detail of the investigations available to us, and their interpretation. The investigations can be sub divided into two broad categories: those that study structure, which are sophisticated imaging techniques, and those that study function, which are very elaborate performance assessment tools.

My first experience of disappointment at the weak link that can exist between sophisticated measurement and clinical relevance occurred in the early 1990s, when, as an orthopaedic resident, I carried out a Masters in Surgery thesis research under the supervision of the late and iconic Professor Tim O’Brien. The aim of the thesis was to analyse the massive amount of raw data that were generated in a gait laboratory, looking at kinematic patterns of walking in children with cerebral palsy and try and identify clinical sub-types and treatment protocols. The assessment technology was, for that time, very sophisticated and generated huge volumes of very accurate measurement data.

Using cluster statistics on these numerical values, we sub-divided the gait patterns into different types. We then endeavoured to identify clinical characteristics of each of these sub-types. It was a very clunky and crude and forced way of picking clinical patterns and pathologies out of large amounts of raw data using a form of artificial intelligence.

However, I believe it was laudable in its attempts to close the gap between sophisticated methods of measurement and its interpretation for a clinician, using automatic data analysis.

In the context of sports medicine, there is a dizzying array of measurements of performance activity and movement. Many of these measurements no longer require laboratory analysis but are based on a smartphone or a bracelet.

When I read about these data, I study very carefully the evidence that links the quality and sophistication of the data gathering with the clinical conclusions and recommendations. I must confess at many times I have that feeling I originally had with the gait analysis data that the interpretation and understanding of what it means is massively behind the quality or presentation of the data. It is easy to be seduced and dazzled by the quality of technology making the measurement and not carefully study the clinical conclusions or recommendations that are being made.

With regard to structure, as orthopaedic surgeons, we are the first and foremost students of anatomy. It is therefore very exciting to experience new and sophisticated imaging modalities. Technology has advanced at such a rate that one can almost microscopically examine the musculoskeletal system using modern MR techniques. However, again, the interpretation and appearances and understanding of what is normal and abnormal lags behind the quality of patient measurements. It is also worth noting that in many areas of orthopaedic surgery, our objective assessments of the patients’ function and our imaging of their structure have disappointingly not always correlated with patient-reported outcomes.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.