The Ultimate Goal of Medical Publishing is Practice-Changing Innovation.

New Year brings a new catchline: Practice-Changing Innovation. Publishing groundbreaking research and inventive techniques that translate to improvements in patient care is an ultimate goal.

Patient Acceptable Symptomatic State and Substantial Clinical Benefit Matter Most to Patients and Must Be Reported Correctly.

Despite a push for a focus on clinical rather than "statistical" significance, and an emphasis on reporting of outcome thresholds such as Patient Acceptable Symptomatic State (PASS) and Substantial Clinical Benefit (SCB), PASS and SCB are rarely reported, and when reported, are often reported incorrectly. Yet, patients require satisfaction (PASS) as a result of our treatments, and patients desire to improve substantially (SCB). Determining whether patients are satisfied and/or substantially improved is simple…just ask them. The questions are known as anchor questions. Obviously, different patients have different thresholds of PASS and SCB, and reliance on previously published literature for values of these thresholds can result in error-thus, the anchor questions. And, each patient must be assessed individually. Outcome thresholds are not group-level metrics, and must be reported as the percentage of individuals who achieve the clinically significant outcome. Certain patients, such as athletes, have high baseline function and may demand Maximum Outcome Improvement or (MOI). In contrast, Minimally Clinically Important Difference (MCID) is a less-than-ideal measure; patients do not desire "minimal" improvement. Journals must do a better job of publishing Patient Reported Outcome Measures (PROM) that matter most to patients: satisfaction and substantial benefit.

Editorial Commentary: Understanding Injury Epidemiology Builds Trust in Baseball Players.

Although the odds are extremely low, some baseball players are fortunate to make it to the professional ranks (minor or major league), where suffering an injury is common. During the 2011 to 2019 seasons, 112,405 injuries were reported in the Major League Baseball Health and Injury Tracking System database. Compared with other professional sports, baseball players have lower rates of returning to play, take longer to return to play, and have shorter careers after shoulder arthroscopy. By understanding injury epidemiology, the treating physician will gain player trust and understand the prognosis and how to properly return the player safely back to the field and best prolong their career.

Editorial Commentary: Platelet-Rich Plasma May Be Superior to Corticosteroid Injection for Rotator Cuff Disease Because of Improved Chance of Healing, Longer-Lasting Pain Relief, and No Detriment if Surgery Is Needed.

Both corticosteroid and platelet-rich plasma (PRP) injections have benefits for patients with rotator cuff tendinopathy. Currently, the published clinical differences are small, and statistical differences aren't as significant without a clinical difference, so the answer is personal. PRP is expensive, but rotator cuff healing is possible, resulting in the best chance to avoid surgery. And, if surgery is required, PRP results in no detriment, unlike corticosteroid. PRP may result in lasting pain relief. Based on the current literature, we prefer PRP despite the cost.

Diversity in Sports Medicine and Rehabilitation Starts With Individual Kindness, Grace, and Compassion.

The definition of diversity remains ill-defined, and there is little consensus as to the solutions to increase diversity. Advancements in diversity, equity, and inclusion (DEI) might first start with kindness, grace, and compassion as an individual response; these attributes are critical ingredients as we embark to increase DEI in orthopaedic surgery, sports medicine, and rehabilitation and in the care for our patients. Given the needed focus and debate on diversity and equity issues, an Arthroscopy, Sports Medicine, and Rehabilitation Special Issue, "Diversity in Sports Medicine and Rehabilitation" can function as a starting point for discourse and a seed for future growth. The authors for the Diversity Special Issue have delivered "pearls" that can be directly incorporated into our practices and understanding of DEI.

Return-to-Sport Outcomes After Anterior Cruciate Ligament Surgical Treatment May Be Improved by Attention to Modifiable Factors and Consideration of Nonmodifiable Factors.

Today, we who treat athletes are able to effect immediate, significant improvement in anterior cruciate ligament (ACL) patient outcomes, regardless of surgical technique, by careful determination of when an athlete is ready to return to sport. "Prehabiliation," bracing, time after surgery to various rehabilitation activities, time after surgery until return to sport, functional testing, strength testing including limb symmetry indices, psychological readiness, age, gender, and type of sport are all factors influencing successful return to sport after ACL injury and treatment. Age and gender are not modifiable, and for some athletes, type of sport may be nonnegotiable. However, each of these factors could be thoughtfully considered before returning an athlete to sport after ACL treatment. All the other factors listed above, from prehab to bracing to strength to psychological readiness, may be modifiable.

Evidence-Based Practice Should Supersede Evidence-Based Medicine Through Consideration of Clinical Experience and Patient Characteristics in Addition to the Published Literature.

On the surface, the benefits of evidence-based medicine (EBM) seem self-evident. However, reliance on the scientific literature alone has limitations. Studies may be biased, statistically fragile, and/or not reproducible. Reliance solely on EBM may ignore physician clinical experience and individual patient characteristics and input. Reliance solely on EBM may overvalue quantitative, statistical significance, resulting in a false sense of certainty. Reliance solely on EBM may fail to consider lack of generalizability of published studies to individually unique patients. The concept of evidence-based practice goes beyond EBM and incorporates (1) EBM, (2) clinical expertise, and (3) individual patient characteristics, values, and preferences. Even if branded as evidence-based, a suggested treatment may not be the best treatment. Evidence-based practice must be considered before determining what is best for our patients.

AANA23 Confirms There is Still a Place for Face-To-Face Meetings.

AANA23, or the AANA Annual Meeting, set a high-water mark for our society and its members. Congratulations to all who planned and executed an exceptional educational meeting. Demonstrating that diversity continues to be front of mind, one of the first events of the meeting was the Diversity Session. Recognizing the topic's importance, next month in Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR), Arthroscopy's companion online journal, we will publish our second annual special issue devoted to rehabilitation and return to sport, also with a focus on diversity as it relates to sports medicine. The Biologic Association held a comprehensive and clinically relevant 2-day meeting in conjunction with and following AANA23. AANA23 set the stage for a greatly anticipated AANA24 to be held in Boston from May 9 to 11, 2024.

Psychological Readiness to Return to Sport: Fear of Reinjury Is the Leading Reason for Failure to Return to Competitive Sport and Is Modifiable.

Many of our patients are athletes, and an ultimate goal is to help these athletes return to their preinjury level of activity or sport. Generally, we focus on patients' injuries and treatments, but there are modifiable factors that can improve patient outcomes independent of surgical technique. A factor frequently ignored is psychological readiness to return to sport. In patients including athletes, particularly teenagers, chronic, clinical depression is a prevalent and pathologic condition. In addition, in nondepressed patients (or in patients who are situationally depressed because of injury), the ability to deal with stressors may still govern clinical outcomes. Specific psychological traits of significance have been identified and defined, including self-efficacy; locus of control; resilience; catastrophizing; kinesiophobia; and fear of reinjury. (Fear of reinjury is the leading reason for failure to return to competitive sport, reduced activity levels after sports injury, and greater reinjury rates.) The traits may overlap and may be modifiable. Thus, like strength and functional testing, we should evaluate for signs or symptoms of depression, and we should measure psychological readiness to return to sport. With awareness, we can intervene or refer as indicated. Psychological readiness to return to sport represents an underexamined domain in which we can help our patients achieve best outcomes.

Minimally Clinically Important Difference (MCID) Is a Low Bar.

Patients don't care about "statistical" significance. Patient-centered outcome measures focus on "clinical" significance and include minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), substantial clinical benefit (SCB), and maximal outcome improvement (MOI). "Minimal" is a low bar. MCID neither addresses whether patients are satisfied nor whether they have derived a substantial benefit. MCID is commonly reported allowing comparison between studies, and MCID can be calculated retrospectively, so reporting MCID is acceptable. However, we also need to report PASS, SCB, and, in unique patients like high-level athletes, we may also need to report MOI to adjust for high pretreatment scores and a ceiling effect. Finally, threshold scores are patient-level metrics and must be reported as percentage of patients who meet the threshold, not reported as to whether, as a group, the mean score for the cohort meets the threshold or not (which is a common error).

Guidelines for Proper Reporting of Clinical Significance, Including Minimal Clinically Important Difference, Patient Acceptable Symptomatic State, Substantial Clinical Benefit, and Maximal Outcome Improvement.

Patient-reported outcome measures (PROM) need to be responsive, reliable, and validated for the specific condition or treatment. PROMs also need to exhibit a dose-dependent response across a diverse patient population, unlimited by floor and ceiling effects. Statistically significant differences between compared groups might not always represent clinically important differences. Measures of clinical significance reflect a spectrum of patient satisfaction after an intervention. A noticeable difference to the patient is assessed with minimal clinically important difference (MCID), patient satisfaction by patient acceptable symptomatic state (PASS), and a "considerable" improvement by substantial clinical benefit (SCB). Clinical relevance measured by these clinically significant outcomes (CSO) are limited by ceiling effects. Maximal outcome improvement (MOI) might more accurately account for patients with higher baseline or preoperative PROMs, thereby limiting ceiling effects. The acts of measuring (and reporting) patient-centered endpoints may actually be of greater importance than collecting objective clinician-measured data. As the old surgeon's aphorism goes, "nothing ruins good results like good follow-up."

Arthroscopy and Musculoskeletal Biologics.

Orthopaedic biologics holds great promise. Absent peer-reviewed clinical musculoskeletal research, orthobiologics indications and treatment recommendations will remain opaque. In a Call for Papers, Arthroscopy; Arthroscopy Techniques; and Arthroscopy, Sports Medicine, and Rehabilitation editors invite authors to submit clinical musculoskeletal biologics original scientific research, and technical notes with video. Each year, the top articles will be awarded inclusion in an annual Biologics Special Issue. Future investigators and current readers could follow the science while being mindful of the regulatory environment.

Strategies to Mitigate Against Least-Publishable Units in Medical and Scientific Research Publications.

Least-publishable units, aka minimal publishable units, smallest publishable units, fractions of scholarly effort, and "salami slicing" divide a single research publication into a number of papers with small amounts of information in each paper. This results in quantity rather than quality; is ethically inappropriate; creates extra work for readers, future authors, reviewers, and editors; and can result in redundancy, self-plagiarism, publication overlap, and duplicate reporting of patient data that can result in inaccurate conclusions in systematic reviews. Increased awareness and actionable intervention can help to reverse this growing trend.

Search Methods for Systematic Reviews and Bibliographic Articles Can Improve: Responsibilities of Authorship Are Vast.

Certain types of scientific articles, including bibliographic articles, systematic reviews, and meta-analyses, require systematic search of electronic databases. Literature must be searched using clearly specified search terms, dates, and algorithms; article inclusion and exclusion criteria; and explicitly named databases. Search methods must be described in detail to allow reproducibility. In addition, responsibilities of all authors include contributing to study conception, design, data acquisition, analysis or interpretation; drafting or critically revising the work; approving the final version to be published; being accountable for the accuracy and integrity; being available to respond to queries including after publication; being able to identify which co-authors are responsible for which parts; and maintaining primary data and underpinning analysis for at least 10 years. The responsibilities of authorship are vast.

Arthroscopy Journal: Reflections on 2023 and Auld Lang Syne.

Auld lang syne; times long past. We were unsuspecting of the coming pandemic. Things changed. COVID-19 impacted each of us, our families, our patients, our medical practices, and our daily lives. The year 2020 was one of cancellation and loss; 2021 and 2022 were years of adaptation, caution, and continued loss. Finally, 2023 began a time of recovery; while COVID-19 is still with us, the pandemic has been declared ended, and we emerge with gratitude. We slowly removed our masks and rediscovered the vitality of meeting face-to-face. And throughout, Arthroscopy has continued to develop, including new journals; special issues on rehabilitation, biologics, and diversity as they relate to musculoskeletal care; collaboration with the American Board of Orthopaedic Surgery, Maintenance of Certification, Web-Based Longitudinal Assessment Pathway; Arthroscopy Techniques; Infographics; Visual Abstracts; and Podcasts. At year end, we extend special thanks to editors whose terms have expired, our team and leaders, our reviewers, our authors and readers, and our patients who offer us their trust and an opportunity to serve.

Biomedical Research Infographics and Visual Abstracts Increase Social Media Attention and Article Citation.

Biomedical research Infographics, a short-form neologism for "information graphics," illustrate medical educational information in an engaging manner by enhancing concise text with figures, tables, and data visualizations in the form of charts and graphs. Visual Abstracts present a graphic summary of the information contained in a medical research abstract. In addition to improving retention, both Infographics and Visual Abstracts allow for dissemination of medical information on social media and increase the breadth of medical journal readership. In addition, these new methods of scientific communication increase citation rates, as well as social media attention as determined by Altmetrics (alternative metrics).

Editorial Commentary: Dynamic Anterior Stabilization via Biceps Tenodesis to the Glenoid Is an Option for Anterior Shoulder Instability With Subcritical Glenoid Bone Loss.

A nuanced approach to treatment of anterior shoulder instability is encouraged, particularly in patients with subcritical glenoid bone loss. In patients with bone loss, recurrent instability after isolated arthroscopic Bankart repair has dampened enthusiasm for this procedure. Adjunctive treatment with remplissage or dynamic anterior stabilization via biceps tenodesis to the glenoid is an alternative to bone transfer procedures, which are effective but have higher complication rates. Dynamic anterior stabilization or tenodesis of the long head of the biceps to the 3-o'clock position on the glenoid through a subscapularis split is biomechanically superior to isolated Bankart repair for reducing anterior translation, even in the setting of minor glenoid bone loss due to a sling effect similar to that produced by the Latarjet procedure. A disadvantage is placement of a large implant into the small space of the anterior glenoid and creation of a soft-tissue defect in the capsule.

Rehabilitation is the Critical Ingredient to Optimize Return to Sport in Athletes.

Medical providers, rehabilitation specialists, and researchers must incessantly refine and adjust specific protocols, understanding that rehabilitation is the critical ingredient for return to sport in athletes. This month introduces a Special Issue in Arthroscopy, Sports Medicine, and Rehabilitation entitled "Rehabilitation and Return to Sport in Athletes." The articles have been authored by invited experts and rehabilitation specialists deemed thought leaders. The goal of the issue is to provide readers, researchers, and clinicians high-yield and high-impact articles that will optimize return to sport in athletes. For athletes, and non-athletes alike, there lies an essential quartet for recovery: 1) correct diagnosis, 2) restoration of anatomy, 3) biological healing, and 4) functional rehabilitation. Most importantly, a coordinated rehabilitation program must be chosen with appropriate specialization to synchronize the return to play. This Special Issue explores specific rehabilitation paradigms regarding return to sport using evidence-based medicine with support from literature to optimize the functional return of athletes.

The 2022 Orthopaedic Surgery Residency Match Leaves Many Qualified Candidates Unmatched.

Orthopaedic surgery has always been a popular and competitive field, but in 2022, approximately 40% of applicants for orthopaedic surgery residency positions did not successfully match, despite their immense talent and commitment. This is a failure of the system, not the medical student applicants, and there is no evident solution. In fact, the problem is expected to get worse, as many of the approximately 600 unmatched 2022 applicants are expected to apply again next year, further flooding the pool. Reflecting on the results of the 2022 Orthopaedic Surgery Residency Match, we feel incredibly fortunate and humbled to serve as orthopaedic surgeons with a subspecialty interest in Arthroscopy, Arthroscopy Techniques, and Arthroscopy, Sports Medicine, and Rehabilitation.

Understanding the Disabled Throwing Shoulder Requires Updated Review of Anatomy, Mechanics, Pathomechanics, and Treatment.

Understanding both shoulder health and shoulder pathology in throwers is relevant to overhead athletes, and also relevant to nonoverhead athletes and even nonathletes. The thrower's shoulder is a clinically relevant topic of medical research scholarship today. Some of the greatest advances in sports medicine result from our ability to visualize normal and pathologic anatomy of joints, including the shoulder, using a small camera and a fiberoptic light source, through small portals, and without disruptive surgical dissection, or, in a word, "arthroscopy." Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder.