Physicians for Social Justice, Diversity and Equity: Take Action and Lead.

Physicians are in a position to take action and lead to actively mitigate against bias and discrimination. Social justice, diversity, and racial, gender, and SGM (sexual and gender minority) equity are sensitive issues. Few orthopaedic surgeons are minorities or female, and orthopaedic surgery is not perceived to be an inclusive specialty. This is an obstacle to equitable diverse hiring. As it takes almost 30 years to advance from preschool to orthopaedic fellowship graduation, we should advocate for educational equity beginning in early childhood. We should serve as role models for young people of all backgrounds and suggest that if they are dedicated and study hard, someday they too could become orthopaedic surgeons and researchers. Wherever possible, each of us in our own way and position should take a leadership role to resolve the disparities in our profession.

Editorial Commentary: Anterior Cruciate Ligament Costs Are Surprising.

Given increasing health care costs and clinical equipoise on numerous topics, value calculations are critical. Cost-minimization analysis evaluates throughout a single episode of care. For anterior cruciate ligament reconstruction, this is a reasonable approach given that cost-effectiveness data have been published. Using Healthcare Cost and Utilization Project data, general anesthesia, anesthesia time, greater age, and medical comorbidities were correlated with higher costs. Among the surprising results were increased costs with male gender and Hispanic race. Interestingly, the location of the surgery, surgery center versus hospital, or meniscal repair did not significantly impact costs. This information can be used by physicians for cost comparison and factors that determine costs.

Letters to the Editor Highlight Current Controversies.

In 2018, Letters to the Editor of Arthroscopy were heated and helped point out the broiling topics in our field including ankle arthroscopy distraction technique versus no-distraction and dorsiflexion, knee anterolateral ligament reconstruction versus lateral extraarticular tenodesis, hip labral primary repair versus primary reconstruction, and shoulder stabilization technique cost-effectiveness.

Medical Device and Pharmaceutical Industry Employees as Medical Research Publication Authors.

As an editorial policy, medical device and pharmaceutical industry employees are generally permitted to publish original scientific research in Arthroscopy journal but are not permitted to publish systematic reviews. All authors complete the International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest, which are thoughtfully considered by our reviewers and editors and readers. In accord with the American Academy of Orthopaedic Surgeons, we believe that "manufacturers of medical devices, biologics, drugs, and other items use(d) in the care of the patient…play an important role in…the development of new technologies. This collaborative effort ensures that patients have the best outcomes through the invention and testing of new technology, research, and evaluation of existing technology." Our peer-review process mitigates against bias including but not limited to commercial bias in the interpretation of scientific research data. In the end, our goal is to publish the best science, and as above, industry plays "an important role in…(t)his collaborative effort."

Cost-Effective Medical Care Optimizes Value Over Time.

Researchers are encouraged to consider value (cost in addition to outcome) when analyzing the results of arthroscopic and related treatments. Given increasing health care costs, value calculations are critical, particularly in cases of clinical equipoise-uncertainty as to which of various treatment options is optimal. Value calculations must not be shortsighted, and rigor is required to determine direct costs as well as more obscure indirect costs. In addition, sometimes the published literature is ambiguous or conflicting with regard to outcomes. Thus, investigations of cost-effectiveness require sensitivity analyses, where a range of possible results for cost-effectiveness (i.e., the dependent variable) could be reported based on a range of values for the independent variables (costs or outcomes). What is more, value analyses should not be shortsighted; costs and outcomes must be considered over the long term. Ultimately, the most cost-effective treatments may be preferred.