Approximately 2,500 years ago in present-day Turkey, an Ancient Greek Ionian wrote the following: “diaish masi sε crh somai ἐp’ ὠ4εlεi ῃ kamno nsun kasὰdu naminkaὶkri sinἐmh n,ἐpὶdhlh sεidὲkaὶ ἀdiki h εἴrxεin.” Direct translation of this passage to modern English was provided by von Staden: “…And I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from [what is] to their harm or injustice I will keep [them].”

For human beings, learning begins when a specific action or experience is coupled with a specific resultda process that requires repetition, high-level cognition, and complex neural processing. However, despite our advanced ability to make these associations, it is not possible to predict the result of a specific action in the absence of a previously learned behavior or series of behaviors. It is the accumulation and integration of cogently linked cause-and-effect relations throughout life that allow us to hypothesize the outcome of some future action. The primary function of published research on any topic is to enhance our knowledge by providing documentation that a specific action produced a specific result within a defined set of circumstances. In medical research, we aim to determine which actions produce the most desirable results following the guid- ance of the Hippocratic Oath. Research in orthopaedic surgery is not an exception.

Research in rotator cuff surgery is not an exception either. Clearly, the past few decades of research has produced volumes of new basic science, biomechanical, and clinical data related to rotator cuff surgery. How do we make sense of all this “mess”? Perhaps it is necessary to take a step back, take a deep breath, and see the big picture.

Full Article: Response to the Letter Entitled “The Rotator Cuff Repair Mess” by Dr. Palomo