The Challenge of SCR Validation
One of the Value add-ons of this group is conversations like this which allow us to crowdsource experts for our patients and highlight what we don't know. In this particular instance, we are discussion a "promising" new technique, namely SCR, but we have different ideas about for whom it is best treatment. Moreover, the few articles written on this are very optimistic about their successes. One can't help but imagine there may be more than one kind of confounding variable of bias in such small cohort studies. I'll remind you that Bhandari made us all aware that fragility due to small N in retrospective cohort studies usually means the conclusions are probably not valid. Furthermore, if you look at Codman Shoulder Society website at my blog, Warner's Corner, I've posted the article by Ionides which is entitled "All Research is Wrong." He pointed out that 75% of all small retrospective cohort studies are ultimately proven incorrect by similar sized cohort studies. So what are we to do to understand if SCR is really "Worth it"?
The only answer is a large cohort study where we agree on indications and we measure together. Randomization, as is usually the case, is very difficult but might be considered with perhaps arthroscopic partial repair. In fact, we did this with the Orthospace IDE.
We have just finished a study reviewing our results and those of the SOS Global database analyzing outcomes of SCR vs Tendon transfer; and we have analyzed our "learning curve" at MGH for SCR as well.
I encourage all of you to think about this and challenge one of you to move to a multicenter Codman Study group on this.
Click Here to view the Codman Case Presentation concerning a discussion of the treatment options for a chronic supraspinatus tear, including the potential use of SCR.
JP Warner, MD