Orthopedic Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped orthopedic surgery practice.

ACL Management Strategy

Rehabilitation challenges reconstruction

Reconstruct-all → KANON (2010) → structured rehab → return-to-sport criteria → meniscal preservation

Every hour counts

No urgency → <48h evidence → HIP ATTACK → <24h push → geriatric co-management

Not every tear needs fixing

Repair-all → UKUFF (2017) → CSAW sham (2018) → conservative for many → refined criteria

When sham-controlled trials disagree

Beneficial → INVEST sham (2009) → VERTOS II positive → VERTOS IV/VAPOUR → controversy

Personalized joint replacement

Cruciate-sacrificing → CR → UKA → patient-specific → robotic → outpatient