There is no consensus that overcomes common sense☆
نویسنده
چکیده
magining that it will be possible at some time for us to ave the solution to an orthopedic or traumatological probem based on a manual or a therapeutic information insert is long-standing dream. However, the classical protocols that are frequently used in ncology, for example, are still not accessible to our specialty nd, in my opinion, never will be. The diversity of variables involved in orthopedics and the ven greater diversity in traumatology make it practically mpossible for us to establish standards for our therapeutic anagement. Evidence-based medicine, which is the dream of those who ee medical practice as a cost or administrative problem, has een very fashionable. However, it is now considered that an cceptable level of evidence-based medicine is very difficult to pply to our specialty. At best, its suggestions for management ay be taken into consideration. There have been many examples of radical changes of irection in case management, aiming toward better results. For many years, in knee surgery, anterior instability was nitially not reconstructed because it was believed that “good uscle reinforcement” would be sufficient to bring stabilty. Practice demonstrated that demands in sports activities ere leading to many episodes of insecurity of the knee, and hus, intra-articular reconstruction of the anterior cruciate igament (ACL) emerged. The surgical results were not satisactory, with significant joint limitation, and so intra-articular econstruction was prescribed and the practice of tensioning he extra-articular ligament structures came to be the great ndication. The long-term results demonstrated that these techniques ere insufficient for stability and for preventing knee arthrois. With improvements in rehabilitation programs and in urgical techniques (with the advent of arthroscopy), techiques for reconstruction of the ACL alone resurged and this
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