Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes JSES

Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes.

This study set out to be a learning curve study in which surgeon experience was related to outcome. An ideal example of such a study can was shown in this previous post, a study in which surgeon experience was treated as a parametric variable and the outcome (in that case complications) was also treated as a parametric variable. In this study, however, surgeon experience was arbitrarily divided into two groups: the first 18 months of practice and afterwards. Such an arbitrary division runs the risk of missing the opportunity to answer the question, "how many cases does it take to achieve a certain level of proficiency?" See this post, for example.

There are essentially three types of learning curves (see below). 

(1) - the progressive, shown by the blue line (the more you do the better you get), (2) the threshold, shown by the red line (after so many you achieve mastery level and do not improve much beyond that) and (3) the non effect, shown by the green line (the result is unrelated to the number you've done).

There is no need for an arbitrary division of the surgeon's experience into two categories as was done in this paper.

The authors of this paper collected the data and had the opportunity to do an interesting study. They collected data on patient age, gender, body mass index, smoking, diabetes, acuity of tear and tear size, as well as surgeon experience. Wouldn't it be wonderful if they did a multivariate analysis of these variables on the improvement patients experienced after their surgery? If they threw in data on the integrity of the repair at followup, it would be even better.

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