University of Pennsylvania, School of Medicine, Philadelphia, PA, USA.
Phys Sportsmed. 2011 Nov;39(4):124-30. doi: 10.3810/psm.2011.11.1944.
Through extensive survey analysis, we investigated expert opinion in sports medicine. The study had 3 purposes: to provide clinical guidance for cases in which the correct action is not necessarily apparent, to examine expert opinion itself, and to delineate areas of future study. A total of 500 members of the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine evaluated a set of 25 statements on unresolved issues in sports medicine. The following 10 statements were deemed false: "It's okay for 12-year-old pitchers to throw curve balls; it's the pitch count that matters"; "Resistance training ('weight lifting') should be avoided until physeal closure"; "Jogging during pregnancy is to be avoided"; "At an athletic event, if sideline coverage is offered by an emergency medical technician and athletic trainer, there is little additional benefit from having a physician present"; "Contact sport athletes who sustain a second concussion should be excluded from contact sports permanently"; "The utility of pre-season medical screening is derived from the history; as such, student-athletes should complete a questionnaire, with physical examination reserved for only those with a positive relevant history"; "Femoroacetabular impingement is a myth-the designation of anatomic variation as disease"; "An AC (acromioclavicular) separation in a contact athlete should not be treated surgically if the athlete won't give up the sport; it will fail"; "Ankle taping induces weakness and atrophy of the dynamic stabilizers of the ankle"; "Only autografts should be used in ACL (anterior cruciate ligament) surgery, as allografts have an unnecessary high failure rate in clinical practice." One statement was accepted as true: "Surgery to treat anterior (patello-femoral) knee pain in a patient with normal patellar mechanics and stability is contraindicated." In short, expert opinion may be a helpful adjunct to clinical practice. Expert opinion cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.
通过广泛的调查分析，我们调查了运动医学领域的专家意见。这项研究有三个目的：为那些正确行动并不明显的病例提供临床指导，检查专家意见本身，并描绘未来研究的领域。美国运动医学学会和美国运动医学骨科协会的 500 名成员评估了一组关于运动医学未解决问题的 25 个陈述。以下 10 个陈述被认为是错误的：“12 岁的投球手可以投曲线球；重要的是投球次数”；“在骺板闭合之前，应避免进行阻力训练（举重）”；“怀孕期间应避免慢跑”；“在体育赛事中，如果场外有急救技术员和运动训练师提供服务，那么有医生在场的好处不大”；“遭受第二次脑震荡的接触性运动运动员应永久排除在接触性运动之外”；“季前医疗筛查的效用来自于病史；因此，学生运动员应该完成一份问卷，只有对那些有阳性相关病史的人才进行体检”；“股骨髋臼撞击症是一个神话——将解剖变异指定为疾病”；“如果运动员不愿意放弃运动，接触性运动员的肩锁关节分离不应接受手术治疗；它会失败”；“踝关节贴扎会导致踝关节的动力稳定剂变弱和萎缩”；“只有自体移植物应在 ACL（前交叉韧带）手术中使用，因为同种异体移植物在临床实践中失败率过高。”有一个陈述被接受为正确：“对于有正常髌骨力学和稳定性的患者，手术治疗前（髌股）膝关节疼痛是禁忌症。”简而言之，专家意见可能是临床实践的有益补充。专家意见不能替代个人判断，当然也不能推翻主要的医学文献。然而，在缺乏更好证据的情况下，即使是最坚定的循证医学实践者，专家意见也是有价值的。
