To understand the extinction of North America’s megafauna, scientists have used a newly developed biomolecular method, Zooarchaeology by Mass Spectrometry (ZooMS) to study the disappearance of mammals that happened 50,000 years ago.

ZooMS allows scientists to study ancient bone collagen and proteins that can be preserved for years. By examining the minute variations in collagen sequences among several species, ZooMS can generate a molecular barcode that facilitates the identification of bone fragments that would otherwise remain unidentified.

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<h2>History&nbsp;</h2>

 
50,000 years ago, North America was the land of Mammoths, Mastodons and sabre-toothed tigers. However, as the last phase of the ice age approached, these mammals vanquished from Earth, leaving behind a mystery to be unfolded by scientists.

<h2>Challenges faced while uncovering the mystery</h2>

 
To study the extinction of megafauna from the face of Earth, it is imperative that scientists study the bones that have been preserved.

Unfortunately, it is not as simple as it sounds. There is an array of obstacles in the way, one of them being inadequate preservation techniques followed by sites.

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With the bones being worn down into smaller, unrecognisable fragments by exposure, abrasion, breakage, and biomolecular decomposition it becomes difficult for researchers to draw accurate results.

<h2>The way forward</h2>

 
Scientists turned to the Smithsonian National Museum of Natural History in Washington, DC to study the extinction of large mammals from North America.

However, a considerable amount of remains preserved by the museum were unrecognisable, proving to be insufficient for researchers to study the extinction in detail.

Watch |&nbsp;Wall Street's rich bet on Trump

<div class="videoWrapper trancodeVideo"><iframe allowfullscreen="" autoplay="1" class="includeVideo" frameborder="0" height="350" src="https://www.wionews.com/videos/wall-streets-rich-bet-on-trump-727627/embed" style="width:100%;max-width:560px;" width="560"></iframe></div>

<div class="videoWrapper trancodeVideo">&nbsp;</div>

<div class="videoWrapper trancodeVideo">
This is when the revolutionary technique, ZooMS came into play. The researchers used this approach to analyse five archaeological sites in Colorado that date to the Late Pleistocene/earliest Holocene period or earlier.

The results obtained via this method were quite promising. 80% of the bone samples had sufficient collagen for ZooMS identifications and 73% were identifiable to a genus level. Bison, Mammuthus (mammoths), Camelidae (the family of camels), and potentially Mammut (mastodons) were among the taxa that ZooMS was able to identify.

ZooMS has opened up a new realm of opportunities for research by providing a cheap and rapid way to extract essential information from fragmented bone samples to understand the extinction of megafauna that happened in North America 50,000 years ago.

(With inputs from agencies)&nbsp;
</div>

To understand the extinction of North America’s megafauna, scientists have used a newly developed biomolecular method, Zooarchaeology by Mass Spectrometry (ZooMS) to study the disappearance of mammals that happened 50,000 years ago.

To understand the extinction of North America’s megafauna, scientists have used a newly developed biomolecular method, Zooarchaeology by Mass Spectrometry (ZooMS) to study the disappearance of mammals that happened 50,000 years ago. ZooMS allows scientists to study ancient bone collagen and proteins that can be preserved for years. By examining the minute variations in collagen sequences among several species, ZooMS can generate a molecular barcode that facilitates the identification of bone fragments that would otherwise remain unidentified. Also read | AI on the hunt to find 'world's loneliest' plant a partner History 50,000 years ago, North America was the land of Mammoths, Mastodons and sabre-toothed tigers. However, as the last phase of the ice age approached, these mammals vanquished from Earth, leaving behind a mystery to be unfolded by scientists. Challenges faced while uncovering the mystery To study the extinction of megafauna from the face of Earth, it is imperative that scientists study the bones that have been preserved. Unfortunately, it is not as simple as it sounds. There is an array of obstacles in the way, one of them being inadequate preservation techniques followed by sites. Also read | Intermediate-mass black holes have a 'birthing nest' in cosmic world, suggests study With the bones being worn down into smaller, unrecognisable fragments by exposure, abrasion, breakage, and biomolecular decomposition it becomes difficult for researchers to draw accurate results. The way forward Scientists turned to the Smithsonian National Museum of Natural History in Washington, DC to study the extinction of large mammals from North America. However, a considerable amount of remains preserved by the museum were unrecognisable, proving to be insufficient for researchers to study the extinction in detail. Watch | Wall Street's rich bet on Trump This is when the revolutionary technique, ZooMS came into play. The researchers used this approach to analyse five archaeological sites in Colorado that date to the Late Pleistocene/earliest Holocene period or earlier. The results obtained via this method were quite promising. 80% of the bone samples had sufficient collagen for ZooMS identifications and 73% were identifiable to a genus level. Bison, Mammuthus (mammoths), Camelidae (the family of camels), and potentially Mammut (mastodons) were among the taxa that ZooMS was able to identify. ZooMS has opened up a new realm of opportunities for research by providing a cheap and rapid way to extract essential information from fragmented bone samples to understand the extinction of megafauna that happened in North America 50,000 years ago. (With inputs from agencies)

A group of mammals suddenly disappeared 50,000 years ago. Ancient bone collagen might tell why

A dog, while digging in the backyard of her owner to find a bone, ended up discovering something rather unexpected.

Homeowner Mathew Sims said that his pup, named Baby, was playing in the backyard of the house in Jacksonville, Florida when the rusted object was dug up by her near the fence line, said the police.&nbsp;

Speaking to FOX 30, Sims said, "You couldn’t tell what it was until you started pulling it up. Once I got it halfway out, I was like oh, I know what this is, let me gently put this back down."

The metallic item discovered was actually an unexploded military bomb, which was decades old.

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"OK is this live?" Sims remembered the first thoughts when he picked up the bomb with his bare hands last Wednesday (Mar 20). "You panic, then you drop," he said.&nbsp;

The weapon was carefully laid back by Sims at the place where his dog discovered it and he then called the authorities. He added that the bomb weighed nearly 10 pounds and was around a foot long.&nbsp;

As per a police report, the amount of decay present on the weapon hinted that the bomb had been underground for years.

<h2>Bomb squad confiscates the bomb&nbsp;</h2>

A bomb squad reached his&nbsp;home, which was located on 15th Street E, and the neighbourhood was evacuated.&nbsp;

Sims said that it was a matter of relief that the bomb was discovered by the dog and was removed from his house. &nbsp;

Meanwhile, his neighbour Carla Smith said that she was not worried about the strange discovery.&nbsp;

Watch:&nbsp;Florida police officer at the right time, right place

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"We just watched. I wasn’t scared because I’ve been around people who have found artefacts in the land," she said while speaking to the news outlet.

"To me, it was interesting to watch. They did their thing and they were out of here in minutes," she added.&nbsp;

The antique bomb was found by the dog two months after a man found a rusty rocket in Bellevue, Washington state. It was said to have been an old Cold War nuclear missile.

Meanwhile, an unexploded hand grenade was discovered by a nine-year-old boy in his garden in Yarcombe, East Devon, England.&nbsp;The grenade was removed by the police and detonated in a close field.

(With inputs from agencies)

A dog, while digging in the backyard of her owner to find a bone, ended up discovering something rather unexpected. Homeowner Mathew Sims said that his pup, named Baby, was playing in the backyard of the house in Jacksonville, Florida when the rusted object was dug up by her near the fence line, said the police.

A dog, while digging in the backyard of her owner to find a bone, ended up discovering something rather unexpected. Homeowner Mathew Sims said that his pup, named Baby, was playing in the backyard of the house in Jacksonville, Florida when the rusted object was dug up by her near the fence line, said the police. Speaking to FOX 30, Sims said, "You couldn’t tell what it was until you started pulling it up. Once I got it halfway out, I was like oh, I know what this is, let me gently put this back down." The metallic item discovered was actually an unexploded military bomb, which was decades old. Also Read: A 7-foot-wide pile of 11 pythons found all coiled up in 'mating balls' in Florida "OK is this live?" Sims remembered the first thoughts when he picked up the bomb with his bare hands last Wednesday (Mar 20). "You panic, then you drop," he said. The weapon was carefully laid back by Sims at the place where his dog discovered it and he then called the authorities. He added that the bomb weighed nearly 10 pounds and was around a foot long. As per a police report, the amount of decay present on the weapon hinted that the bomb had been underground for years. Bomb squad confiscates the bomb A bomb squad reached his home, which was located on 15th Street E, and the neighbourhood was evacuated. Sims said that it was a matter of relief that the bomb was discovered by the dog and was removed from his house. Meanwhile, his neighbour Carla Smith said that she was not worried about the strange discovery. Watch: Florida police officer at the right time, right place "We just watched. I wasn’t scared because I’ve been around people who have found artefacts in the land," she said while speaking to the news outlet. "To me, it was interesting to watch. They did their thing and they were out of here in minutes," she added. The antique bomb was found by the dog two months after a man found a rusty rocket in Bellevue, Washington state. It was said to have been an old Cold War nuclear missile. Meanwhile, an unexploded hand grenade was discovered by a nine-year-old boy in his garden in Yarcombe, East Devon, England. The grenade was removed by the police and detonated in a close field. (With inputs from agencies)

Dog, while digging for bone, unearths decades-old unexploded bomb in Florida home

An analysis by University of Bristol and the University of Uppsala scientists showed that the extinct species of kangaroos did not hop around with its hind legs, rather used alternate methods for their commute such as walking on two or all four legs.

The researchers used fossil evidence and a new analysis of shin and ankle bone data to unveil the mystery behind the evolution of the species and how macropodoids moved around over the past 25 million years.

According to the review published by the team of scientists, the hop of famous Qantas Airlines 'flying kangaroo' that "many people regard as the pinnacle of kangaroo evolution", represents one of the many alternate ways these animals evolved to be successful in distinctive habitats.

"In fact, modern large hopping kangaroos are the exception in kangaroo evolution," says vertebrate paleontologist Christine Janis from the University of Bristol, lead author of the study.

"Large kangaroos were much more diverse as recently as 50 thousand years ago, which may also mean that the habitat in Australia then was rather different from today."

The earliest recognized late Oligocene–middle Miocene, basal types of kangaroos, known to be existing 25 to 15 million years ago, most likely used quadrupedal bounding, climbing and slower speed hopping as their primary modes of locomotion.&nbsp;

The scientists examined the weight-bearing shin bones (tibia) and heel bones (calcaneus) of kangaroos to demonstrate how the hop traits transformed over time.

The research showed that the modern kangaroos' hopping was either rare or absent in all but a few lineages.

Early macropodoids, lived nearly 25–50 million years ago and were small and could bound, climb, and hop to some capacity.

"We want people to appreciate that large kangaroos were much more diverse as recently as 50,000 years ago, which may also mean that the habitat in Australia then was rather different from today. In fact, modern large hopping kangaroos are the exception in kangaroo evolution," Phys.org quoted lead author, Professor Christine Janis, from Bristol's School of Earth Sciences as saying.

Co-author Adrian O'Driscoll, a former Master's student in the Palaeobiology program at Bristol and now a Ph.D. student at the University of York said, "Especially supported by this new data is the notion of bipedal striding rather than hopping in the sthenurines, as their calcanea lack the anatomy (a long calcaneal heel) that would help resist rotational forces at the ankle experienced during hopping, and suggests a more-erect limb posture rather than the crouched posture essential for hopping."

Professor Janis concluded, "The assumption that increasing continent-wide aridity after the end of the Miocene selectively favoured hopping kangaroos is overly simplistic. Hopping is only one of many gait modes employed by kangaroos both in the past and today, and the fast endurance hopping of modern kangaroos should not be regarded as some 'evolutionary pinnacle."

"What makes modern endurance-hopping kangaroos appear so unusual is the geologically recent extinction of similar animals who moved in different ways. We are perhaps then in need of a rival Australian airline that covers shorter distances than QANTAS and boasts a novel motif of a striding sthenurine."

&nbsp;

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An analysis by University of Bristol and the University of Uppsala scientists showed that the extinct species of kangaroos did not hop around with its hind legs, rather used alternate methods for their commute such as walking on two or all four legs.

An analysis by University of Bristol and the University of Uppsala scientists showed that the extinct species of kangaroos did not hop around with its hind legs, rather used alternate methods for their commute such as walking on two or all four legs. The researchers used fossil evidence and a new analysis of shin and ankle bone data to unveil the mystery behind the evolution of the species and how macropodoids moved around over the past 25 million years. According to the review published by the team of scientists, the hop of famous Qantas Airlines 'flying kangaroo' that "many people regard as the pinnacle of kangaroo evolution", represents one of the many alternate ways these animals evolved to be successful in distinctive habitats. "In fact, modern large hopping kangaroos are the exception in kangaroo evolution," says vertebrate paleontologist Christine Janis from the University of Bristol, lead author of the study. "Large kangaroos were much more diverse as recently as 50 thousand years ago, which may also mean that the habitat in Australia then was rather different from today." The earliest recognized late Oligocene–middle Miocene, basal types of kangaroos, known to be existing 25 to 15 million years ago, most likely used quadrupedal bounding, climbing and slower speed hopping as their primary modes of locomotion. The scientists examined the weight-bearing shin bones (tibia) and heel bones (calcaneus) of kangaroos to demonstrate how the hop traits transformed over time. The research showed that the modern kangaroos' hopping was either rare or absent in all but a few lineages. Early macropodoids, lived nearly 25–50 million years ago and were small and could bound, climb, and hop to some capacity. "We want people to appreciate that large kangaroos were much more diverse as recently as 50,000 years ago, which may also mean that the habitat in Australia then was rather different from today. In fact, modern large hopping kangaroos are the exception in kangaroo evolution," Phys.org quoted lead author, Professor Christine Janis, from Bristol's School of Earth Sciences as saying. Co-author Adrian O'Driscoll, a former Master's student in the Palaeobiology program at Bristol and now a Ph.D. student at the University of York said, "Especially supported by this new data is the notion of bipedal striding rather than hopping in the sthenurines, as their calcanea lack the anatomy (a long calcaneal heel) that would help resist rotational forces at the ankle experienced during hopping, and suggests a more-erect limb posture rather than the crouched posture essential for hopping." Professor Janis concluded, "The assumption that increasing continent-wide aridity after the end of the Miocene selectively favoured hopping kangaroos is overly simplistic. Hopping is only one of many gait modes employed by kangaroos both in the past and today, and the fast endurance hopping of modern kangaroos should not be regarded as some 'evolutionary pinnacle." "What makes modern endurance-hopping kangaroos appear so unusual is the geologically recent extinction of similar animals who moved in different ways. We are perhaps then in need of a rival Australian airline that covers shorter distances than QANTAS and boasts a novel motif of a striding sthenurine." WATCH WION LIVE HERE ]

Kangaroos didn't hop always, suggests fossil evidence-based new research

A 26-year-old woman shared a shocking diagnosis she went through after she suffered a knee fracture while sitting on the toilet seat at her home.&nbsp;

According to a report published by New York Post, Bethany Eason had been experiencing knee pain for seven years and had been referred to a doctor.

The woman was advised to get an X-ray done of her knee. After checking the X-ray, the doctor told her there was "something there" and asked Eason to visit a therapist for treatment, stated the outlet.&nbsp;

In February 2017, the woman was facing extreme pain in her left leg while climbing the stairs. Later when she sat on the toilet seat, her knee bone fractured.

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<h2>Giant cell tumour in knee</h2>

On visiting the hospital, Eason was informed it happened because of the presence of a giant cell tumour in her knee because of which her bones and surrounding soft tissue had weakened.&nbsp;

The diagnosis was earth-shattering and beyond Eason's imagination as she had just graduated from college.&nbsp;

"It just shattered,” Eason said, while speaking about her “one-in-a-million” happening. “I felt this immense pain and it was almost like a pop — it was really traumatic," she added.&nbsp;

Eason was informed by the doctors that she needs to undergo both a knee and thighbone replacement because of the tumour.

"I was heartbroken - I used to dance, run and swim and thought I would never be able to do those things again. At that moment in time you don't see a way out - I was told when I had surgery that 99 per cent of patients wouldn't have full mobility after surgery," she said.&nbsp;

WATCH |&nbsp;UK Strike woes: Senior doctors in UK to vote on Industrial Action over pay on June 27th

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Doctors added that the woman will have to learn to walk again and that there is a possibility that she may never be able to wear heels again.

However, defying the odds, Eason was able to regain full mobility. “I said, ‘Well, one per cent&nbsp;can and I can be that one per cent&nbsp;and prove you wrong,’ and I did,” said Eason.&nbsp;

She went through intense physical therapy for seven weeks and worked on strengthening her new leg for a year through home exercises and finally wore her pair of heels.

“I didn’t know what my life was going to look like. Now I can do all those things they thought I wouldn’t be able to — I can kneel and run after my little boy,” Eason further explained.

You can&nbsp;now write for&nbsp;wionews.com&nbsp;and be a part of the community. Share your stories and opinions with us&nbsp;<a href="https://www.wionews.com/content-contribution-registration-form">here</a>.

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A 26-year-old woman shared a shocking diagnosis she went through after she suffered a knee fracture while sitting on the toilet seat at her home. According to a report published by New York Post, Bethany Eason had been experiencing knee pain for seven years and had been referred to a doctor.

A 26-year-old woman shared a shocking diagnosis she went through after she suffered a knee fracture while sitting on the toilet seat at her home. According to a report published by New York Post, Bethany Eason had been experiencing knee pain for seven years and had been referred to a doctor. The woman was advised to get an X-ray done of her knee. After checking the X-ray, the doctor told her there was "something there" and asked Eason to visit a therapist for treatment, stated the outlet. In February 2017, the woman was facing extreme pain in her left leg while climbing the stairs. Later when she sat on the toilet seat, her knee bone fractured. ALSO READ | Romania probes five doctors suspected of reusing medical implants extracted from dead patients Giant cell tumour in knee On visiting the hospital, Eason was informed it happened because of the presence of a giant cell tumour in her knee because of which her bones and surrounding soft tissue had weakened. The diagnosis was earth-shattering and beyond Eason's imagination as she had just graduated from college. "It just shattered,” Eason said, while speaking about her “one-in-a-million” happening. “I felt this immense pain and it was almost like a pop — it was really traumatic," she added. Eason was informed by the doctors that she needs to undergo both a knee and thighbone replacement because of the tumour. "I was heartbroken - I used to dance, run and swim and thought I would never be able to do those things again. At that moment in time you don't see a way out - I was told when I had surgery that 99 per cent of patients wouldn't have full mobility after surgery," she said. WATCH | UK Strike woes: Senior doctors in UK to vote on Industrial Action over pay on June 27th Doctors added that the woman will have to learn to walk again and that there is a possibility that she may never be able to wear heels again. However, defying the odds, Eason was able to regain full mobility. “I said, ‘Well, one per cent can and I can be that one per cent and prove you wrong,’ and I did,” said Eason. She went through intense physical therapy for seven weeks and worked on strengthening her new leg for a year through home exercises and finally wore her pair of heels. “I didn’t know what my life was going to look like. Now I can do all those things they thought I wouldn’t be able to — I can kneel and run after my little boy,” Eason further explained. You can now write for wionews.com and be a part of the community. Share your stories and opinions with us here. WATCH WION LIVE HERE

UK: Woman's knee bone shatters after sitting on toilet seat. Here's her shocking diagnosis

The study examined bone loss in astronauts, its effects, and their recovery after returning to Earth.

Astronauts lose bone while in space, new study reveals

Remains of Europe's largest dinosaur have been unearthed. Fossilised bones were found on the isle of Wight. Named the 'White Rock Spinosaurid' it lived 125 million years ago.

A dinosaur that lived 125 million years ago: Europe's largest dinosaur unearthed

Considering bone or joint surgery? In many cases, surgery may be no more effective than options like exercise, physical therapy and drug treatments.

Hip and knee replacements, surgery for carpal tunnel syndrome and other orthopedic procedures are among the most common elective surgeries performed today, but they involve cost, risk and sometimes weeks or months of recovery. Many of these surgeries are not supported by evidence from randomized trials, a review found. Even when surgery has been shown to be effective, the review concluded, it may not be significantly better than nonsurgical care.

British researchers looked at studies of 10 common orthopedic operations, including surgeries of the knee, hip, shoulder, spine and wrist. They found good evidence of the superiority of surgery over other treatments for carpal tunnel syndrome and total knee replacement. For six other common surgeries, randomized trials found little advantage over interventions like exercise, weight management, physical therapy and drug treatment. The researchers found no controlled trials that had compared hip replacement or knee cartilage repair with nonsurgical care. The study is in The BMJ.

“Our study doesn’t show that these operations don’t make patients better,” said the lead author, Dr. Ashley W. Blom, a professor of orthopedic surgery at the University of Bristol in England. “And it does not say that treatments do not work if they have not undergone testing by randomized controlled trials. It’s just that some don’t work any better than the best nonsurgical treatments.”

Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco, who was not involved in the study, said, “I think it’s fair that we hold the mirror up to ourselves and scrutinize effectiveness for some of these operations. It’s important to understand where we have gaps in knowledge of the efficacy or nonefficacy of common surgical treatments.”

At the same time, he said, “It’s also important to understand that just because there isn’t a randomized trial supporting a given treatment, that doesn’t mean that the treatment is not effective.” Hip surgery, he said, is a good example. There may be no randomized trials of hip surgery, but there is overwhelming observational evidence for its effectiveness compared with nonsurgical treatment.

In other common procedures, the picture may be different. An arthroscopic operation to repair the anterior cruciate ligament, or ACL, in the knee, among the most common sports injury surgeries in the United States, has a rate of success as high as 97% in some studies. But when the operation was compared with nonsurgical treatments, the review found, there was little difference in pain scores or the need for further surgical or nonsurgical treatment.

The researchers describe a large review of studies of the operation to repair the rotator cuff, the group of tendons and muscles that keeps the upper arm bone in the shoulder socket. Compared with exercise and steroid injections, the review found, there was little or no clinically significant difference in pain, function, quality of life or patient satisfaction with the results.

Some studies were randomized controlled trials, giving one group of patients real surgery and a matched group a placebo operation. In two such studies of surgery for shoulder impingement, a condition that causes pain on raising the arm, there was no difference between surgery and placebo surgery in patient-reported outcomes or adverse events.

Lumbar spine decompression is an operation to relieve the pain caused by a ruptured or bulging disk, sometimes called a pinched nerve, in the lower spine. Although the quality of the evidence was low, three analyses showed that surgery and nonsurgical treatments provided equivalent improvements.

There were no studies that compared surgical repair of the meniscus, the cartilage that covers the knee, with nonoperative care or a placebo. But in 10 randomized trials comparing a different procedure known as meniscectomy, or partial removal of the meniscus, with more conservative treatment, the operation did not provide meaningful improvement in knee pain, function or quality of life.

“The best nonoperative care is often multimodal and may involve a combination of physical, medical and psychological interventions, and it should not be assumed that these are necessarily the easiest or most cost-effective options for patients,” Blom said. “Clinicians should discuss both operative and the best nonoperative care with patients so that patients can consider all options and thereby make informed choices.”

Patient outcomes from these surgeries vary greatly, and these differences are important, Morshed said. “Future research is going to provide more nuanced inferences on the effect of surgery as we begin to understand on a patient level those characteristics that make them more or less likely to respond to a procedure,” he said.

Considering bone or joint surgery? In many cases, surgery may be no more effective than options like exercise, physical therapy and drug treatments. Hip and knee replacements, surgery for carpal tunnel syndrome and other orthopedic procedures are among the most common elective surgeries performed today, but they involve cost, risk and sometimes weeks or months of recovery.

Considering bone or joint surgery? In many cases, surgery may be no more effective than options like exercise, physical therapy and drug treatments. Hip and knee replacements, surgery for carpal tunnel syndrome and other orthopedic procedures are among the most common elective surgeries performed today, but they involve cost, risk and sometimes weeks or months of recovery. Many of these surgeries are not supported by evidence from randomized trials, a review found. Even when surgery has been shown to be effective, the review concluded, it may not be significantly better than nonsurgical care. British researchers looked at studies of 10 common orthopedic operations, including surgeries of the knee, hip, shoulder, spine and wrist. They found good evidence of the superiority of surgery over other treatments for carpal tunnel syndrome and total knee replacement. For six other common surgeries, randomized trials found little advantage over interventions like exercise, weight management, physical therapy and drug treatment. The researchers found no controlled trials that had compared hip replacement or knee cartilage repair with nonsurgical care. The study is in The BMJ. “Our study doesn’t show that these operations don’t make patients better,” said the lead author, Dr. Ashley W. Blom, a professor of orthopedic surgery at the University of Bristol in England. “And it does not say that treatments do not work if they have not undergone testing by randomized controlled trials. It’s just that some don’t work any better than the best nonsurgical treatments.” Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco, who was not involved in the study, said, “I think it’s fair that we hold the mirror up to ourselves and scrutinize effectiveness for some of these operations. It’s important to understand where we have gaps in knowledge of the efficacy or nonefficacy of common surgical treatments.” At the same time, he said, “It’s also important to understand that just because there isn’t a randomized trial supporting a given treatment, that doesn’t mean that the treatment is not effective.” Hip surgery, he said, is a good example. There may be no randomized trials of hip surgery, but there is overwhelming observational evidence for its effectiveness compared with nonsurgical treatment. In other common procedures, the picture may be different. An arthroscopic operation to repair the anterior cruciate ligament, or ACL, in the knee, among the most common sports injury surgeries in the United States, has a rate of success as high as 97% in some studies. But when the operation was compared with nonsurgical treatments, the review found, there was little difference in pain scores or the need for further surgical or nonsurgical treatment. The researchers describe a large review of studies of the operation to repair the rotator cuff, the group of tendons and muscles that keeps the upper arm bone in the shoulder socket. Compared with exercise and steroid injections, the review found, there was little or no clinically significant difference in pain, function, quality of life or patient satisfaction with the results. Some studies were randomized controlled trials, giving one group of patients real surgery and a matched group a placebo operation. In two such studies of surgery for shoulder impingement, a condition that causes pain on raising the arm, there was no difference between surgery and placebo surgery in patient-reported outcomes or adverse events. Lumbar spine decompression is an operation to relieve the pain caused by a ruptured or bulging disk, sometimes called a pinched nerve, in the lower spine. Although the quality of the evidence was low, three analyses showed that surgery and nonsurgical treatments provided equivalent improvements. There were no studies that compared surgical repair of the meniscus, the cartilage that covers the knee, with nonoperative care or a placebo. But in 10 randomized trials comparing a different procedure known as meniscectomy, or partial removal of the meniscus, with more conservative treatment, the operation did not provide meaningful improvement in knee pain, function or quality of life. “The best nonoperative care is often multimodal and may involve a combination of physical, medical and psychological interventions, and it should not be assumed that these are necessarily the easiest or most cost-effective options for patients,” Blom said. “Clinicians should discuss both operative and the best nonoperative care with patients so that patients can consider all options and thereby make informed choices.” Patient outcomes from these surgeries vary greatly, and these differences are important, Morshed said. “Future research is going to provide more nuanced inferences on the effect of surgery as we begin to understand on a patient level those characteristics that make them more or less likely to respond to a procedure,” he said.

Considering bone or joint surgery? You may not need it.

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