Oh, look at us, we’ve got a global cross-sectional survey on our hands. Apparently, the AO Spine Sacral Injury Classification System has been validated by surgeons worldwide, but – shocker – there’s no consensus on a surgical algorithm for sacral fractures. So, what do we do? We send out a survey, of course!

The survey was sent to orthopedic surgeons, spine surgeons, and neurosurgeons across the globe. They were given descriptions of controversial sacral injuries and asked whether the patient should undergo operative or non-operative management. The results were then used to create a surgical algorithm.

The AO Spine Knowledge Forum Trauma experts decided that a 70% international agreement would indicate a recommendation for initial operative intervention. So, sacral fracture subtypes of AOSIS 5 or greater were considered operative, while those with AOSIS 4 or less were generally non-operative. But wait, there’s a twist! For subtypes with an AOSIS of 3 or 4, if the sacral fracture was associated with an anterior pelvic ring injury, the decision was left to the surgeons’ discretion.

So, the AO Spine Sacral Injury Classification System offers a validated hierarchical system to approach sacral injuries. And thanks to the input of surgeons worldwide, a surgical algorithm was developed. But hold your horses, it still needs further validation. But hey, at least it gives surgeons a basis for discussion and the development of standard of care treatment.

And just to remind you, this is all Level IV. Whatever that means.

RECAP: Oh, brace yourselves, folks! We’ve been on a wild ride since the Fifth International Scientific Tendinopathy Symposium in 2019. Apparently, our understanding of tendinopathy has “substantially advanced”. So, we’ve decided to play favorites and pick the ‘best paper’ for each year from 2019 to 2023. Because, you know, why not add a little competition to science? It was a tough job, but someone had to do it. Did your favorite paper make it to our elite list? Or are you fuming because we overlooked some groundbreaking research? Feel free to vent your frustrations or shower us with praise using the hashtag #JOSPTtendon. Because nothing says scientific discourse like a good old social media debate, right?

TL;DR: So, apparently, we’ve got these guidelines for Achilles tendinopathy that say “Nah, you don’t need imaging for diagnosis.” But, surprise, surprise, there’s a whole lot of variation in how imaging is used, especially in research and sports. Now, if you jump the gun and start imaging too early, people might get all worked up over what they ‘see’ as the problem and think that’s the main cause of pain. This could lead to patients getting invasive treatments based on a picture, when a bit of rehab might have done the trick. But hey, on the flip side, imaging can help rule out Achilles tendinopathy and identify other potential issues. And as more rehab clinicians are becoming direct access practitioners and primary health practitioners, ultrasound imaging could be a handy tool for diagnosis, identifying conditions that need a referral, and managing conditions like Achilles tendinopathy. So, despite the potential limitations, we’re arguing that the benefits of ultrasound imaging for diagnosing tendinopathy outweigh the drawbacks. But hey, what do we know? We’re just the researchers.