Note from the Editor-in-Chief

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• Note from the Deputy International Editor
• Copyright

At the 2007 American and Shoulder Elbow Surgeons meeting, I had the pleasure to sit down to lunch with Christian Gerber, the esteemed Swiss shoulder specialist. Christian remarked how unique it was that the shoulder and elbow world had such international representation, and what a strength it was for our organization. When Charles Neer helped establish the American Shoulder and Elbow Surgeons in 1982 and the Journal of Shoulder and Elbow Surgery (JSES) in 1991, he insisted on both having a global presence. The second Chairman of the Board of Trustees of JSES was a Dane, Otto Sneppen. And since its existence, JSES has had an international Editorial Board and solicited articles from around the world. This is something we will continue to do and continue to emphasize. We in North America learn continually from our European, Asian, Oceanic, South American, and African associates.

When JSES was founded in 1991, all communication was done by snail mail for mailing of articles and reviews back and forth. When I started as an Associate Editor in 2004, we still worked that way. With the international nature of the group, and the concomitant delays in mailing internationally, it made sense to segregate the Editorial Board into regions. We are trying to move away from that, as we have long since moved to e-mail and electronic submission of articles and editing. The International Olympic Committee (IOC) often states that its members are representatives of the IOC to their nations, rather than representatives of their nations on the IOC. In a similar vein, I would like to see all of our editors be considered international editors of JSES, and not editors only to a specific nation or region.

In this regard, one of the most significant additions we have made to JSES is the new position of Deputy International Editor. This position is being ably manned by Roger Emery, who is from England. Roger had been a Regional Associate Editor of JSES for several years, and is well qualified for this new position. And other discussions are ongoing in ways we can increase the representation of surgeons and providers from outside North America in the workings of the Journal. We consider it of paramount importance to maintain the international status of the Journal of Shoulder and Elbow Surgery. And we will.

In that regard, the Board of Trustees of the Journal has designed this issue to be especially devoted to internationally authored papers. The articles for this issue have also been selected by Dr Emery, who discusses this selection process below.

Bill Mallon, MD

Editor-in-Chief

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Note from the Deputy International Editor 

The July/August edition of the Journal of Shoulder and Elbow Surgery (JSES) focuses on contributions from Europe and internationally. The selection has been made from the large number of submissions received from surgeons and scientists working internationally. These papers were assessed by the reviewers, selected globally, and handled by a minimum of 3 editors from different continents. The selection does not attempt to archive the scientific activities internationally, but rather to focus on the difficult problems in shoulder arthroplasty and our ability to surgically manage rotator cuff disease.

The Journal of Shoulder and Elbow Surgery has been the official publication of the Société Éuropéenne pour la Chirurgie de l'Épaule et du Coude (SECEC) since 1992, as it has for several international shoulder and elbow groups. Many of SECEC's members are reviewers, assistant editors, or associate editors for the Journal. SECEC is a vibrant society with a strong and important history. The Journal seeks to provide the platform for dissemination of its most important contributions that influence—and often change—the management of our individual patients.

The major change in the European surgical arena has been the trend to communicate and publish in a common language. This has been exemplified particularly by France and Italy, whose contributions are now familiar to us all. The trend is constantly balanced by the argument for new journals, reflecting diversity in thought with respect to medical publishing and specific national requirements. We should be aware of the risks of creating parochial and possibly superfluous journals of lesser influence. This is particularly relevant at a time of change in publishing considered as significant as Johannes Gutenberg's development of the mechanical printing press.

Where can European and international shoulder and elbow surgeons contribute? The greatest contributions have arisen from original and unstifled thinking, exemplified by the development of reverse anatomy shoulder prostheses. The ability in Europe to organize large multicenter studies, even across national borders, is commendable; however, these studies must be designed stringently to make these huge efforts worthwhile. The important questions in our field can often only be answered by complex and expertly run clinical trials. These trials are expensive and beyond the support of the most ambitious professional societies. For example, the United Kingdom Rotator Cuff (UKUFF) trial, a multicenter randomized controlled trial to measure the clinical and cost effectiveness of different types of rotator cuff repairs (www.hta.ac.uk/project/1551.asp?src=b07), has been funded by the United Kingdom's Department of Health's Technology Assessment Programme at a cost of in excess of $3 million.

International collaboration can be measured by the publication ratio of papers whose affiliations include addresses from more than one country. For the Journal of Shoulder and Elbow Surgery, this index has risen from 2.68 in 1999 to 10.48 in 2007 (SCImago. (2007). SJR—SCImago Journal & Country Rank. http://www.scimagojr.com). Although this can be expected to continue to increase, pan-European projects face strong competition for European Economic Community (EEC) funding. Within individual countries in Europe there have been many changes, particularly in the traditional strongholds of public sector care, namely the United Kingdom and Scandinavia. In these countries, outsourcing orthopedic care to the private sector has dramatically increased. This potentially weakens the ability of the profession to participate in major trials.

Working with the implant industry is undoubtedly important. Better implant design and facilitated techniques may help the patient's journey. Future research should help us to achieve our aims and reduce the risk of implant failure. But will it ever answer the major and fundamental questions of our understanding of the pathophysiologic and genetic basis of the conditions we treat, and can we influence their natural history by surgery?

Our profession needs to work together to create programmed research and deliver results that either change or support our practice. We need to identify these projects, rather than wait for calls from government agencies, usually as a result of increased economic burden in health care. The Journal needs to work towards creating the platform for dissemination of this type of information and the forum for discussion. Only a global publication, such as the Journal of Shoulder and Elbow Surgery, can achieve this. Surgeons in Europe believe in the traditional peer review process to ensure quality, whether it be originality, scientific rigor, or impact.

Roger Emery, MD, FRCS

Deputy International Editor