S. Samuel Bederman, MD, PhD, FRCSC, Josie Chundamala, MA and James G. Wright, MD, MPH, FRCSC J Am Acad Orthop Surg, Vol 18, No 8, August 2010 Randomized clinical trials (RCTs) generally provide the highest quality and least biased evidence for treatment effectiveness. Relatively few high-quality RCTs have been published in the orthopaedic literature. Barriers to increasing the quantity of trials include the orthopaedic culture, patient preferences, and the availability of treatment outside trials. Challenges to conducting better quality trials include sample size, random allocation, and blinding. Undertaking more high-quality trials can improve the evidence available for determining treatment effectiveness, resulting in better patient care.