The late Dr. Vladimir Janda (1923-2002), a Czech neurologist, observed that there
are two schools of thought in musculoskeletal medicine: structural and functional.
The traditional structural approach is rooted in anatomy and biomechanics.
Orthopedic medicine is influenced by a structural approach to pathology, relying
heavily on visualization of structures through X-ray imaging, magnetic resonance
imaging (MRI), or surgery. Structural lesions are damages to physical structures such
as ligaments and bones that can be diagnosed by special clinical tests such as the
anterior drawer sign in anterior cruciate ligament (ACL) dysfunction. These structural
lesions are repaired through immobilization, surgery, or rehabilitation. The diagnosis
and treatment of structural lesions such as ligament tears are well supported in the
scientific literature. The structural approach is the foundation of medical education
and practice.