J.G. Wright, T.A. Einhorn, and J.D. Heckman reply: Mr. Rama
states that Grades of Recommendation are "simple [and] useful for a busy
orthopaedic surgeon." He is also correct that Grades of Recommendation
are built on Levels of Evidence and, thus, are complementary to the efforts of
JBJS to promote evidence-based orthopaedics. We appreciate Mr. Rama's
support for evidence-based orthopaedics and the changes to JBJS.With regard to Mr. Rama's specific comments, he first points out that if
randomized trials have not been performed, then treatment recommendations
arising from those studies cannot be Grade A. We agree.