Evidence-Based Orthopaedics   |    
American Academy of Orthopaedic Surgeons Clinical Practice Guideline onOptimizing the Management of Rotator Cuff Problems
Robert A. Pedowitz, MD, PhD; Ken Yamaguchi, MD; Christopher S. Ahmad, MD; Robert T. Burks, MD; Evan L. Flatow, MD; Andrew Green, MD; Janet L. Wies, MPH; Justin St. Andre, MA; Kevin Boyer; Joseph P. Iannotti, MD, PhD; Bruce S. Miller, MD, MS; Robert Tashjian, MD; William C. Watters, III, MD; Kristy Weber, MD; Charles M. Turkelson, PhD; Laura Raymond, MA; Patrick Sluka, MPH; Richard McGowan, MLS
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A commentary by Robert A. Pedowitz, MD, PhD, is linked to the online version of this article at jbjs.org.

A commentary by James O. Sanders, MD, David Jevsevar, MD, MBA, Michael J. Goldberg, MD, and Kristy L. Weber, MD, is linked to the online version of this article at jbjs.org.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
Disclaimer: This clinical guideline was developed by an AAOS physician volunteer Work Group and is provided as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment. It is not intended to be a fixed protocol as some patients may require more or less treatment. Patient care and treatment should always be based on a clinician's independent medical judgment given the individual clinical circumstances.
The complete AAOS guideline can be found at http://www.aaos.org/Research/guidelines/RCP_summary.pdf

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jan 18;94(2):163-167
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


AAOS Guideline on Optimizing the Management of Rotator Cuff Problems
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    A. Bruce Reid, MD, ABOS, FRCSC
    Posted on March 09, 2012
    Are You Kidding Me!
    Griffin, GA

    After 5 years of residency, 20 years of private practice in general orthopaedics, 2 recertifications, I'm embarrassed at the summation and Clinical Practice Guideline on Optimizing the Management of Rotator Cuff Problems. JBJS 2012: 94 163-7. Rotator cuff problems make up 10-15% of my practice and to sum up ALL of the evidence based, reproducible, unbiased, transparent, meta analysis knowledge that we have in our profession to treat this common problem is the following: on the positive side we have 1. an only moderate recommendation to treat symptomatic impingement with exercise and NSAIDs and 2. an only consensus recommendation to use ice as post op pain relief. On the negative side we have an only moderate recommendation that 1. workers compensation cases have a less favorable outcome; 2. don't use grafts; 3. acromioplasty is not needed with a repair; and only a consensus recommendation to 4. not operate on an asymptomatic tear. If this is the sum total of our scientific knowledge on the Management of Rotator Cuff Problems, it only reinforces my assessment that we have a long, long way to go before Orthopaedic Surgery ever becomes Evidenced Based, and reinforces the old adage that Medicine is an Art and not a Science. We treat our patients by what works in our training and our personal experience and there are no Gold Standards. I can't imagine the amount of work and effort that the authors and Academy put into this Guideline but I appreciate the honesty and integrity of admitting the paucity of true knowledge we have. I look forward to future Guidelines. Truly humbling !

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