Friday, September 20, 2013

Rotator cuff tears - ?appropriate use criteria? AAOS

According to the AAOS website, The AAOS Board of Directors has approved new appropriate use criteria (AUC) on "Optimizing the Management of Full-Thickness Rotator Cuff (RC) Tears." This is the second AUC released by AAOS, and is supported by both a written document and the AAOS mobile-optimized AUC web app. The AUC is based on a systematic review of the literature as well as clinician expertise from several specialties. It covers five treatments—nonsurgical modalities, partial repair and/or debridement, repair, reconstruction, and arthroplasty—and presents 432 different patient scenarios to help clinicians identify for whom and when the treatments are appropriate.

It is very entertaining to play with their app.

We tried two scenarios, both of a patient with moderate symptoms, ASA 2, no factors that would interfere with healing or the outcome, both with moderate sized tears and small amounts of fatty infiltration. Let's say that the patient was 'some better' with non-surgical management. In the first scenario the surgeon enters that the patient had responded to previous treatment - the result is that non-operative treatment is appropriate. In the second, the surgeon enters that the patient had not responded to previous treatment - the result is that the appropriate treatment is repair. Thus one small change in the response justifies it really that simple? We encourage you to 'play' with this app and see if the 'appropriate use' recommendations make sense to you.

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