Saturday, August 8, 2015

Rotator cuff tears: are the AAOS appropriate use criteria of use?

Management of full-thickness rotator cuff tears: appropriate use criteria.

According to the authors, appropriate use criteria (AUC) were developed for full-thickness rotator cuff tears "to determine when it is reasonable to recommend nonoperative care, partial repair/d├ębridement, repair, reconstruction, or arthroplasty".

A panel attempted to interpret the clinical importance attributed to the various patient and pathologic variables. The panel's conclusions were:

(1) A nonoperative program was appropriate if the patient had a positive response to conservative care; however, a repair maybe appropriate.
(2) Rotator cuff repair was appropriate when conservative treatment failed in symptomatic patients. (3) Arthroplasty maybe appropriate only in healthy patients with pseudoparalysis and chronic massive tears. 

Surprisingly, neither factors that decreased healing nor adversely affected outcome had a strong influence on the panel's treatment recommendations.

Comment: After reading this article we do not feel additionally informed regarding the management of patients with rotator cuff tears. It is of note that a prior AAOS effort also had difficulty in coming up with useful guidance in the management of cuff pathology. Similarly a Cochrane Review found no difference in either functional outcome scores or pain relief between surgical and active nonoperative treatment for cuff disorders. Firm conclusions could not be made regarding the effectiveness of open versus arthroscopic surgical approaches and conservative management for rotator cuff disease. 

Our approach to cuff disease - the most common affliction of the shoulder -  is described here.

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