Sports Medicine Research: In the Lab & In the Field: American Academy of Orthopaedic Surgeons Clinical Practice Guideline on: Optimizing the Management of Rotator Cuff Problems (Sports Med Res)
Friday, January 27, 2012

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on: Optimizing the Management of Rotator Cuff Problems

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on: Optimizing the Management of Rotator Cuff Problems

Pedowitz RA, Yamaguchi K, Ahmad CS, Burks RT, Flatow EL, Green A, Wies JL, St Andre J, Boyer K, Iannotti JP, Miller BS, Tashjian R, Watters WC, Weber K, Turkelson CM, Raymond L, Sluka P, McGowan R. J Bone Joint Surg Am. 2012 Jan 18;94(2):163-7.

The Journal of Bone and Joint Surgery (American Volume) has published a summary of the American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Optimizing the Management of Rotator Cuff Problems along with several commentaries.

The first commentary is a personal perspective on the guidelines process by the chair of the of the rotator cuff guidelines working group: Does Every Question Need a Level-I Answer? Pragmatic and Ethical Considerations of Clinical Practice Guidelines: Commentary on an article by Robert A. Pedowitz, MD, PhD, et al.: “American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Optimizing the Management of Rotator Cuff Problems” (Free Full Text Available). Dr. Pedowitz proposes “A guideline does not replace expert surgical judgment. Lack of Level-I evidence does not mean that treatments are ineffective, irrational, or unsafe. It simply means that an RCT has not been published. For some clinical questions, Level-I investigation is not the best answer.”

The second commentary was provided by Sanders et al and offers a response to Dr. Pedowitz’s commentary: Quality Guidelines Need Evidence, Not Opinion: Commentary on an article by Robert A. Pedowitz, MD, PhD, et al.: “American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Optimizing the Management of Rotator Cuff Problems” (Free Full Text Available). The authors provide several relevant points: “Expert opinion needs to be placed in proper perspective. Many of our experts may have undisclosed conflicts of interest, may see a different group of patients than we do, or may value certain outcomes more than our patients do, which may bias their perspectives…lack of evidence for a treatment does not necessarily mean that the treatment does not work. Ultimately, only evidence that a treatment does not work means that it does not work. The inconclusive recommendations cry for high-quality research.”

Other American Academy of Orthopaedic Surgeons’ clinical practice guidelines can be found on their website.

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