Optimizing the management of full-thickness rotator cuff tears.

Abstract

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) on Optimizing the Management of Full-Thickness Rotator Cuff Tears (RC). Evidence-based information, in conjunction with clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The RC AUC Writing Panel began the development of the clinical scenarios by identifying clinical indications typical of patients commonly presenting with full-thickness rotator cuff tears in clinical practice, as well as from the current evidence-based clinical practice guidelines and its supporting literature. The 432 patient scenarios and 5 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (median rating, 7 to 9), may be appropriate (median rating, 4 to 6), or rarely appropriate (median rating, 1 to 3).