title: Surgical management of rotator cuff tears in adults: Prospective study of 50 consecutive patients and professional practice self-assessment.
abstract: BACKGROUND
  As part of quality-improvement efforts, we self-assessed our professional practices regarding the surgical management of rotator cuff tears comparatively to recommendations issued by the French National Authority for Health (HAS).
  
  
  METHODS
  An independent observer prospectively evaluated 50 consecutive patients with rotator cuff tears treated surgically over a 1-year period. For each patient, we identified divergences with the 20 relevant HAS recommendations.
  
  
  RESULTS
  Initially, 54% of practices were found to diverge from HAS recommendations, 10% regarding the preoperative work-up, 14% the duration of initial medical treatment, and 30% the nature of the surgical procedure.
  
  
  CONCLUSIONS
  A review of the data showed that 26% of practices diverged from recommendations, 10% regarding the preoperative work-up, 2% the duration of initial medical treatment, and 14% the nature of the surgical procedure. Overall, for the 26% of divergent practices, 10% were related to judgement or evaluation errors and 16% to a deliberate and substantiated decision made by the surgeons.
  
  
  CONCLUSIONS
  The clinical practice guidelines issued by the HAS, although useful and necessary, were shown by our study to exhibit a number of limitations. Thus, our data illustrate the complexity of surgical management decisions.
  
  
  METHODS
  Level IV (cases series).
authors.affiliation: Service de chirurgie orthopédique 1, hôpital Trousseau, CHU de Tours, avenue de la République, Chambray-lès-Tours, Tours, France.
authors.forename: A
authors.initials: A
authors.lastname: Williot
authors.forename: L
authors.initials: L
authors.lastname: Favard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012647:Self-Assessment; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013708:Tendon Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome