title: Evaluation of American Academy of Orthopaedic Surgeons Appropriate Use Criteria for the management of full-thickness rotator cuff tears.
abstract: BACKGROUND
  The American Academy of Orthopaedic Surgeons (AAOS) recently released Appropriate Use Criteria (AUC) to aid in determining the appropriateness of treatment options. This study compares AAOS AUC recommendations with a cohort of patients treated for known full-thickness rotator cuff tears (RCTs).
  
  
  METHODS
  Prospectively collected demographic information, treatment allocation, and American Shoulder and Elbow Surgeons (ASES) shoulder and Western Ontario Rotator Cuff Index scores of 134 patients were retrospectively reviewed. Other criteria required by the AAOS AUC were collected by retrospective record review. Criteria were entered into the AAOS AUC Web-based application to rate the "appropriateness" of treatment options. Ratings were compared with actual treatments and outcomes at 32- or 48-week follow-up.
  
  
  RESULTS
  There was excellent agreement between the AUC recommendations and the actual treatment administered (κ = .945; 95% confidence interval, 0.892-1.000; P <.0001). The administered treatment was "appropriate" for 79% of patients, "may be appropriate" for 19%, and "rarely appropriate" for 2%. Response to previous treatment (P <.0001), American Society of Anesthesiologists Physical Status Classification (P <.0001), and presence of muscle atrophy or fatty infiltration (P = .047) were the only variables that significantly and independently predicted discordance between treatment and the AUC recommendation. In the cases (n = 3) of discordance, the American Shoulder and Elbow Surgeons score improved significantly more (P = .049) than when there was agreement.
  
  
  CONCLUSIONS
  Improved clinical outcomes may be achieved for full-thickness RCTs when AAOS AUC recommendations are followed; however, because improved clinical outcomes may also be achieved when the recommendations are not followed, further investigation is needed in a population of patients in whom there is discordance between AAOS AUC recommendations and the treatment administered.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Cowan
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Carpenter
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Robbins
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Gagnier
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: bsmiller@med.umich.edu.
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D012955:Societies, Medical; D016896:Treatment Outcome
keywords: AAOS; Appropriate Use Criteria; discordance; rotator cuff tear; shoulder; treatment consensus