All Guidelines

All Guidelines 2020-01-08T18:06:15+00:00
Acute Compartment Syndrome (2018)
Anesthesia and Analgesia in TJA (2020)
Anterior Cruciate Ligament Injuries (2014)
Carpal Tunnel Syndrome (2016)
Distal Radius Fractures (2009)
Glenohumeral Joint Osteoarthritis (2020)
Hip Fractures in the Elderly (2014)
Limb Salvage or Early Amputation (2019)
Osteoarthritis of the Hip (2017)
Osteoarthritis of the Knee (Arthroplasty) (2015)
Osteoarthritis of the Knee (Non-Arthroplasty) (2013)
Osteochondritis Dissecans (2010)
Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months (2014)
Pediatric Diaphyseal Femur Fractures (2015)
Pediatric Supracondylar Humerus Fractures (2011)
Periprosthetic Joint Infections (2019)
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures (2012)
Psychosocial Factors Influencing Trauma Recovery (2019)
Rotator Cuff Injuries (2019)
Surgical Site Infections (2018)
Tranexamic Acid in Total Joint Arthroplasty (2018)
Treatment of Metastatic Carcinoma and Myeloma of the Femur (2020)
Use of Imaging Prior to Referral to a Musculoskeletal Oncologist (2018)
Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty (2011)
Strong Evidence

Anesthesia and Analgesia in Total Joint Arthroplasty
Acetaminophen and Postoperative Complications
Strong Evidence Strong Evidence
Gabapentinoids and Postoperative Pain and/or Opioid Use
Strong Evidence Strong Evidence
Gabapentinoid Use Following Discharge
Strong Evidence Strong Evidence
Oral NSAIDs and Postoperatiave Pain and/or Opioid Use
Strong Evidence Strong Evidence
Intravenous Ketorolac and Postoperative Pain and/or Opioid Consumption
Strong Evidence Strong Evidence
Opioids Administered Immediately Prior to TJA Surgery
Strong Evidence Strong Evidence

Diagnosis and Prevention of Periprosthetic Joint Infections
Blood Tests for Preoperative Diagnosis (Strong Evidence)
Strong Evidence Strong Evidence
Infected Joint Replacements - Intraoperative Tests - (Strong)
Strong Evidence Strong Evidence
Antibiotics With Low Preoperative Suspicion or Established PJI
Strong Evidence Strong Evidence

Limb Salvage or Early Amputation
Psychosocial Factors
Strong Evidence Strong Evidence

Management of Anterior Cruciate Ligament Injuries
History and Physical
Strong Evidence Strong Evidence
Magnetic Resonance Imaging (MRI)
Strong Evidence Strong Evidence
Single or Double Bundle Reconstruction
Strong Evidence Strong Evidence
Autograft Source
Strong Evidence Strong Evidence
Autograft vs Allograft
Strong Evidence Strong Evidence

Management of Carpal Tunnel Syndrome
Observation
Strong Evidence Strong Evidence
Physical Signs
Strong Evidence Strong Evidence
Increased Risk of CTS (Strong Evidence)
Strong Evidence Strong Evidence
Immobilization
Strong Evidence Strong Evidence
Steroid Injections
Strong Evidence Strong Evidence
Magnet Therapy
Strong Evidence Strong Evidence
Surgical Release Location
Strong Evidence Strong Evidence
Surgical Procedures Versus Nonoperative Treatments
Strong Evidence Strong Evidence
Postoperative Immobilization
Strong Evidence Strong Evidence

Management of Glenohumeral Joint Osteoarthritis
HYALURONIC ACID
Strong Evidence Strong Evidence
PROGNOSTIC FACTORS (BMI)
Strong Evidence Strong Evidence
PROGNOSTIC FACTORS (GENDER/SEX)
Strong Evidence Strong Evidence
PROGNOSTIC FACTORS (COMORBIDITIES)
Strong Evidence Strong Evidence
TOTAL SHOULDER ARTHROPLASTY
Strong Evidence Strong Evidence
GLENOID COMPONENT – PEGGED OR KEELED
Strong Evidence Strong Evidence

Management of Hip Fractures in the Elderly
Preoperative Regional Analgesia
Strong Evidence Strong Evidence
Anesthesia
Strong Evidence Strong Evidence
Displaced Femoral Neck Fractures
Strong Evidence Strong Evidence
Subtrochanteric or Reverse Obliquity Fractures
Strong Evidence Strong Evidence
Transfusion Threshold
Strong Evidence Strong Evidence
Intensive Physical Therapy
Strong Evidence Strong Evidence
Interdisciplinary Care Program
Strong Evidence Strong Evidence
Postoperative MultiModal Analgesia
Strong Evidence Strong Evidence

Management of Osteoarthritis of the Hip
Non-narcotic management
Strong Evidence Strong Evidence
Intraarticular corticosteroids: supported
Strong Evidence Strong Evidence
Intraarticular hyaluronic acid: not supported
Strong Evidence Strong Evidence
Physical Therapy as a Conservative Treatment
Strong Evidence Strong Evidence

Management of Rotator Cuff Injuries
Management of Small to Medium Tears
Strong Evidence Strong Evidence
Long Term Non-Operative Management
Strong Evidence Strong Evidence
Diagnosis (Clinical Examination)
Strong Evidence Strong Evidence
Diagnosis (Imaging)
Strong Evidence Strong Evidence
Post-Op Mobilization Timing
Strong Evidence Strong Evidence
High-Grade Partial Thickness Rotator Cuff Tears
Strong Evidence Strong Evidence
Prognostic Factors (Age)
Strong Evidence Strong Evidence
Prognostic Factors (Worker's Compensation)
Strong Evidence Strong Evidence
Biological Augmentation with Platelet Derived Products
Strong Evidence Strong Evidence
Single-Row vs Double-Row Repair
Strong Evidence Strong Evidence
Single-Row vs Double-Row Repair Re-Tears
Strong Evidence Strong Evidence
Open vs Arthroscopic Repairs
Strong Evidence Strong Evidence

Management of Surgical Site Infections
Cultures
Strong Evidence Strong Evidence
C-Reactive Protein
Strong Evidence Strong Evidence
Strong Evidence of Factors Associated with Increased Risk of SSI
Strong Evidence Strong Evidence

Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Routine Duplex Ultrasonography Screening
Strong Evidence Strong Evidence

Surgical Management of Osteoarthritis of the Knee
BMI as A Risk Factor
Strong Evidence Strong Evidence
Peri-Articular Local Anesthetic Infiltration
Strong Evidence Strong Evidence
Peripheral Nerve Blockade (PNB)
Strong Evidence Strong Evidence
Tourniquet: Postoperative Pain Reduction
Strong Evidence Strong Evidence
Tranexamic Acid
Strong Evidence Strong Evidence
Cruciate Retaining Arthroplasty
Strong Evidence Strong Evidence
Polyethylene Tibial Components
Strong Evidence Strong Evidence
Patellar Resurfacing: Pain and Function
Strong Evidence Strong Evidence
Bone Cement: Cemented Tibial Components VERSUS Cementless Tibial Components
Strong Evidence Strong Evidence
Surgical Navigation
Strong Evidence Strong Evidence
Patient Specific Instrumentation: Pain and Function
Strong Evidence Strong Evidence
Drains
Strong Evidence Strong Evidence
Continuous Passive Motion (CPM)
Strong Evidence Strong Evidence
Postoperative Mobilization: Length of Stay
Strong Evidence Strong Evidence

Tranexamic Acid in Total Joint Arthroplasty
Administration Method Versus Other Methods
Strong Evidence Strong Evidence
Administration Method Versus Placebo
Strong Evidence Strong Evidence
Dosing
Strong Evidence Strong Evidence
Multiple Dose vs. Single Dose
Strong Evidence Strong Evidence
VTE Risk (Patients Without History)
Strong Evidence Strong Evidence

Treatment of Metastatic Carcinoma and Myeloma of the Femur
Doseage Response of BMAs
Strong Evidence Strong Evidence

Treatment of Osteoarthritis of the Knee (2nd edition)
Rehabilitation, Education & Wellness Activity
Strong Evidence Strong Evidence
Acupuncture; cannot recommend
Strong Evidence Strong Evidence
Use of Glucosamine and Chondroitin; cannot recommend
Strong Evidence Strong Evidence
NSAIDs
Strong Evidence Strong Evidence
Viscosupplementation; cannot recommend
Strong Evidence Strong Evidence
Arthroscopy with Lavage; cannot recommend
Strong Evidence Strong Evidence

Treatment of Pediatric Diaphyseal Femur Fractures
Child Abuse
Strong Evidence Strong Evidence

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist
MRI: Use of Contrast
Moderate Evidence Moderate Evidence
MRI: Use of Contrast Benign or Malignant
Strong Evidence Strong Evidence
Tumor Size: Greater than 5 cm
Strong Evidence Strong Evidence

Defining Strength Ratings
 
Range Terminology Definition Language Stem
6/2013 - Present Strong (2nd Ed) Two or more HIGH quality studies Strong evidence supports that the practitioner should/should not do X, because…
7/2009 - 5/2013 Strong (1st Ed) Two or more HIGH quality studies We recommend…
or We cannot recommend
2007 - 6/2009 A More than one Level I study with consistent findings for or against recommending intervention. We recommend Treatment X
 
Moderate Evidence

Anesthesia and Analgesia in Total Joint Arthroplasty
Acetaminophen and Postoperative Pain and/or Opiod Use
Moderate Evidence Moderate Evidence
Efficacy Between Low- and High-Dose Gabapentinoids
Moderate Evidence Moderate Evidence
Oral COX-2 NSAID and Postoperative Pain and/or Opioid Use
Moderate Evidence Moderate Evidence
Oral NSAID Use After Discharge Following TKA
Moderate Evidence Moderate Evidence
Postoperative IV Ketorolac
Moderate Evidence Moderate Evidence
TJA and Preoperative Opioid Use
Moderate Evidence Moderate Evidence
Opioids Administered Intraoperatively
Moderate Evidence Moderate Evidence
Opioid Use Following TJA Surgery
Moderate Evidence Moderate Evidence
Opioid Use Following TJA Surgery
Moderate Evidence Moderate Evidence
Tramadol Use Following TJA Surgery
Moderate Evidence Moderate Evidence

Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age
Universal Ultrasound Screening
Moderate Evidence Moderate Evidence
Evaluation of Infants with Risk Factors for DDH
Moderate Evidence Moderate Evidence

Diagnosis and Prevention of Periprosthetic Joint Infections
Risk Factors for PJI (Moderate Evidence)
Moderate Evidence Moderate Evidence
Blood Tests for Preoperative Diagnosis (Moderate Evidence)
Moderate Evidence Moderate Evidence
Infected Joint Replacements - Synovial Fluid Tests
Moderate Evidence Moderate Evidence
Infected Joint Replacements - Intraoperative Tests - (Moderate)
Moderate Evidence Moderate Evidence
Gram Stain
Moderate Evidence Moderate Evidence
Initiating Antimicrobials Prior to Obtaining Intra-Articular Culture
Moderate Evidence Moderate Evidence

Evaluation of Psychosocial Factors Influencing Recovery From Adult Orthopaedic Trauma
Factors Associated with Patient Outcomes
Moderate Evidence Moderate Evidence

Limb Salvage or Early Amputation
Burden of Injury (Non-Limb Specific Injury - Time 0 and Time 1)
Moderate Evidence Moderate Evidence
Burden of Injury (Non-Limb Specific Injury - Time 0 and Time 1)
Moderate Evidence Moderate Evidence
Burden of Injury (Limb Specific Injury - Time 1 and Beyond)
Moderate Evidence Moderate Evidence
Rehabilitation
Moderate Evidence Moderate Evidence
Smoking
Moderate Evidence Moderate Evidence
Lower Extremity Injury Scores
Moderate Evidence Moderate Evidence

Management of Acute Compartment Syndrome
Serum Biomarkers - Femoral Vein Lactate Concentration
Moderate Evidence Moderate Evidence
Pressure Methods - Diagnosis
Moderate Evidence Moderate Evidence
Pressure Methods - Ruling Out
Moderate Evidence Moderate Evidence

Management of Anterior Cruciate Ligament Injuries
Young Active Adult
Moderate Evidence Moderate Evidence
Surgery Timing
Moderate Evidence Moderate Evidence
Femoral Tunnel Technique
Moderate Evidence Moderate Evidence
Post-Op Functional Bracing
Moderate Evidence Moderate Evidence
Neuromuscular Training Programs
Moderate Evidence Moderate Evidence
Post-Op Physical Therapy
Moderate Evidence Moderate Evidence

Management of Carpal Tunnel Syndrome
Maneuvers
Moderate Evidence Moderate Evidence
History Interview Topics
Moderate Evidence Moderate Evidence
MRI
Moderate Evidence Moderate Evidence
Diagnostic Scales
Moderate Evidence Moderate Evidence
Increased Risk of CTS (Moderate Evidence)
Moderate Evidence Moderate Evidence
Decreased Risk of CTS
Moderate Evidence Moderate Evidence
Factors Showing No Associated Risk of CTS (Moderate Evidence)
Moderate Evidence Moderate Evidence
Oral Treatments
Moderate Evidence Moderate Evidence
Oral Steroids
Moderate Evidence Moderate Evidence
Ketoprofen Phonophoresis
Moderate Evidence Moderate Evidence
Adjunctive Techniques
Moderate Evidence Moderate Evidence
Buffered Versus Plain Lidocaine
Moderate Evidence Moderate Evidence
Supervised Versus Home Therapy
Moderate Evidence Moderate Evidence

Management of Glenohumeral Joint Osteoarthritis
PROGNOSTIC FACTORS (AGE)
Moderate Evidence Moderate Evidence
PROGNOSTIC FACTORS (SMOKING)
Moderate Evidence Moderate Evidence
PROGNOSTIC FACTORS (PRE-OPERATIVE FUNCTION)
Moderate Evidence Moderate Evidence
PROGNOSTIC FACTORS (DEPRESSION)
Moderate Evidence Moderate Evidence
GLENOID COMPONENT – METAL BACKED CEMENTLESS
Moderate Evidence Moderate Evidence
TOTAL SHOULDER ARTHROPLASTY – SUBSCAPULARIS PEEL, LESSER TUBEROSITY OSTEOTOMY, TENOTOMY
Moderate Evidence Moderate Evidence

Management of Hip Fractures in the Elderly
Advanced Imaging
Moderate Evidence Moderate Evidence
Preoperative Traction
Moderate Evidence Moderate Evidence
Surgical Timing
Moderate Evidence Moderate Evidence
Stable Femoral Neck Fractures
Moderate Evidence Moderate Evidence
Unipolar versus Bipolar
Moderate Evidence Moderate Evidence
Hemi Versus Total Hip Arthroplasty
Moderate Evidence Moderate Evidence
Cemented Femoral Stems
Moderate Evidence Moderate Evidence
Stable Intertrochanteric Fractures
Moderate Evidence Moderate Evidence
Surgical Approach
Moderate Evidence Moderate Evidence
Unstable Intertrochanteric Fractures
Moderate Evidence Moderate Evidence
VTE Prophylaxis
Moderate Evidence Moderate Evidence
Occupational and Physical Therapy
Moderate Evidence Moderate Evidence
Nutrition
Moderate Evidence Moderate Evidence
Calcium and Vitamin D
Moderate Evidence Moderate Evidence
Osteoporosis Evaluation and Treatment
Moderate Evidence Moderate Evidence

Management of Osteoarthritis of the Hip
Risk Assessment Tools
Moderate Evidence Moderate Evidence
BMI and THA- Association with Patient Satisfaction and Pain and Function
Moderate Evidence Moderate Evidence
Age and THA- Associated Risk of Lower Functional and QoL Outcomes
Moderate Evidence Moderate Evidence
Mental health disorder
Moderate Evidence Moderate Evidence
Glucosamine sulfate
Moderate Evidence Moderate Evidence
Postoperative Physical Therapy
Moderate Evidence Moderate Evidence
Tranexamic Acid
Moderate Evidence Moderate Evidence
Approach Exposure
Moderate Evidence Moderate Evidence

Management of Rotator Cuff Injuries
Operative Management
Moderate Evidence Moderate Evidence
Acromioplasty & Rotator Cuff Repair
Moderate Evidence Moderate Evidence
Distal Clavicle Resection
Moderate Evidence Moderate Evidence
Corticosteroid Injections for Rotator Cuff Tears
Moderate Evidence Moderate Evidence
Prognostic Factors (Higher BMI)
Moderate Evidence Moderate Evidence
Prognostic Factors (Comorbidities)
Moderate Evidence Moderate Evidence
Prognostic Factors (Diabetes)
Moderate Evidence Moderate Evidence
Prognostic Factors (Patient Expectations)
Moderate Evidence Moderate Evidence
Postoperative Pain Management
Moderate Evidence Moderate Evidence

Management of Surgical Site Infections
Clinical Exam for the Diagnosis of Surgical Site Infections
Moderate Evidence Moderate Evidence
Increased Associated Risk of SSI
Moderate Evidence Moderate Evidence
Antibiotic Duration for Management of Surgical Site Infections
Moderate Evidence Moderate Evidence
Rifampin Use for Management of Surgical Site Infections
Moderate Evidence Moderate Evidence

Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Antiplatelet Agents
Moderate Evidence Moderate Evidence
Pharmacologic Agents and Mechanical Compressive Devices
Moderate Evidence Moderate Evidence
Neuraxial Anesthesia
Moderate Evidence Moderate Evidence

Surgical Management of Osteoarthritis of the Knee
Diabetes as a Risk Factor
Moderate Evidence Moderate Evidence
Chronic Pain as a Risk Factor
Moderate Evidence Moderate Evidence
Delayed Total Knee Arthroplasty
Moderate Evidence Moderate Evidence
Neuraxial Anesthesia
Moderate Evidence Moderate Evidence
Tourniquet: Blood Loss Reduction
Moderate Evidence Moderate Evidence
Patellar Resurfacing: Reoperations
Moderate Evidence Moderate Evidence
Bone Cement: Cemented Femoral & Tibial Components Versus Cementless Femoral & Tibial Components
Moderate Evidence Moderate Evidence
Bone Cement: All Cemented Components versus Hybrid Fixation (Cementless Femoral Component)
Moderate Evidence Moderate Evidence
UKA: Revisions
Moderate Evidence Moderate Evidence
UKA Versus Osteotomy
Moderate Evidence Moderate Evidence
Patient Specific Instrumentation: Transfusions and Complications
Moderate Evidence Moderate Evidence
Cryotherapy Devices
Moderate Evidence Moderate Evidence
Postoperative Mobilization: Pain and Function
Moderate Evidence Moderate Evidence
Early Stage Supervised Exercise Program: Function
Moderate Evidence Moderate Evidence

Tranexamic Acid in Total Joint Arthroplasty
ATE Risk
Moderate Evidence Moderate Evidence
Timing of Administration
Moderate Evidence Moderate Evidence
VTE Risk (Patients With History)
Moderate Evidence Moderate Evidence

Treatment of Distal Radius Fractures
Indications for Fixation
Moderate Evidence Moderate Evidence
Rigid Immobilization for Displaced Fractures
Moderate Evidence Moderate Evidence
Post-Reduction Imaging
Moderate Evidence Moderate Evidence
Timing of Rehabilitation
Moderate Evidence Moderate Evidence
Vitamin C Therapy
Moderate Evidence Moderate Evidence

Treatment of Metastatic Carcinoma and Myeloma of the Femur
Efficacy of Radiation Therapy
Moderate Evidence Moderate Evidence
Multi-Fraction Radiation Treatment
Moderate Evidence Moderate Evidence

Treatment of Osteoarthritis of the Knee (2nd edition)
Weight Loss
Moderate Evidence Moderate Evidence
Lateral Wedge Insoles
Moderate Evidence Moderate Evidence
Needle Lavage
Moderate Evidence Moderate Evidence

Treatment of Pediatric Diaphyseal Femur Fractures
Early or Delayed Spica Casting
Moderate Evidence Moderate Evidence

Treatment of Pediatric Supracondylar Humerus Fractures
Gartland Type 1 Immobilization
Moderate Evidence Moderate Evidence
Closed Reduction Fixation
Moderate Evidence Moderate Evidence

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist
Cortical Irregularity/Periosteal Reaction
Moderate Evidence Moderate Evidence
History of Growth: Soft Tissue Tumor
Moderate Evidence Moderate Evidence
History of Pain: Radiographs and MRI
Moderate Evidence Moderate Evidence
Plain Radiographs: Unknown Etiology
Moderate Evidence Moderate Evidence
Tumor Interface
Moderate Evidence Moderate Evidence
Ultrasound: Benign Tumor
Moderate Evidence Moderate Evidence

Defining Strength Ratings
 
Range Terminology Definition Language Stem
6/2013 - Present Moderate (2nd Ed) 1 HIGH or 2 MODERATE quality studies Moderate evidence supports that the practitioner could/could not do X, because…       
7/2009 - 5/2013 Moderate (1st Ed) 1 HIGH or 2 MODERATE quality studies We suggest…
2007 - 6/2009 B More than 1 Level II or III study with
consistent findings or a single
Level I study for or against recommending intervention
We suggest Treatment X
Limited Evidence

Anesthesia and Analgesia in Total Joint Arthroplasty
NSAIDs Use and Postoperative Medical Complications
Limited Evidence Limited Evidence
Reduction of Opioid Use Prior to TJA
Limited Evidence Limited Evidence

Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age
Imaging of the Unstable Hip
Limited Evidence Limited Evidence
Imaging of the Infant Hip
Limited Evidence Limited Evidence
Surveillance after Normal Hip Exam
Limited Evidence Limited Evidence
Stable Hip with Ultrasound Imaging Abnormalities
Limited Evidence Limited Evidence
Treatment of Clinical Instability
Limited Evidence Limited Evidence
Type of Brace for the Unstable Hip
Limited Evidence Limited Evidence
Monitoring of Patients during Brace Treatment
Limited Evidence Limited Evidence

Diagnosis and Prevention of Periprosthetic Joint Infections
Risk Factors for PJI (Limited Evidence)
Limited Evidence Limited Evidence
Injections Prior to Arthroplasty
Limited Evidence Limited Evidence
Infected Joint Replacements - Intraoperative Tests - (Limited)
Limited Evidence Limited Evidence
Diagnostic Imaging
Limited Evidence Limited Evidence
Diagnostic Imaging - Nuclear Imaging
Limited Evidence Limited Evidence
Avoiding Antimicrobials Two Weeks Prior to Obtaining Intra-Articular Culture
Limited Evidence Limited Evidence
Perioperative Antibiotic Selection - (Limited)
Limited Evidence Limited Evidence
Antibiotic Cement
Limited Evidence Limited Evidence
Antibiotic Cement
Limited Evidence Limited Evidence
Preoperative Screening and Decolonization - (Limited)
Limited Evidence Limited Evidence

Diagnosis and Treatment of Osteochondritis Dissecans
Imaging
Limited Evidence Limited Evidence
MRI OCD Knee
Limited Evidence Limited Evidence

Limb Salvage or Early Amputation
Nerve Injury
Limited Evidence Limited Evidence
Massive Soft Tissue and Muscle Damage (Time 1)
Limited Evidence Limited Evidence
Vascular Injury/Limb Ischmia
Limited Evidence Limited Evidence
Amputation/Limb Salvage
Limited Evidence Limited Evidence

Management of Acute Compartment Syndrome
Biomarkers - Myoglobinuria and Serum Troponin
Limited Evidence Limited Evidence
Biomarkers - Electrical Injury
Limited Evidence Limited Evidence
Physical Exam (Awake)
Limited Evidence Limited Evidence
Wound Management
Limited Evidence Limited Evidence

Management of Anterior Cruciate Ligament Injuries
Pediatric
Limited Evidence Limited Evidence
Meniscal Repair
Limited Evidence Limited Evidence
Recurrent Instability
Limited Evidence Limited Evidence
Conservative Treatment
Limited Evidence Limited Evidence
Combined MCL
Limited Evidence Limited Evidence
Prophylactic Braces
Limited Evidence Limited Evidence
Return to Sports
Limited Evidence Limited Evidence

Management of Carpal Tunnel Syndrome
Patient Reported Numbness and Pain
Limited Evidence Limited Evidence
Hand-Held Nerve Conduction Study (NCS)
Limited Evidence Limited Evidence
Diagnostic Ultrasound
Limited Evidence Limited Evidence
Increased Risk of CTS (Limited Evidence)
Limited Evidence Limited Evidence
Factors Showing No Associated Risk of CTS (Limited Evidence)
Limited Evidence Limited Evidence
Factors Showing Conflicting Risk of CTS
Limited Evidence Limited Evidence
Therapeutic Ultrasound
Limited Evidence Limited Evidence
Laser Therapy
Limited Evidence Limited Evidence
Surgical Release Procedure
Limited Evidence Limited Evidence
Bilateral Versus Staged Carpal Tunnel Release
Limited Evidence Limited Evidence
Local Versus Intravenous (IV) Regional Anesthesia
Limited Evidence Limited Evidence
Aspirin Use
Limited Evidence Limited Evidence
Preoperative Antibiotics
Limited Evidence Limited Evidence

Management of Glenohumeral Joint Osteoarthritis
HEMIARTHROPLASTY - STEMS
Limited Evidence Limited Evidence

Management of Hip Fractures in the Elderly
Aspirin and Clopidogrel
Limited Evidence Limited Evidence
Screening
Limited Evidence Limited Evidence

Management of Osteoarthritis of the Hip
BMI and THA- Risk Factor for Adverse Events
Limited Evidence Limited Evidence
Age and THA- Associated Risk of Mortality
Limited Evidence Limited Evidence
Age and THA- Associated Risk of Revision
Limited Evidence Limited Evidence
Tobacco use
Limited Evidence Limited Evidence
Preoperative Physical Therapy
Limited Evidence Limited Evidence
Anesthetic Types
Limited Evidence Limited Evidence

Management of Rotator Cuff Injuries
Hyaluronic Acid Injections for Rotator Cuff Tears
Limited Evidence Limited Evidence
Platelet Rich Plasma (PRP) Injection in Partial-Thickness Tears
Limited Evidence Limited Evidence
Marrow Stimulation
Limited Evidence Limited Evidence
Dermal Allografts
Limited Evidence Limited Evidence
Xenografts
Limited Evidence Limited Evidence

Management of Surgical Site Infections
Use of Imaging
Limited Evidence Limited Evidence
Erythrocyte Sedimentation Rate
Limited Evidence Limited Evidence
Limited Evidence of Increased Associated SSI Risk
Limited Evidence Limited Evidence

Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Patient History and Risk
Limited Evidence Limited Evidence

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
Prophylactic Antibiotics
Limited Evidence Limited Evidence

Surgical Management of Osteoarthritis of the Knee
Depression/Anxiety as a Risk Factor
Limited Evidence Limited Evidence
Cirrhosis/Hepatitis C as a Risk Factor
Limited Evidence Limited Evidence
Preoperative Physical Therapy
Limited Evidence Limited Evidence
Tourniquet: Postoperative Function
Limited Evidence Limited Evidence
Antibiotic Bone Cement
Limited Evidence Limited Evidence
Bone Cement: All Cementless Components versus Hybrid Fixation (Cementless Femoral Component)
Limited Evidence Limited Evidence
Bilateral TKA
Limited Evidence Limited Evidence
UKA: DVT & Manipulation Under Anesthesia
Limited Evidence Limited Evidence
Early Stage Supervised Exercise Program: Pain
Limited Evidence Limited Evidence
Late Stage Postoperative Supervised Exercise Program: Function
Limited Evidence Limited Evidence

Treatment of Distal Radius Fractures
Splint for Minimally Displaced Fractures
Limited Evidence Limited Evidence
Intraoperative Arthroscopy
Limited Evidence Limited Evidence
Operative Treatment of Associated Carpal Ligament Injuries
Limited Evidence Limited Evidence
CT and Adjunctive Arthroscopy
Limited Evidence Limited Evidence
Home Exercise Program
Limited Evidence Limited Evidence
Duration of External Fixation
Limited Evidence Limited Evidence
Adjuvant Therapy for Rehabilitation
Limited Evidence Limited Evidence

Treatment of Metastatic Carcinoma and Myeloma of the Femur
Arthroplasty
Limited Evidence Limited Evidence

Treatment of Osteoarthritis of the Knee (2nd edition)
Tibial Osteotomy
Limited Evidence Limited Evidence

Treatment of Pediatric Diaphyseal Femur Fractures
Infant Femur Fracture
Limited Evidence Limited Evidence
Elastic Intramedullary Nails
Limited Evidence Limited Evidence
ORIF Pediatric Femur Fractures
Limited Evidence Limited Evidence
Pain Control
Limited Evidence Limited Evidence
Waterproof Casting
Limited Evidence Limited Evidence

Treatment of Pediatric Supracondylar Humerus Fractures
Medial vs. Lateral Pinning
Limited Evidence Limited Evidence
Open Reduction Criteria
Limited Evidence Limited Evidence

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist
History of Pain: Tc99 Bone Scan
Limited Evidence Limited Evidence

Defining Strength Ratings
 
Range Terminology Definition Language Stem
6/2013 - Present Limited (2nd Ed) 1 MODERATE or 1 or more LOW quality studies Limited evidence supports that the practitioner might/might not do X, because…
7/2009 - 5/2013 Limited (1st Ed) 1 MODERATE or 2 LOW quality studies Treatment X is an OPTION
2007 - 6/2009 N/A N/A N/A
Consensus

Anesthesia and Analgesia in Total Joint Arthroplasty
Acetaminophen Use After Discharge
Consensus Consensus
Oral NSAID Use After Discharge Following THA
Consensus Consensus

Diagnosis and Prevention of Periprosthetic Joint Infections
Risk Factors for PJI (Consensus)
Consensus Consensus
Risk Factors for PJI (Consensus)
Consensus Consensus
Diagnostic Imaging - (Consensus)
Consensus Consensus
Perioperative Antibiotic Selection - (Consensus)
Consensus Consensus
Preoperative Screening and Decolonization - (Consensus)
Consensus Consensus
Intraoperative Technical Factors
Consensus Consensus

Diagnosis and Treatment of Osteochondritis Dissecans
Option of Surgery for Skeletally Immature Patients with Salvageable Unstable OCD lesions
Consensus Consensus
Option of Surgery for Skeletally Mature Patients with Salvageable Unstable OCD lesions
Consensus Consensus
Evaluation of OCD Healing
Consensus Consensus
Post-Operative Physical Therapy
Consensus Consensus

Limb Salvage or Early Amputation
Massive Muscle Damage (Time 0)
Consensus Consensus
Orthotics/Prosthetics
Consensus Consensus
Comorbidities
Consensus Consensus

Management of Acute Compartment Syndrome
Serum Biomarkers in Late/Missed ACS
Consensus Consensus
Pressure Monitoring in Late/Missed ACS
Consensus Consensus
Physical Exam (Obtunded)
Consensus Consensus
Alternative Methods of Diagnosis
Consensus Consensus
Fasciotomy Methods
Consensus Consensus
Fasciotomy for Late/Missed ACS
Consensus Consensus
Associated Fracture
Consensus Consensus
Pain Management Effects on Diagnosis
Consensus Consensus

Management of Anterior Cruciate Ligament Injuries
Radiographs
Consensus Consensus
Locked Knee
Consensus Consensus
Immediate Treatment of Acute Traumatic Knee Joint Injury
Consensus Consensus
Aspiration of the Knee
Consensus Consensus
Physical Exam
Consensus Consensus
Rehabilitation
Consensus Consensus

Management of Glenohumeral Joint Osteoarthritis
PRE-OPERATIVE PHYSICAL THERAPY
Consensus Consensus
POST-OPERATIVE PHYSICAL THERAPY
Consensus Consensus
INJECTABLE BIOLOGICS
Consensus Consensus
ALTERNATIVE NON-SURGICAL TREATMENTS
Consensus Consensus
OPIOID PAIN MEDICATION
Consensus Consensus
NON-PROSTHETIC SURGICAL OPTIONS
Consensus Consensus
RADIOGRAPHS
Consensus Consensus
ANATOMIC OR REVERSE TOTAL SHOULDER ARTHROPLASTY
Consensus Consensus
CEMENTED STEMS
Consensus Consensus
GLENOID COMPONENTS – POLYETHYLENE-METAL OR ALL POLYETHYLENE
Consensus Consensus
BICEP TENODESIS AND TENOTOMY
Consensus Consensus
TRANEXAMIC ACID
Consensus Consensus
SUPRASPINATUS TEARS
Consensus Consensus
DISCHARGE
Consensus Consensus
CRYOTHERAPY
Consensus Consensus
MULTIMODAL PAIN MANAGEMENT
Consensus Consensus

Management of Hip Fractures in the Elderly
Long Cephalomedullary Nails
Consensus Consensus
Negative Plain Films and Exam
Consensus Consensus
Initial Patient Evaluation
Consensus Consensus

Management of Osteoarthritis of the Hip
Weight Loss as a Conservative Statement
Consensus Consensus
Diabetes as a Risk Factor for Total Hip Arthroplasty (THA)
Consensus Consensus
Social Comorbidities as a Risk Factor for Total Hip Arthroplasty (THA)
Consensus Consensus
Intraarticular Imaging
Consensus Consensus
Prescription Opioids
Consensus Consensus

Management of Rotator Cuff Injuries
Supervised Exercise vs Unsupervised Exercise
Consensus Consensus
Multiple Steroid Injections for Rotator Cuff Tears
Consensus Consensus
Platelet Rich Plasma (PRP) Injection in Full-Thickness Tears
Consensus Consensus
Partial Rotator Cuff Tear
Consensus Consensus
Unrepairable Tears Without Arthropathy (Non-Reverse Arthroplasty)
Consensus Consensus
Massive, Unrepairable Rotator Cuff Tear (Reverse Arthroplasty)
Consensus Consensus
Unrepairable Tears with Arthropathy
Consensus Consensus

Management of Surgical Site Infections
Adjunctive Treatment
Consensus Consensus
Surgical Timing and Percutaneous Drainage
Consensus Consensus
Surgical Timing
Consensus Consensus
Timing and Implant Removal
Consensus Consensus

Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Patient assessment of Bleeding Disorders
Consensus Consensus
Duration of Prophylactic Strategies
Consensus Consensus
Management of Repeated VTED
Consensus Consensus
Bleeding Disorders and use of Mechanical Compressive Devices
Consensus Consensus
Early Mobilization
Consensus Consensus

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
Oral Hygiene
Consensus Consensus

Treatment of Distal Radius Fractures
Serial Radiography
Consensus Consensus
Re-evaluate Unremitting Pain
Consensus Consensus
Finger Exercise
Consensus Consensus

Treatment of Metastatic Carcinoma and Myeloma of the Femur
Imaging and Clinical Findings
Consensus Consensus
Efficacy of Bone Modifying Agents
Consensus Consensus
BMAs for Various Diagnosis
Consensus Consensus
Imaging Findings and Atypical Fractures
Consensus Consensus
Radiation Therapy and Prophylactic Femur Stabilization
Consensus Consensus
Radiation Therapy after Resection and Reconstruction
Consensus Consensus
Estimating Survival and Reconstruction Method
Consensus Consensus
Long Stem Hemiarthroplasty
Consensus Consensus
Cephalomedullary Nailing
Consensus Consensus

Treatment of Osteoarthritis of the Knee (2nd edition)
Failure of Unispacer
Consensus Consensus

Treatment of Pediatric Supracondylar Humerus Fractures
Closed Reduction with Decreased Perfusion of Hand
Consensus Consensus
Open Exploration for No Pulse and Underperfused Hand
Consensus Consensus

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist
CT Scans: Prior Chest Radiograph
Consensus Consensus
CT Scans: Staging
Consensus Consensus
CT Scans: Staging
Consensus Consensus
History of Growth: MRI
Consensus Consensus
History of Pain: Contrast-Enhanced CT Scan
Consensus Consensus
History of Pain: MRI
Consensus Consensus
History of Pain: Unknown Etiology
Consensus Consensus
MRI and CT Scans: Area to Visualize
Consensus Consensus
MRI and CT Scans: Area to Visualize
Consensus Consensus
MRI: Magnet Strength
Consensus Consensus
MRI: Use of Contrast
Consensus Consensus
Plain Radiographs: Initial Evaluation
Consensus Consensus
Tumor Size: Bone or Soft Tissue
Consensus Consensus
Ultrasound in Large > 5 cm
Consensus Consensus
Ultrasound in Small < 5 cm
Consensus Consensus

Defining Strength Ratings
 
Range Terminology Definition Language Stem
6/2013 - Present Consensus (2nd Ed) Expert opinion (no studies) Only used in one circumstance: It pertains to medical interventions that potentially prevent loss of life or limb (catastrophic consequences). In the absence of reliable evidence, it is the opinion of the work group that…
7/2009 - 5/2013 Consensus (1st Ed) Expert opinion (no studies) Only used in two circumstances: 1.Procedures have virtually no associated harm, are of relatively low cost, and reflect routine clinical care. 2. It pertains to medical interventions that potentially prevent loss of life or limb. In the absence of reliable Evidence, it is the opinion of the work group…*
2007 - 6/2009 N/A N/A N/A
Inconclusive

Diagnosis and Treatment of Osteochondritis Dissecans
X-Ray on Contralateral Asymptomatic Knee
Strength: Inconclusive
Non-Surgical Treatment Asymptomatic
Strength: Inconclusive
Non-Surgical Treatment Symptomatic
Strength: Inconclusive
Arthroscopic Drilling
Strength: Inconclusive
Cartilage Repair Technique: Skeletally Immature
Strength: Inconclusive
MRI OCD Adult
Strength: Inconclusive
Asymptomatic Progression
Strength: Inconclusive
Cartilage Repair Technique - Skeletally Mature
Strength: Inconclusive
Physical Therapy
Strength: Inconclusive
Prevention and Progression of OCD
Strength: Inconclusive

Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Assessment of Risk Factors
Strength: Inconclusive
Additional Risk Factors Related to Bleeding Disorders
Strength: Inconclusive
Prophylactic Strategies
Strength: Inconclusive
Inferior Vena Cava Filters
Strength: Inconclusive

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
Topical Oral Antimicrobials
Strength: Inconclusive

Treatment of Distal Radius Fractures
Median Neuropathy
Strength: Inconclusive
Cast Treatment
Strength: Inconclusive
Fixation Technique
Strength: Inconclusive
Surgical Age Limitations
Strength: Inconclusive
Use of Locking Plates
Strength: Inconclusive
Elbow Immobilization
Strength: Inconclusive
Supplemental bone grafts and Locking Plates
Strength: Inconclusive
Supplemental Grafting as Adjunct to Other Operative Treatments
Strength: Inconclusive
Kirschner wire fixation
Strength: Inconclusive
Prediction of Fragility Fractures
Strength: Inconclusive
Surgery for Radioulnar Joint Instability
Strength: Inconclusive
Amount of Distraction
Strength: Inconclusive
Ulnar Styloid Fracture Fixation
Strength: Inconclusive
Lunate Fossa Depression
Strength: Inconclusive

Treatment of Osteoarthritis of the Knee (2nd edition)
Physical Agents & Electrotherapeutic Modalities
Strength: Inconclusive
Manual Therapy
Strength: Inconclusive
Valgus Directing Force Brace
Strength: Inconclusive
Acetaminophen, Opioids, or Pain Patches
Strength: Inconclusive
Intraarticular Corticosteroids
Strength: Inconclusive
Biologic Injections
Strength: Inconclusive
Arthroscopic Partial Meniscectomy
Strength: Inconclusive

Treatment of Pediatric Supracondylar Humerus Fractures
Open Incision for Medial Pin
Strength: Inconclusive
Time Threshold for Reduction
Strength: Inconclusive
Open Exploration for No Pulse and Perfused Hand
Strength: Inconclusive
Timing of Pin Removal
Strength: Inconclusive
Physical Therapy or Occupational Therapy
Strength: Inconclusive
Return to Activity
Strength: Inconclusive
Nerve Injuries
Strength: Inconclusive
Open Reduction for Adolescents
Strength: Inconclusive

Defining Strength Ratings
 
Range Terminology Definition Language Stem
6/2013 - Present N/A N/A N/A
7/2009 - 5/2013 Inconclusive 1 LOW quality study, Contradictory studies, Lack of evidence (no studies) We are unable to recommend FOR OR AGAINST treatment X
2007 - 6/2009 I There is insufficient or conflicting evidence not allowing a
recommendation for or against intervention.
We are
unable to recommend for or against…

Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age
Universal Ultrasound Screening
Evaluation of Infants with Risk Factors for DDH

Diagnosis and Prevention of Periprosthetic Joint Infections
Risk Factors for PJI (Moderate Evidence)
Risk Factors for PJI (Limited Evidence)
Injections Prior to Arthroplasty
Antibiotics With Low Preoperative Suspicion or Established PJI
Perioperative Antibiotic Selection - (Limited)
Perioperative Antibiotic Selection - (Consensus)
Antibiotic Cement
Antibiotic Cement
Preoperative Screening and Decolonization - (Limited)
Preoperative Screening and Decolonization - (Consensus)
Intraoperative Technical Factors

Diagnosis and Treatment of Osteochondritis Dissecans
Prevention and Progression of OCD

Management of Anterior Cruciate Ligament Injuries
Neuromuscular Training Programs

Management of Glenohumeral Joint Osteoarthritis
PROGNOSTIC FACTORS (BMI)
PROGNOSTIC FACTORS (GENDER/SEX)

Management of Hip Fractures in the Elderly
VTE Prophylaxis

Management of Osteoarthritis of the Hip
Risk Assessment Tools
BMI and THA- Association with Patient Satisfaction and Pain and Function
BMI and THA- Risk Factor for Adverse Events
Age and THA- Associated Risk of Lower Functional and QoL Outcomes
Age and THA- Associated Risk of Mortality
Age and THA- Associated Risk of Revision
Mental health disorder
Tobacco use
Glucosamine sulfate
Intraarticular corticosteroids: supported
Intraarticular hyaluronic acid: not supported
Preoperative Physical Therapy
Weight Loss as a Conservative Statement
Diabetes as a Risk Factor for Total Hip Arthroplasty (THA)
Social Comorbidities as a Risk Factor for Total Hip Arthroplasty (THA)

Management of Rotator Cuff Injuries
Prognostic Factors (Higher BMI)

Management of Surgical Site Infections
Increased Associated Risk of SSI

Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Antiplatelet Agents
Prophylactic Strategies
Bleeding Disorders and use of Mechanical Compressive Devices

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
Prophylactic Antibiotics
Topical Oral Antimicrobials
Oral Hygiene

Surgical Management of Osteoarthritis of the Knee
Preoperative Physical Therapy

Treatment of Distal Radius Fractures
Vitamin C Therapy

Treatment of Metastatic Carcinoma and Myeloma of the Femur
Efficacy of Bone Modifying Agents
Doseage Response of BMAs
BMAs for Various Diagnosis
Imaging Findings and Atypical Fractures
Efficacy of Radiation Therapy
Radiation Therapy and Prophylactic Femur Stabilization
Radiation Therapy after Resection and Reconstruction
Multi-Fraction Radiation Treatment

Treatment of Osteoarthritis of the Knee (2nd edition)
Rehabilitation, Education & Wellness Activity
Weight Loss

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist
CT Scans: Prior Chest Radiograph
CT Scans: Staging
CT Scans: Staging
Cortical Irregularity/Periosteal Reaction
History of Growth: MRI
History of Growth: Soft Tissue Tumor
History of Pain: Contrast-Enhanced CT Scan
History of Pain: MRI
History of Pain: Radiographs and MRI
History of Pain: Tc99 Bone Scan
History of Pain: Unknown Etiology
MRI and CT Scans: Area to Visualize
MRI and CT Scans: Area to Visualize
MRI: Magnet Strength
MRI: Use of Contrast
MRI: Use of Contrast
MRI: Use of Contrast Benign or Malignant
Plain Radiographs: Initial Evaluation
Plain Radiographs: Unknown Etiology
Tumor Interface
Tumor Size: Bone or Soft Tissue
Tumor Size: Greater than 5 cm