All Guidelines

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

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

Limb Salvage or Early Amputation
Psychosocial Factors Strong Evidence

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

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

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

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

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

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

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

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

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

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

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

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

Treatment of Pediatric Diaphyseal Femur Fractures
Child Abuse Strong Evidence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Anesthesia and Analgesia in Total Joint Arthroplasty
NSAIDs Use and Postoperative Medical Complications Limited Evidence
Reduction of Opioid Use Prior to TJA 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
Imaging of the Infant Hip Limited Evidence
Surveillance after Normal Hip Exam Limited Evidence
Stable Hip with Ultrasound Imaging Abnormalities Limited Evidence
Treatment of Clinical Instability Limited Evidence
Type of Brace for the Unstable Hip Limited Evidence
Monitoring of Patients during Brace Treatment Limited Evidence

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

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

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

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

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

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

Management of Glenohumeral Joint Osteoarthritis
HEMIARTHROPLASTY - STEMS Limited Evidence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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…