All Guidelines

Anesthesia and Analgesia in Total Joint Arthroplasty (2020)
Acetaminophen and Postoperative Complications Strong Recommendation
Gabapentinoids and Postoperative Pain and/or Opioid Use Strong Recommendation
Gabapentinoid Use Following Discharge Strong Recommendation
Oral NSAIDs and Postoperatiave Pain and/or Opioid Use Strong Recommendation
Intravenous Ketorolac and Postoperative Pain and/or Opioid Consumption Strong Recommendation
Opioids Administered Immediately Prior to TJA Surgery Strong Recommendation

Anesthesia and Analgesia in Total Joint Arthroplasty (2021)
Perioperative Corticosteroids and Postoperative Pain/Opioid Use/Nausea/Vomiting Strong Recommendation
Perioperative Corticosteroid - Multiple Doses Strong Recommendation
Femoral Nerve Block vs Adductor Canal Block in TKA Strong Recommendation
Block vs. Block - Single or Continuous in TKA Strong Recommendation
Block vs. Block - Single-Shot Femoral Nerve Block vs. Adductor Canal Block in TKA Strong Recommendation
Block vs. Block - Continuous Femoral Nerve Block or Adductor Canal Block in TKA Strong Recommendation
Ketamine and Postoperative Opioid Consumption Strong Recommendation
Ketamine and Adverse Events Strong Recommendation
Intraoperative Periarticular Injection and Postoperative Pain/Opioid Use in TJA Strong Recommendation
Long Acting Local Anesthetics and Postoperative Pain/Opioid Use Strong Recommendation
Particular Injections with Liposomal Lupivacaine vs. Ropivacaine or Bupivacaine in TJA Strong Recommendation
Morphine in Periarticular Injection in TJA Strong Recommendation

Clinical Practice Guideline for the Treatment of Clavicle Fractures (2022)
ISOLATED DISPLACED MIDSHAFT FRACTURE: OPERATIVE VS. NON-OPERATIVE TREATMENT [ADULT] Strong Recommendation

Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants Up to Six Months of Age (2022)
Evaluation of Infants with Risk Factors for DDH Strong Recommendation

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

Limb Salvage or Early Amputation
Psychosocial Factors Strong Recommendation

Management of Anterior Cruciate Ligament Injuries (2022)
HISTORY AND PHYSICAL Strong Recommendation
SURGICAL TIMING Strong Recommendation
SINGLE OR DOUBLE BUNDLE ACL RECONSTRUCTION Strong Recommendation
AUTOGRAFT SOURCE Moderate Recommendation
AUTOGRAFT VS. ALLOGRAFT Strong Recommendation
REPAIR VS. RECONSTRUCTION Strong Recommendation

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

Management of Distal Radius Fractures
Indications for Fixation (Geriatric Patients) Strong Recommendation
Fixation Tech Strong Recommendation

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

Management of Hip Fractures in Older Adults
Preoperative Traction Strong Recommendation
Venous Thromboembolism Prophylaxis Strong Recommendation
Anesthesia Strong Recommendation
Unstable Femoral Neck Fractures - Arthroplasty vs Fixation Strong Recommendation
Cemented Femoral Stems Strong Recommendation
Cephalomedullary Device - Stable Intertrochanteric Fractures Strong Recommendation
Cephalomedullary Device - Subtrochanteric/Reverse Obliquity Fractures Strong Recommendation
Cephalomedullary Device - Unstable Intertrochanteric Fractures Strong Recommendation
Multimodal Analgesia Strong Recommendation
Tranexamic Acid Strong Recommendation
Interdisciplinary Care Programs Strong Recommendation

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

Management of Osteoarthritis of the Knee (Non-Arthroplasty) (3rd Edition)
Lateral Wedge Insoles Strong Recommendation
Topical Treatments Strong Recommendation
Supervised Exercise Strong Recommendation
Self-Management Strong Recommendation
Patient Education Strong Recommendation
Oral NSAIDs Strong Recommendation
Oral Acetaminophen Strong Recommendation
Oral Narcotics Strong Recommendation

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

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

Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery
Neuromuscular Electrical Stimulation Strong Recommendation
Peri-op Injections Total Shoulder Arthroplasty Strong Recommendation
COX-2 Strong Recommendation
Oral Acetaminophen Strong Recommendation
Acetaminophen Strong Recommendation
Gabapentin Strong Recommendation
Gabapentin Strong Recommendation
Ketamine Strong Recommendation

Prevention of Surgical Site Infection After Extremity Trauma (2022)
Perioperative and Postoperative Antibiotics - Systemic and Local Strong Recommendation
Initial Wound Management -Irrigation and Fixation Strong Recommendation
Negative Pressure Wound Therapy - Open and Closed Fractures Strong Recommendation
Open Wound Closure Strong Recommendation
Modifiable Risk Factors Strong Recommendation

Surgical Management of Osteoarthritis of the Knee (2022)
PERIPHERAL NERVE BLOCKADE (PNB) Strong Recommendation
PERIARTICULAR LOCAL INFILTRATION Strong Recommendation
TRANEXAMIC ACID Strong Recommendation
RISK FACTORS: BODY MASS INDEX (BMI) Strong Recommendation
RISK FACTORS: DIABETES/HYPERGLYCEMIA Strong Recommendation
TOURNIQUETS Strong Recommendation
PATELLAR RESURFACING Strong Recommendation
CRUCIATE RETAINING ARTHROPLASTY Strong Recommendation
PATIENT SPECIFIC TECHNOLOGY Strong Recommendation
KINEMATIC VS. MECHANICAL ALIGNMENT Strong Recommendation

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

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

Treatment of Pediatric Diaphyseal Femur Fractures
Child Abuse Strong Recommendation
Elastic Intramedullary Nails Strong Recommendation

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

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 (2020)
Acetaminophen and Postoperative Pain and/or Opiod Use Moderate Recommendation
Efficacy Between Low- and High-Dose Gabapentinoids Moderate Recommendation
Oral COX-2 NSAID and Postoperative Pain and/or Opioid Use Moderate Recommendation
Oral NSAID Use After Discharge Following TKA Moderate Recommendation
Postoperative IV Ketorolac Moderate Recommendation
TJA and Preoperative Opioid Use Moderate Recommendation
Opioids Administered Intraoperatively Moderate Recommendation
Opioid Use Following TJA Surgery Moderate Recommendation
Opioid Use Following TJA Surgery Moderate Recommendation
Tramadol Use Following TJA Surgery Moderate Recommendation

Anesthesia and Analgesia in Total Joint Arthroplasty (2021)
Single Shot Lumbar Plexus Nerve Block in THA Moderate Recommendation
Single-Shot Fascia Ilicia Block in THA Moderate Recommendation
Single-Shot Fascia Ilicia Block vs Lumbar Plexus Nerve Block in THA Moderate Recommendation
Fascia Iliaca Block vs Peri-Articular Local Anesthetic Infiltration In THA Moderate Recommendation
Lumbar Plexus Block vs Peri-Articular Local Anesthetic Infiltration in THA Moderate Recommendation
Continuous vs. Single-Shot Adductor Canal Block in TKA Moderate Recommendation
Single-Shot Adductor Canal Block vs Peri-Articular Local Anesthetic Infiltration in TKA Moderate Recommendation
Combined Single-Shot Adductor Canal Block and Peri-Articular Local Anesthetic Infiltration Moderate Recommendation
Single-Shot Adductor Block & Peri-Articular Local Anesthetic Infiltration vs. Single-Shot Alone Moderate Recommendation
Ketamine and Postoperative Pain/Nausea/Vomiting Moderate Recommendation
Periarticular Injections of Ketorolac in TKA Moderate Recommendation
Periarticular Injections of Corticosteroids in TKA Moderate Recommendation

Clinical Practice Guideline for the Treatment of Clavicle Fractures (2022)
BONE STIMULATOR Moderate Recommendation
HOOK PLATE VS. LATERAL LOCKING PLATE FOR LATERAL FRACTURE Moderate Recommendation
NAILING VS. SINGLE PLATE Moderate Recommendation

Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants Up to Six Months of Age (2022)
Universal Ultrasound Screening Moderate Recommendation
Surveillance After Normal Infant Hip Exam Moderate Recommendation
Type of Brace for the Unstable Hip Moderate Recommendation

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

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

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

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

Management of Anterior Cruciate Ligament Injuries (2022)
ACL TRAINING PROGRAMS Moderate Recommendation
ANTEROLATERAL LIGAMENT / LATERAL EXTRAARTICULAR TENODESIS Moderate Recommendation

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

Management of Distal Radius Fractures
Arthroscopic Assistance Moderate Recommendation
Indications for Fixation (Non-Geriatric Patients) Moderate Recommendation

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

Management of Hip Fractures in Older Adults
Surgical Timing Moderate Recommendation
Unipolar/Bipolar Hemiarthroplasty Moderate Recommendation
Unstable Femoral Neck Fractures - Total Arthroplasty vs. Hemi Arthroplasty Moderate Recommendation
Surgical Approach Moderate Recommendation
Transfusion Moderate Recommendation

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

Management of Osteoarthritis of the Knee (Non-Arthroplasty) (3rd Edition)
Canes Moderate Recommendation
Braces Moderate Recommendation
Neuromuscular Training Moderate Recommendation
Weight Loss Intervention Moderate Recommendation
Hyaluronic Acid Moderate Recommendation
Intra-articular Corticosteroids Moderate Recommendation
Lavage/Debridement Moderate Recommendation
Partial Meniscectomy Moderate Recommendation

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

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

Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery
Massage Moderate Recommendation
Transcutaneous Electrical Nerve Stimulation Moderate Recommendation
Peri-op Injections Moderate Recommendation
Guided Relaxation Therapy Moderate Recommendation
Pregabalin Moderate Recommendation
Oral Relaxants Moderate Recommendation

Prevention of Surgical Site Infection After Extremity Trauma (2022)
Initial Antibiotics Moderate Recommendation
Preoperative Antibiotics Moderate Recommendation
Surgery Timing Moderate Recommendation
Perioperative and Postoperative Antibiotics - Systemic and Local Moderate Recommendation
Initial Wound Management -Irrigation and Fixation Moderate Recommendation
Wound Coverage Moderate Recommendation
Silver Coated Dressings Moderate Recommendation
Modifiable Risk Factors Moderate Recommendation
Administrative Risk Factors Moderate Recommendation

Surgical Management of Osteoarthritis of the Knee (2022)
DRAINS Moderate Recommendation
CEMENTLESS FIXATION: CEMENTED FEMORAL & TIBIAL COMPONENTS VS. CEMENTLESS FEMORAL & TIBIAL COMPONENTS Moderate Recommendation
CEMENTLESS FIXATION: ALL CEMENTED COMPONENTS VS. HYBRID FIXATION (CEMENTLESS FEMORAL COMPONENT) Moderate Recommendation
UNICOMPARTMENTAL VS. TOTAL KNEE ARTHROPLASTY Moderate Recommendation
SURGICAL NAVIGATION Moderate Recommendation
PRE-OPERATIVE OPIOID USE Moderate Recommendation

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

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

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

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

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

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 (2020)
NSAIDs Use and Postoperative Medical Complications Limited Recommendation
Reduction of Opioid Use Prior to TJA Limited Recommendation

Anesthesia and Analgesia in Total Joint Arthroplasty (2021)
Perioperative Corticosteroid Doseage Limited Recommendation
Single Shot Quadratus Lumborum Block in THA Limited Recommendation
Block vs. Control iPACK in TKA Limited Recommendation
Epinephrine in Periarticular Injection in TKA Limited Recommendation
Clonidine in Periarticular Injections and TKA Limited Recommendation

Clinical Practice Guideline for the Treatment of Clavicle Fractures (2022)
NON-MODIFIABLE RISK FACTORS: AGE AND SEX Limited Recommendation
MODIFIABLE RISK FACTORS: SMOKING Limited Recommendation
DUAL PLATING Limited Recommendation
ANTERIOR VS. SUPERIOR PLATING Limited Recommendation
PRE-CONTOURED PLATE VS. NON-PRE-CONTOURED PLATE Limited Recommendation
RADIOGRAPH: SUPINE VS. UPRIGHT Limited Recommendation
PREDICTORS OF NON-UNION FOLLOWING NON-OPERATIVELY TREATED CLAVICLE FRACTURE Limited Recommendation
ISOLATED DISPLACED MIDSHAFT FRACTURE: OPERATIVE VS. NON-OPERATIVE TREATMENT[ADOLESCENT ≤18 YEARS] Limited Recommendation

Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants Up to Six Months of Age (2022)
Imaging of the Unstable Hip Limited Recommendation
Imaging of the Infant Hip Limited Recommendation
Stable Hip With Ultrasound Imaging Abnormalities Limited Recommendation
Treatment of Clinical Instability Limited Recommendation
Monitoring of Patients During Brace Treatment Limited Recommendation

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

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

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

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

Management of Anterior Cruciate Ligament Injuries (2022)
ACL SURGICAL RECONSTRUCTION Limited Recommendation
MENISCAL REPAIR Limited Recommendation
COMBINED ACL / MCL TEAR Limited Recommendation
PROPHYLACTIC KNEE BRACING Limited Recommendation
RETURN TO SPORT Limited Recommendation
RETURN TO ACTIVITY FUNCTIONAL BRACING Limited Recommendation

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

Management of Distal Radius Fractures
Home Exercise Program Limited Recommendation
Serial Radiography Limited Recommendation

Management of Glenohumeral Joint Osteoarthritis
HEMIARTHROPLASTY - STEMS Limited Recommendation

Management of Hip Fractures in Older Adults
Stable Femoral Neck Fractures Limited Recommendation
Cephalomedullary Device - Pertrochanteric Fractures Limited Recommendation
Weight Bearing Limited Recommendation

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

Management of Osteoarthritis of the Knee (Non-Arthroplasty) (3rd Edition)
Oral/Dietary Supplements Limited Recommendation
Manual Therapy Limited Recommendation
Massage Limited Recommendation
Laser Treatment Limited Recommendation
Acupuncture Limited Recommendation
Transcutaneous Electrical Nerve Stimulation Limited Recommendation
Percutaneous Electrical Nerve Stimulation Limited Recommendation
Extracorporeal Shockwave Therapy Limited Recommendation
Platelet-rich Plasma Limited Recommendation
Denervation Therapy Limited Recommendation
Tibial Osteotomy Limited Recommendation

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

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

Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery
Acupuncture Limited Recommendation
Acupuncture Limited Recommendation
Acupressure Limited Recommendation
Compression Limited Recommendation
Cryotherapy Limited Recommendation
Early Mobilization Limited Recommendation
Cognitive/Behavioral Treatment Limited Recommendation
Music Therapy Limited Recommendation
Patient Education Limited Recommendation
Virtual Reality Limited Recommendation
Intra-Articular Opioids vs NSAIDs Limited Recommendation
Opioid Combo vs NSAID Limited Recommendation
Tramadol Combo vs NSAID Limited Recommendation
Fentanyl Patch vs Morphine Limited Recommendation
Tramadol vs NSAID Limited Recommendation
Acetaminophen/NSAID Combination Treatment vs NSAID Limited Recommendation

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

Prevention of Surgical Site Infection After Extremity Trauma (2022)
Modifiable Risk Factors Limited Recommendation
Administrative Risk Factors Limited Recommendation
Negative Pressure Wound Therapy - High Risk Surgical Incisions Limited Recommendation
Orthoplastic Team Limited Recommendation
Hyperbaric O2 Limited Recommendation

Surgical Management of Osteoarthritis of the Knee (2022)
CEMENTLESS FIXATION: ALL CEMENTLESS COMPONENTS VS. HYBRID FIXATION (CEMENTLESS TIBIAL COMPONENT) Limited Recommendation
UNICOMPARTMENTAL KNEE ARTHROPLASTY VS. HIGH/PROXIMAL TIBIAL OSTEOTOMY Limited Recommendation
DISCHARGE FACILITIES / DISPOSITION Limited Recommendation
ROBOTICS IN TOTAL KNEE ARTHROPLASTY Limited Recommendation
ROBOTICS IN UNICOMPARTMENTAL KNEE ARTHROPLASTY Limited Recommendation

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

Treatment of Pediatric Diaphyseal Femur Fractures
Infant Femur Fracture Limited Recommendation
ORIF Pediatric Femur Fractures Limited Recommendation
Pain Control Limited Recommendation
Waterproof Casting Limited Recommendation

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

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

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 (2020)
Acetaminophen Use After Discharge Consensus Recommendation
Oral NSAID Use After Discharge Following THA Consensus Recommendation

Anesthesia and Analgesia in Total Joint Arthroplasty (2021)
Perioperative Corticosteroids and Complications after TJA Consensus Recommendation
Contraindications to Perioperative Corticosteroid Use Consensus Recommendation
Periarticular Injections of Ketorolac in THA Consensus Recommendation
Perioperative Corticosteroids and Postoperative Pain/Opioid Use in THA Consensus Recommendation
Epinephrine in Periarticular Injection in THA Consensus Recommendation
Clonidine in Periarticular Injections and THA Consensus Recommendation

Clinical Practice Guideline for the Treatment of Clavicle Fractures (2022)
IMMOBILIZATION METHOD Consensus Recommendation
LATERAL CLAVICLE FRACTURE: OPERATIVE VS. NON-OPERATIVE TREATMENT Consensus Recommendation

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

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

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

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

Management of Anterior Cruciate Ligament Injuries (2022)
ASPIRATION OF THE KNEE Consensus Recommendation

Management of Distal Radius Fractures
Opioid Use Consensus Recommendation

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

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

Management of Osteoarthritis of the Knee (Non-Arthroplasty) (3rd Edition)
Dry Needling Consensus Recommendation
Free Floating Interpositional Devices Consensus Recommendation

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

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

Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery
Anti-Depressants Consensus Recommendation

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

Prevention of Surgical Site Infection After Extremity Trauma (2022)
Preoperative Skin Preparation Consensus Recommendation

Surgical Management of Osteoarthritis of the Knee (2022)
BILATERAL SIMULTANEOUS TOTAL KNEE ARTHROPLASTY VS. STAGED Consensus Recommendation
RISK FACTORS: SMOKING Consensus Recommendation

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

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

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

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

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
Topical Oral Antimicrobials 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…