Surgical management of rotator cuff tears in adults: Prospective study of 50 consecutive patients and professional practice self-assessment.

INTRODUCTION: As part of quality-improvement efforts, we self-assessed our professional practices regarding the surgical management of rotator cuff tears comparatively to recommendations issued by the French National Authority for Health (HAS). MATERIAL AND METHODS: An independent observer prospectively evaluated 50 consecutive patients with rotator cuff tears treated surgically over a 1-year period. For each patient, we identified divergences with the 20 relevant HAS recommendations. RESULTS: Initially, 54% of practices were found to diverge from HAS recommendations, 10% regarding the preoperative work-up, 14% the duration of initial medical treatment, and 30% the nature of the surgical procedure. DISCUSSION: A review of the data showed that 26% of practices diverged from recommendations, 10% regarding the preoperative work-up, 2% the duration of initial medical treatment, and 14% the nature of the surgical procedure. Overall, for the 26% of divergent practices, 10% were related to judgement or evaluation errors and 16% to a deliberate and substantiated decision made by the surgeons. CONCLUSION: The clinical practice guidelines issued by the HAS, although useful and necessary, were shown by our study to exhibit a number of limitations. Thus, our data illustrate the complexity of surgical management decisions. LEVEL OF EVIDENCE: Level IV (cases series).

Total knee arthroplasty in valgus knee.

Total knee arthroplasty (TKA) in valgus knee has the reputation of being more difficult than in well aligned or varus knee, and there is no management consensus. Results on a continuous series of 100 TKAs on valgus knee were compared to the literature data, to define surgical strategy adapted to the various types of valgus knee.