Abstract：
BACKGROUND:The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS' educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported. QUESTIONS/PURPOSES:We wished to assess the overall quality of the AAOS guidelines using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument. METHODS:All 14 guidelines available on the AAOS website as of August 2, 2013 were evaluated. Appraisal was performed by three reviewers, independently, using the AGREE II instrument. This is an internationally recognized and validated assessment tool for evaluating guideline quality. Interrater reliability was calculated and descriptive statistics were performed. Strong interrater reliability was shown using a Spearman's Rho test (correlation coefficient ≥ 0.95). RESULTS:The overall results for AGREE II domains across all 14 guidelines were: scope and purpose (median score, 95%), stakeholder involvement (median score, 83%), rigor of development (median score, 94%), clarity of presentation (median score, 92%), applicability (median score, 48%), and editorial independence (median score, 79%). CONCLUSIONS:This study showed that the overall quality of the AAOS guidelines is high, however their applicability was found to be poor. The value of guidelines that have a high quality but that are difficult for clinicians to implement is questionable. Numerous suggestions have been proposed to improve applicability including; health economist involvement in guideline production, implementation of pilot studies and audit to monitor uptake of the guidelines and clinician feedback sessions and barrier analysis studies. Future AAOS guidelines should consider and implement steps that can improve their applicability.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Sabharwal S,Patel NK,Gauher S,Holloway I,Athanasiou Tdoi
10.1007/s11999-014-3530-0subject
Has Abstractpub_date
2014-06-01 00:00:00pages
1982-8issue
6eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章abstract：:This is a report of replantation of a completely severed forefoot which was divided through the distal tarsus by a samurai sword cut. Primary reconstruction of bone, vessels, nerve and skin was carried out 2 hours following amputation. Neither the long extensor nor the long flexor tendons were repaired. Three years fo...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1979-03-01 00:00:00
abstract：:The effect of immobility on the biomechanical properties of an anterior cruciate bone-ligament-bone unit of rhesus monkey is reported. Wild primates were used and the captivity time was minimized to lessen disuse changes from cage confinement. The ligament-bone specimens were tested in tension to failure under high st...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-03-01 00:00:00
abstract：:After permanent loss of the sciatic nerve, most patients eventually have problems with the insensate skin and need transitibial amputation. The authors have designed a long medial sensate myocutaneous flap down to the foot based on the saphenous branch of the femoral nerve that resulted in good sensation over the enti...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1998-02-01 00:00:00
abstract：:Experience with cementless fixation over the last six years indicates that the technique offers greater opportunities for bone conservation. Thus, when cement is used, and especially if it is forced into the skeleton under pressure, the amount of bone incorporated into the implant is considerable. Conversely, if no ce...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-01-01 00:00:00
abstract：:Recent technologic advances in bone mineral densitometry have resulted in increasingly precise and accurate methods of estimating bone mineral density. Dual-photon absorptiometry has been made obsolete by the introduction of dual-energy radiography, a development that is likely to result in more widespread use of dens...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1991-10-01 00:00:00
abstract：:The accessory navicular, which is considered an anatomic variant, may be the source of pain in athletes. There are three types of accessory naviculars: Type I is an ossicle in the substance of the posterior tibial tendon; Type II forms a synchondrosis with the navicular; and Type III, "the cornuate navicular," represe...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-08-01 00:00:00
abstract：:Evidence from studies on migration raises serious doubts regarding the part played by fatigue failure of acrylic bone cement in the genesis of aseptic loosening of the components of total hip arthroplasties. Moreover, the viscoelastic properties of cement raise serious doubts concerning the relevance of conventional l...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-199810000-00026
更新日期：1998-10-01 00:00:00
abstract：BACKGROUND:In a previous study, we described the distribution of coronal alignment in a normal asymptomatic population and recognized the occurrence of constitutional varus in one of four individuals. It is important to further investigate the influence of this condition on the joint line orientation and how the latter...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-2898-6
更新日期：2014-01-01 00:00:00
abstract：:Proper femoral and tibial component rotational positioning in TKA is critical for outcomes. Several rotational landmarks are frequently used with different advantages and limitations. We wondered whether coronal axes in the tibia and femur based on the transepicondylar axis in the femur would correlate with anteropost...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-008-0452-8
更新日期：2008-11-01 00:00:00
abstract：UNLABELLED:Metastatic bone disease of the humerus may require surgery for treatment of an impending or existing pathologic fracture or for alleviating disabling pain. Prompt restoration of function is a main goal of surgery, although published results do not reveal if that goal is being met. We retrospectively reviewed...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000165857.12676.00
更新日期：2005-08-01 00:00:00
abstract：:The percentage of necrosis in a primary osteosarcoma after the patient has received preoperative chemotherapy is prognostic and is usually used to select subsequent chemotherapy. However, the percentage of necrosis that occurs spontaneously, without preoperative chemotherapy, has not been adequately studied. The exami...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1991-02-01 00:00:00
abstract：:Laboratory experiments show the following relationships between electricity and bone: (1) stressed bone exhibits electronegativity in areas of compression, (2) living, nonstressed bone exhibits electronegativity in areas of bone growth and healing, and (3) the application of low magnitude direct current to bone induce...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-05-01 00:00:00
abstract：:Rupture of the Achilles tendon is being reported more frequently. Results published in the literature in the past 25 years were reviewed to determine the overall outcome comparing surgical with nonsurgical treatment and to identify areas needing further study. The rerupture rate for surgically treated patients was 12/...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-06-01 00:00:00
abstract：:Sciatic nerve entrapment secondary to trochanteric wiring is a rare but serious complication following total hip arthroplasty (THA) in which the transtrochanteric approach has been used. To eliminate this risk, the authors modified the Charnley drill-and-wire-guide forceps for the femur, an instrument that facilitates...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-06-01 00:00:00
abstract：:Retrospective review of 30 patients with nonunion of the humeral shaft treated from 1984-1999 revealed nine patients with an initial fracture pattern which to our knowledge was not described previously. Humeral fractures originated at the junction of the proximal and middle thirds of the diaphysis as an hemitransverse...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：2004-07-01 00:00:00
abstract：BACKGROUND:Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-015-4322-x
更新日期：2015-09-01 00:00:00
abstract：:Despite the advanced age of many patients having total knee arthroplasty, previous attempts to quantify patient function postoperatively have not allowed for normal deterioration of musculoskeletal function that occurs with aging. We determined the effects of aging on knee function, thereby providing a realistic level...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000150130.03519.fb
更新日期：2005-02-01 00:00:00
abstract：:Popliteal artery injury during surgery of the knee is rare but can have devastating consequences. The position of knee flexion has been thought to be protective for the popliteal artery, allowing it to fall back from the knee joint. No prior study has provided in vivo cross sectional evidence of the behavior of the po...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1999-10-01 00:00:00
abstract：:Benign solitary schwannomas of the foot are a rare occurrence; only four cases have been previously reported. A schwannoma associated with the medial plantar nerve present for more than 40 years before the onset of symptoms was diagnosed in a 73-year-old man. Excision of the mass, with preservation of the involved ner...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-03-01 00:00:00
abstract：:Accurate diagnosis of the degree of malignancy of individual chondrosarcomas is a difficult problem for the orthopedist. To determine whether certain biochemical and metabolic parameters might provide a useful supplement to roentgenologic and histologic evaluations, 19 human chondrosarcomas were analyzed for DNA and c...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-08-01 00:00:00
abstract：:The acute flare of joint inflammation in the child with known juvenile rheumatoid arthritis causes concern primarily regarding the need for additional or modified medical treatment. Acute joint inflammation in an otherwise healthy child creates concern regarding the existence of joint infection. In the early phase of ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200401000-00037
更新日期：2004-01-01 00:00:00
abstract：:Severe involvement of the wrist in rheumatoid arthritis poses great functional restrictions in eating, maintaining personal hygiene, and in performing general daily activities. Twenty-six Swanson radiocarpal implant arthroplasties were performed in 23 patients. Patients' average age was 57 years, with a preoperative d...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-06-01 00:00:00
abstract：:In many designs of total knee arthroplasty, the patella with one central peg has been replaced by a patella with three small pegs for cement fixation. There have been recent reports of failure of this design. This is a prospective, consecutive study of two types of patella component fixation in 228 posterior-stabilize...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200111000-00012
更新日期：2001-11-01 00:00:00
abstract：:Seven patients with chronic osteomyelitis were treated by surgical debridement. Cefamandole was administered intravenously before surgery. During the debridement, cefamandole concentrations were measured in serum and necrotic bone. Although adequate levels of antibiotic were achieved in the serum, minimal or no concen...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-10-01 00:00:00
abstract：BACKGROUND:Extensive posteromedial release to correct severe varus deformity during TKA may result in mediolateral or flexion instability and may require a constrained implant. We describe a technique combining computer navigation and medial condylar osteotomy in severe varus deformity to achieve a primary goal of liga...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-012-2773-x
更新日期：2013-05-01 00:00:00
abstract：:Fibrin sealants have until now been used to a very limited extent in patients with a bleeding diathesis. The authors have accumulated experience from 8 minor and 40 major surgical procedures, plus 10 circumcisions and 118 tooth extractions in 106 patients suffering from hemophilia A, B, or von Willebrand's disease. Mo...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-199607000-00013
更新日期：1996-07-01 00:00:00
abstract：:A prospective study of 236 patients with neglected femoral neck fractures was done to determine the usefulness of a preoperative classification based on the radiologic changes that occur at the site of the fracture. Thirty-four patients were observed in Group I, 125 patients were observed in Group II, and nine patient...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：2005-02-01 00:00:00
abstract：BACKGROUND:The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN)--so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capita...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-012-2339-y
更新日期：2012-08-01 00:00:00
abstract：:This biographical sketch of Marshall R. Urist corresponds to the historic texts, The Classic: Bone Morphogenetic Protein, available at DOI 10.1007/s11999-009-1068-3; The Classic: A Morphogenetic Matrix for Differentiation of Cartilage in Tissue Culture, available at DOI 10.1007/s11999-009-1069-2; and The Classic: A Mo...
journal_title：Clinical orthopaedics and related research
pub_type： 传,历史文章,杂志文章
doi：10.1007/s11999-009-1067-4
更新日期：2009-12-01 00:00:00
abstract：:Osteonecrosis (ON) is commonly caused by high doses of glucocorticoids or ethanol intake. We previously reported suppression of BMP-2 by dexamethasone was more pronounced and enhancement by lovastatin was less pronounced in bone marrow stromal cells (BMSCs) from patients with ON than from patients without ON. We there...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-009-0803-0
更新日期：2009-08-01 00:00:00
