The American Academy of Orthopaedic Surgeons (AAOS) approved new Appropriate Use Criteria (AUC) for the management of carpal tunnel syndrome and the surgical management of osteoarthritis of the knee. The new AUCs serve as a complement to the existing clinical practice guidelines “Management of Carpal Tunnel Syndrome” and “Surgical Management of Osteoarthritis of the Knee.” 

The AUC for the management of carpal tunnel syndrome contains 135 diagnostic scenarios to help surgeons and other clinicians determine whether the patient has carpal tunnel syndrome or not. The examples include patient-reported pain and impairment, and whether or not an exam or electrodiagnostic testing were conducted in addition to the outcomes. If carpal tunnel syndrome is confirmed, the AUC provides optimal treatment such as non-operative methods (eg, splint, steroid injection) and surgery.  

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Robert H. Quinn, MD, AUC Section Leader on the Committee on Evidence-Based Quality and Value, noted, “With a very common condition like carpal tunnel syndrome, which has seen a significant variation in the approach, diagnosis and treatment, the AUC succinctly directs the provider toward a fairly narrow and evidence-based decision making and treatment pathway.”

The AUC for surgical management of osteoarthritis of the knee addresses three types of treatment and the appropriate scenarios for each: total knee replacement, unicompartmental knee replacement, and realignment osteotomy. A total of 864 scenarios which take into account pain, knee instability, patient age, knee alignment/extension, affected knee compartments, and varus/valgus are included. 

In general, the AUC directed older patients towards total knee replacement and directed younger patients as well those with more limited osteoarthritis to unicompartmental surgery and realignment osteotomy. 

Dr. Quinn added, “We want to preserve as much of the normal anatomy as possible.”

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