Clinical decision making based on evidence.

2 urgeons make decisions with patients about when to operate and when to recommend nonoperative are on a daily basis. We must decide when to invesigate and which investigations to order. If it is to be urgery, the decision on which operation is the best hould, ideally, be based on prospective, randomized ontrolled studies, free of bias and relevant to the linical decision. However, in many cases we ask “Do e have sufficient evidence?” The answer is: in some ases “Yes” and in some cases “No.” A study by Vitale et al.1 showed that the rate of otator cuff repair in the United States varied up to 9 imes from one state to another. This large variation as not related to the density of orthopaedic surgeons n a given state, and the rates were inversely proporional to population density. In other words, there is a ack of evidence in the literature to support surgical ecision making. This variation in orthopaedic sureons’ perceptions about the indication for rotator cuff urgery was further highlighted in a study by Dunn et l.2 In a survey of the members of the American cademy of Orthopaedic Surgeons, these authors ound significant variations in the surgeons’ undertanding of the natural history of the condition and ndications for surgery.