Meniscal tears of the knee (aka, torn cartilage) are extraordinarily prevalent and become universally present as one ages. Treatment often involves surgery, but is surgery the best option? Not necessarily according to scientific evidence presented in the newly published 3rd edition of the American College of Occupational and Environmental Medicine's (ACOEM's) Occupational Medicine Practice Guidelines, knee disorders chapter.
"We have to be much more careful about which patients need surgery for these tears as it is abundantly clear from the evidence that the vast majority do not require surgical treatment," said Kurt Hegmann, MD, MPH, Editor in Chief. The 3rd edition represents the completion of years of effort by ACOEM, its primary research partner, the University of Utah's Rocky Mountain Center for Occupational and Environmental Health, and scores of volunteer expert panelists, reviewers, and other contributors.
The gold standard in effective treatment of occupational injuries and illnesses, the 3rd Edition 4-volume set (now shipping) totals more than 2,500 evidence-based recommendations and 12,000 references in 4,000 pages. "The 3rd edition of the Practice Guidelines offers more value than ever before for musculoskeletal injuries, providing not just recommendations, but the evidence and rationale behind them, which is vital to good medical decision-making," said ACOEM President, T. Warner Hudson, MD.
Other evidence-based findings include recommendations on aerobic exercise for knee arthritis and postsurgical rehabilitation. "There is no quality evidence that early rehabilitation after musculoskeletal surgery is inferior to usual timing of rehabilitation. This raises major questions about how early is too early for rehabilitation, and whether there is such a thing as 'too early'," said Dr. Hegmann.
With the release of the 3rd Edition, ACOEM has completed its transition to an enhanced evidence-based methodology, which includes original systematic reviews, evidence tables, and a completely independent multi-specialty panel development process. ACOEM is a signatory to the Council on Medical Specialty Societies Code for Interactions with Industry and its guideline development process conforms to standards called for by the Institute of Medicine.
In addition to the print version, the Guidelines are also available electronically in an on-line version, APG-I , which allows subscribers to browse content and search via text and keyword, and ICD9 codes. ACOEM's guidelines development platform also supports other legislative-based guidelines including New York and California allowing users additional access to the most current evidence-based guidelines. This development platform is also the basis for the just released Montana Utilization and Treatment Guidelines (www.mtguidelines.com). "The combination of ACOEM's comprehensive truly evidence-based guidelines and development technology is unique for a specialty society and allows many pathways for product development and is not restricted to occupational medicine," said ACOEM's Director of Practice Guidelines, Chris Wolfkiel, PhD.
First published in 1997, Occupational Medicine Practice Guidelines has become the leading source in the United States for evidence-based guidelines used by occupational physicians and other health care professionals. ACOEM's guidelines are also used by insurers, employers, attorneys, and other individuals and organizations involved in health and safety in the workplace.
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