Clinical Decision Making Based on Evidence

Surgeons make decisions with patients about whento operate and when to recommend nonoperative care on a daily basis. We must decide when to inves-tigate and which investigations to order. If it is to be surgery, the decision on which operation is the best should, ideally, be based on prospective, randomized controlled studies, free of bias and relevant to the clinical decision. However, in many cases we ask “Do we have sufficient evidence? ” The answer is: in some cases “Yes ” and in some cases “No.” A study by Vitale et al.1 showed that the rate of rotator cuff repair in the United States varied up to 9 tim wa in tio lac de ge su al. Ac fou sta ind Level I evidence is desired for all clinical decisions but it is not always available. In many cases, we have to make clinical decisions without adequate evidence. Although our research will constantly strive to im-prove our evidence-based knowledge, we will always have to use our common sense to make clinical judg-ments to help patients. Nevertheless, an in-depth un-derstanding of the available evidence will always as-sist us to take better care of patients. Starting in this issue of Arthroscopy, the members of the ISAKOS Scientific Committee are sponsoring the publication of a series of evidence-based medicine reviews on topics tha the bu pro d