YouTube Recommendations for Indications and Surgical Decision-Making in Arthroscopic Rotator Cuff Repair Show Low Concordance with 2025 AAOS Clinical Practice Guidelines

Purpose To evaluate the concordance of YouTube videos addressing rotator cuff tear management with the 2025 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG), with particular focus on treatment indications and surgical decision-making for arthroscopic rotator cuff repair, and to determine whether video characteristics are associated with guideline concordance. Methods A cross-sectional content analysis of publicly available YouTube videos was performed between January and February 2026 using predefined search terms related to rotator cuff tear treatment and surgical decision-making. English-language videos ≥ 1 minute in duration discussing management of rotator cuff tears were included. Videos focused exclusively on postoperative rehabilitation were excluded. Two independent reviewers coded each video against nine AAOS CPG-derived decision points, classifying each as concordant, discordant, or not addressed. Multivariable logistic regression was used to assess associations between video characteristics and above-median concordance. Results A total of 108 videos were included. Median guideline concordance was 11.1% (IQR: 0.0-33.3. 24 (22.2%) of videos addressed no decision-making domain. Highest concordance rates were observed for physical therapy effectiveness (45.4%), surgical indications (46.3%), and management of high-grade partial-thickness tears (42.6%). Surgical technique and adjunctive domains demonstrated low concordance, including arthroscopic versus open repair (3.7% concordant; 21.3% discordant) and biologic therapies (3.7% concordant; 16.7% discordant). In multivariable analysis, longer video duration was associated with higher concordance (OR 1.14 per minute [95% CI: 1.02-1.27]; p=0.021). Higher view count was associated with lower concordance (OR 0.63 per log 10 (views+1) [95% CI: 0.43-0.91]; p=0.014). Uploader category was not significantly associated with concordance. Conclusion YouTube videos addressing rotator cuff tear management demonstrate low concordance with the 2025 AAOS Clinical Practice Guideline, with discordance concentrated in surgical approach and adjunctive therapy domains. Higher view counts were associated with lower guideline concordance.