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Published by American Academy of Orthopaedic Surgeons · GRADE Evidence-to-Decision Framework
Osteoarthritis results from an imbalance between breakdown and repair of the tissues in the synovial joint organ. This guideline systematically reviews evidence to make clinical recommendations for non-arthroplasty management.
Key Takeaways
This guideline replaces the 2nd edition completed in 2013. A significant change is the adoption of the GRADE Evidence-to-Decision Framework (April 2019) to incorporate additional factors into the strength of recommendations. For example, the 2013 edition strongly recommended against the use of viscosupplementation, whereas this 2021 update downgrades it to a Moderate recommendation against routine use, noting some subsets of patients might benefit.
Lateral wedge insoles are not recommended for patients with knee osteoarthritis.
Canes could be used to improve pain and function in patients with knee osteoarthritis.
Brace treatment could be used to improve function, pain, and quality of life in patients with knee osteoarthritis.
The following supplements may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis: Turmeric, Ginger extract, Glucosamine, Chondroitin, Vitamin D.
Topical NSAIDs should be used to improve function and quality of life for treatment of osteoarthritis of the knee, when not contraindicated.
Supervised exercise, unsupervised exercise, and/or aquatic exercise are recommended over no exercise to improve pain and function for treatment of knee osteoarthritis.
Neuromuscular training (i.e. balance, agility, coordination) programs in combination with traditional exercise could be used to improve performance-based function and walking speed for treatment of knee osteoarthritis.
Self-management programs are recommended to improve pain and function for patients with knee osteoarthritis.
Patient education programs are recommended to improve pain in patients with knee osteoarthritis.
Sustained weight loss is recommended to improve pain and function in overweight and obese patients with knee osteoarthritis.
Manual therapy in addition to an exercise program may be used to improve pain and function in patients with knee osteoarthritis.
Massage may be used in addition to usual care to improve pain and function in patients with knee osteoarthritis.
FDA-approved laser treatment may be used to improve pain and function in patients with knee osteoarthritis.
Acupuncture may improve pain and function in patients with knee osteoarthritis.
Transcutaneous Electrical Nerve Stimulation may be used to improve pain in patients with knee osteoarthritis.
Percutaneous Electrical Nerve Stimulation (pain and function) or Pulsed Electromagnetic Field Therapy (pain) may be used to improve pain and/or function in patients with knee osteoarthritis.
Extracorporeal shockwave therapy may be used to improve pain and function for treatment of osteoarthritis of the knee.
Oral NSAIDs are recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.
Oral acetaminophen is recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.
Oral narcotics, including tramadol, result in a significant increase of adverse events and are not effective at improving pain or function for treatment of osteoarthritis of the knee.
Hyaluronic acid intra-articular injection(s) is not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee.
Intra-articular (IA) corticosteroids could provide short-term relief for patients with symptomatic osteoarthritis of the knee.
Platelet-rich plasma (PRP) may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee.
Denervation therapy may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee.
Arthroscopy with lavage and/or debridement in patients with a primary diagnosis of knee osteoarthritis is not recommended.
Arthroscopic partial meniscectomy can be used for the treatment of meniscal tears in patients with concomitant mild to moderate osteoarthritis who have failed physical therapy or other nonsurgical treatments.
High tibial osteotomy may be considered to improve pain and function in properly indicated patients with unicompartmental knee osteoarthritis.
In the absence of reliable evidence, it is the opinion of the workgroup that the utility/efficacy of dry needling is unclear and requires additional evidence.
In the absence of reliable or new evidence, it is the opinion of the work group not to use free-floating (un-fixed) interpositional devices in patients with symptomatic medial compartment osteoarthritis of the knee.
Clinical Topic
Osteoarthritis of the Knee
Objectives
Provide recommendations that will help practitioners to integrate the current evidence and clinical practice for non-arthroplasty treatment of knee osteoarthritis.
Target Patient Population
Adults (ages 17 years and older) who have been diagnosed by a trained healthcare provider with osteoarthritis of the knee and are undergoing treatment.
Target Providers
Therapeutic Area
Orthopaedics / RheumatologyGuideline Scope
Exclusion Criteria
Special Populations
System: GRADE Evidence-to-Decision Framework
Evidence Levels
Recommendation Strength
Contraindications
Difficulty
advanced
Learning Paths