Management of osteoarthritis of the knee (non-arthroplasty): AAOS Guideline

Key recommendations include:

• 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; however, the evidence is inconsistent/limited, and additional research clarifying the efficacy of each supplement is needed – 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 performancebased function and walking speed for the 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.
• Modalities that may be used to improve pain and/or function in patients with knee osteoarthritis include: - Transcutaneous Electrical Nerve Stimulation (pain).
• Modalities that may be used to improve pain and/or function in patients with knee osteoarthritis include a) Percutaneous Electrical Nerve Stimulation (pain and function) and b) Pulsed Electromagnetic Field Therapy (pain).
• Extracorporeal shockwave therapy may be used to improve pain and function for the 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 the 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 workgroup not to use free-floating (un-fixed) interpositional devices in patients with symptomatic medial compartment osteoarthritis of the knee.

Reference:

American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). https://www.aaos.org/oak3cpg Published August 31, 2021.