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Management of Osteoarthritis of the Knee (Non-Arthroplasty)

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Management of Osteoarthritis of the Knee (Non-Arthroplasty) Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline Adopted by: The American Academy of Orthopaedic Surgeons Board of Directors August 30, 2021 Please cite this guideline as: American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline. https://www.aaos.org/oak3cpg Published August 31, 2021 View background material via the OAK3 CPG eAppendix 1 View data summaries via the OAK3 CPG eAppendix 2 Disclaimer This clinical practice guideline (CPG) was developed by a physician volunteer clinical practice guideline development group based on a formal systematic review of the available scientific and clinical information and accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s specific clinical circumstances. Disclosure Requirement In accordance with AAOS policy, all individuals whose names appear as authors or contributors to this clinical practice guideline filed a disclosure statement as part of the submission process. All panel members provided full disclosure of potential conflicts of interest prior to voting on the recommendations contained within this clinical practice guideline. Funding Source This clinical practice guideline was funded exclusively by the American Academy of Orthopaedic Surgeons who received no funding from outside commercial sources to support the development of this document. FDA Clearance Some drugs or medical devices referenced or described in this Clinical practice guideline may not have been cleared by the Food and Drug Administration (FDA) or may have been cleared for a specific use only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice. Copyright All rights reserved. No part of this clinical practice guideline may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the AAOS. If you wish to request permission please contact the AAOS Department of Clinical Quality and Value at [email protected]. Published 2021 by the American Academy of Orthopaedic Surgeons (AAOS) 9400 W Higgins Rosemont, IL First Edition Copyright 2021 by the American Academy of Orthopaedic Surgeons (AAOS) 2 View background material via the OAK3 CPG eAppendix 1 View data summaries via the OAK3 CPG eAppendix 2 To View All AAOS and AAOS-Endorsed Evidence-Based clinical practice guidelines and Appropriate Use Criteria in a User-Friendly Format, Please Visit the OrthoGuidelines Web-Based App at www.orthoguidelines.org or by downloading to your smartphone or tablet via the Apple and Google Play stores! 3 Contents SUMMARY OF RECOMMENDATIONS ................................................................................. 7 Lateral Wedge Insoles ............................................................................................................... 7 Canes .......................................................................................................................................... 7 Braces ......................................................................................................................................... 7 Oral/Dietary Supplements ........................................................................................................ 7 Topical Treatments ................................................................................................................... 8 Supervised Exercise................................................................................................................... 8 Neuromuscular Training .......................................................................................................... 8 Self-Management ....................................................................................................................... 8 Patient Education ...................................................................................................................... 8 Weight Loss Intervention ......................................................................................................... 9 Manual Therapy ........................................................................................................................ 9 Massage ...................................................................................................................................... 9 Laser Treatment ........................................................................................................................ 9 Acupuncture .............................................................................................................................. 9 Transcutaneous Electrical Nerve Stimulation ...................................................................... 10 Percutaneous Electrical Nerve Stimulation/Pulsed Electromagnetic Field Therapy ....... 10 Extracorporeal Shockwave Therapy ..................................................................................... 10 Oral NSAIDs ............................................................................................................................ 10 Oral Acetaminophen ............................................................................................................... 11 Oral Narcotics .......................................................................................................................... 11 Hyaluronic Acid....................................................................................................................... 11 Intra-articular Corticosteroids .............................................................................................. 11 Platelet-rich Plasma ................................................................................................................ 11 Denervation Therapy .............................................................................................................. 12 Lavage/Debridement ............................................................................................................... 12 Partial Meniscectomy .............................................................................................................. 12 Tibial Osteotomy ..................................................................................................................... 12 Summary of Consensus Statement ............................................................................................ 13 Dry Needling ............................................................................................................................ 13 Free Floating Interpositional Devices .................................................................................... 13 DEVELOPMENT GROUP ROSTER ...................................................................................... 14 VOTING MEMBERS ............................................................................................................. 14 4 View background material via the OAK3 CPG eAppendix 1 View data summaries via the OAK3 CPG eAppendix 2 NON-VOTING MEMBERS ................................................................................................... 14 AAOS STAFF .......................................................................................................................... 14 INTRODUCTION....................................................................................................................... 15 METHODS .................................................................................................................................. 17 LITERATURE SEARCHES .................................................................................................. 17 DEFINING THE STRENGTH OF RECOMMENDATION .............................................. 17 VOTING ON THE RECOMMENDATIONS ...................................................................... 18 INTERPRETING THE STRENGTH OF EVIDENCE ....................................................... 19 Table I. LEVEL OF EVIDENCE DESCRIPTIONS ........................................................ 19 Table II. INTERPRETING THE STRENGTH OF A RECOMMENDATION ............ 19 REVIEW PERIOD .................................................................................................................. 20 THE AAOS CPG APPROVAL PROCESS .......................................................................... 21 REVISION PLANS ................................................................................................................. 21 CPG DISSEMINATION PLANS .......................................................................................... 21 Study Attrition Flowchart ...................................................................................................... 22 RECOMMENDATIONS ............................................................................................................ 23 Lateral Wedge Insoles ........................................................................................................
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