Management of Osteoarthritis of the Knee (Non-Arthroplasty) - Evidence-Based Clinical Practice Guideline - AAOS Adopted 2021

Sep 26, 2026

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Evidence-based clinical practice guideline for managing knee osteoarthritis without arthroplasty, developed through a formal systematic review and an AAOS physician volunteer guideline development group. Adopted by the American Academy of Orthopaedic Surgeons Board of Directors on August 31, 2021, and includes endorsed, disclosure, and funding statements. Provides clinical recommendations across nonoperative interventions—such as insoles, canes, braces, exercise, education, weight loss, manual therapy, and multiple pharmacologic and nonpharmacologic treatment options—while emphasizing individualized patient care based on clinician judgment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages126

Reading Time5 h 18 min

AccessFree to download

Summary of Recommendations

Lateral Wedge Insoles

Canes

Braces

Oral/Dietary Supplements

Topical Treatments

Supervised Exercise

Neuromuscular Training

Self-Management

Patient Education

Weight Loss Intervention

Manual Therapy

Massage

Laser Treatment

Acupuncture

Transcutaneous Electrical Nerve Stimulation

Percutaneous Electrical Nerve Stimulation/Pulsed Electromagnetic Field Therapy

Extracorporeal Shockwave Therapy

Oral NSAIDs

Oral Acetaminophen

Oral Narcotics

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 31, 2021 Endorsed by: Please cite this guideline as: American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (NonArthroplasty) Evidence-Based Clinical Practice Guideline. [https://www.aaos.org/oak3cpg](https://www.aaos.org/oak3cpg) Published 08/31/2021 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](at orthoguidelines@aaos.org)[ ](at orthoguidelines@aaos.org)[orthoguidelines@aaos.org](at orthoguidelines@aaos.org). 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) 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](www.orthoguidelines.org) or by downloading to your smartphone or tablet via the Apple and Google Play stores! Contents SUMMARY OF RECOMMENDATIONS................................................................................. 7 Lateral Wedge Insoles............................................................................................................... 7 Canes .......................................................................................................................................... 7 Braces ......................................................................................................................................... 7 Oral/Dietary Supplements ........................................................................................................ 7 Topical Treatments ...........................................................................................

FAQs

What is the scope of this AAOS guideline for knee osteoarthritis?

It focuses on management of knee osteoarthritis using non-arthroplasty approaches. Recommendations cover a range of nonoperative treatments and therapies.

How was the guideline developed and how should clinicians use it?

It was developed based on a formal systematic review of scientific and clinical information and accepted approaches to treatment and/or diagnosis. It is not a fixed protocol, and patient care should rely on clinician independent medical judgment and individual circumstances.

Are there regulatory and safety considerations for medicines or devices mentioned in the guideline?

Yes. The guideline states that some referenced drugs or medical devices may not be FDA-cleared or may be cleared for specific uses only, and it is the physician’s responsibility to confirm FDA clearance status for each item used.

Sep 26, 2026

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