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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 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) 3 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! INTRODUCTION OVERVIEW This clinical practice guideline is based on a systematic review of published studies examining the nonarthroplasty treatment of knee osteoarthritis in adults. It provides recommendations that will help practitioners to integrate the current evidence and clinical practice, and it highlights gaps in the literature in need of future research. This guideline is intended to be used by appropriately trained physicians and clinicians who manage the treatment of osteoarthritis of the knee. It also serves as an information resource for developers and applied users of clinical practice guidelines. GOALS AND RATIONALE The purpose of this clinical practice guideline is to evaluate the current best evidence associated with treatment. Evidence-based medicine (EBM) standards advocate for use of empirical evidence by physicians in their clinical decision making. To assist with access to the large resources of information, a systematic review of the literature in publication was conducted between March 2018 and April 28, 2020. It highlights where there is good evidence, where evidence is lacking, and what topics future research will need to target in order to help facilitate evidence-based decision making in the treatment of patients with osteoarthritis of the knee. AAOS staff methodologists assisted the physician/clinician work group in evaluating the existing literature so that they could formulate the following recommendations based on a rigorous systematic process. Musculoskeletal care is provided in many different settings and by a variety of providers. We created this guideline as an educational tool to guide qualified physicians and clinicians in making treatment decisions that improve the quality and efficacy of care. This guideline should not be construed as including all possible methods of care or excluding acceptable interventions similarly directed at obtaining favorable outcomes. The final decision to use a specific procedure must be made after assessing all concerns presented by the patient and consideration of locality-specific resources. INTENDED USERS This guideline is intended to be used by orthopaedic surgeons and other healthcare providers managing patients with osteoarthritis of the knee. It serves as an information resource for medical practitioners. In general, individual practicing physicians and clinicians do not have the resources required to complete a project of comparable scope and duration involving the evaluation of an extensive literature base. In April 2019, the AAOS adopted the use of the GRADE Evidence-to-Decision Framework into its clinical practice guideline development methodology. This Framework enables work group members to incorporate additional factors into the strength of each recommendation and move away from the rigidity of previous AAOS recommendation language stems. The AAOS intends for this guideline to assist treatment providers not only in making shared clinical decisions with their patients, but also in describing to patients and their loved ones why a selected intervention represents the best available course of treatment. This guideline is not intended for use as a benefits determination document. It does not cover allocation of resources, business and ethical considerations, and other factors needed to determine the material value of orthopaedic care. Users of this guideline may also want to consider the appropriate use
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