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criteria (AUC) related to the treatment of osteoarthritis of the knee. PATIENT POPULATION This guideline is intended for use with adults (ages 17 years and older) who have been diagnosed by a trained healthcare provider with osteoarthritis of the knee and are undergoing treatment. SCOPE The scope of this guideline includes non-pharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee as well as operative procedures less invasive than knee 16 View background material via the OAK3 CPG eAppendix 1 View data summaries via the OAK3 CPG eAppendix 2 replacement (arthroplasty). It does not provide recommendations for patients diagnosed with rheumatoid arthritis, osteoarthritis of other joints, or other inflammatory arthropathies. ETIOLOGY Osteoarthritis results from an imbalance between breakdown and repair of the tissues in the synovial joint organ and occurs as a result of multiple risk factors including trauma, overuse, and genetic predisposition. INCIDENCE AND PREVALENCE The incidence of knee osteoarthritis in the United States is estimated at 240 persons per 100,000 per year. Worldwide prevalence of radiographically confirmed symptomatic knee OA is estimated to be 3.8% overall, increasing with age to over 10% in the population over the age of 60. BURDEN OF DISEASE Osteoarthritis (of any joint) was the primary diagnosis for 23.7 million ambulatory care visits in 2013. An estimated 32.5 million adults in American, 14% of that population, suffered from symptomatic knee osteoarthritis between 2008 and 2014. Risk factors of the condition increase with age, especially in women. Although women represent 51% of the general population in the United States, they represent 78% of the patients diagnosed with osteoarthritis between 2008 and 2014. Genetics and hereditary vulnerability, elevated body mass, certain occupations, and traumatic knee injuries are other factors that increase one’s risk of developing the disease. EMOTIONAL AND PHYSICAL IMPACT Older adults with self-reported osteoarthritis visit their physicians more frequently and experience greater functional limitations than others in the same age group. The aging of the baby boomers, rise in rates of obesity, and greater emphasis on staying active suggest that the social and physical impact of knee osteoarthritis will continue to be widespread. POTENTIAL BENEFITS, HARM, AND CONTRAINDICATIONS Individuals with osteoarthritis of the knee often complain of joint pain, stiffness, and difficulty with purposeful movement. The aim of treatment is to provide pain relief and improve the patient’s functioning. Most interventions are associated with some potential for adverse outcomes, especially if invasive or operative. Because the clinical research does not differentiate between the sexes, it is possible future research may result in a better understanding of how a patient’s sex alters treatment benefits and harms. Contraindications vary widely by procedure. Reducing risks improves treatment efficacy and is accomplished through collaboration between patient and physician. DIFFERENCES BETWEEN THE PRESENT AND PREVIOUS GUIDELINES This updated clinical practice guideline replaces the second edition that was completed in 2013, “Treatment of Osteoarthritis of the Knee (Non-Arthroplasty) 2nd edition.” This update considered the literature that we previously examined as well as the empirical evidence published since the 2013 guideline. 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 complete listing of inclusion criteria for this guideline is detailed in the section, “Study Selection Criteria,” (eAppendix 1). 17 METHODS The methods used to perform this systematic review were employed to minimize bias and enhance transparency in the selection, appraisal, and analysis of the available evidence. These processes are vital to the development of reliable, transparent, and accurate clinical recommendations. To view the full AAOS clinical practice guideline methodology please visit https://www.aaos.org/additonalresources/ . This clinical practice guideline evaluates the management of osteoarthritis of the knee (non-arthroplasty) patient outcomes. The AAOS approach incorporates practicing physicians (clinical experts) and methodologists who are free of potential conflicts of interest relevant to the topic under study, as recommended by clinical practice guideline development experts.1 This clinical practice guideline was prepared by the AAOS Osteoarthritis of the Knee Guideline physician development group (clinical experts) with the assistance of the AAOS Clinical Quality and Value (CQV) Department (methodologists). To develop this clinical practice guideline, the clinical practice guideline development group held an introductory meeting on February 23, 2018 to establish the scope of the clinical practice guideline. As the physician experts, the clinical practice guideline development group defined the scope of the clinical practice guideline by creating PICO Questions (i.e. population, intervention,
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