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© 2009 the American Academy of Orthopaedic Surgeons
Treatment of Osteoarthritis of the Knee (Nonarthroplasty)
Dr. Richmond is Chairman, Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA. Dr. Hunter is Chief, Division of Research, New England Baptist Hospital. Dr. Irrgang is Director of Clinical Research, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA. Dr. Jones is Associate, Department of Orthopaedic Surgery, and Director, Surgical Sports Medicine Research, Sports Health Center, Cleveland Clinic, Cleveland, OH. Dr. Levy is Orthopaedic Surgeon, Departments of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN. Dr. Marx is Orthopaedic Surgeon, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, and Professor, Orthopedic Surgery, Weill Medical College, Cornell University, New York. Dr. Snyder-Mackler is Physical Therapy Professor, Department of Physical Therapy, University of Delaware, Newark, DE. Dr. Watters is Orthopaedic Surgeon, Bone and Joint Clinic of Houston, Houston, TX. Dr. Haralson is Executive Director of Medical Affairs, AAOS, Rosemont, IL. Dr. Turkelson is Director of Research and Scientific Affairs, AAOS. Ms. Wies is Manager, Clinical Practice Guidelines Unit, Research and Scientific Affairs Department, AAOS. Mr. Boyer is Research Analyst, Guidelines, Research and Scientific Affairs Department, AAOS. Ms. Anderson is Research Analyst, Guidelines, Research and Scientific Affairs Department, AAOS. Mr. St. Andre at the time this guideline was being developed was Research Analyst, Guidelines, Research and Scientific Affairs Department, AAOS. Mr. Sluka is Research Analyst, Guidelines, Research and Scientific Affairs Department, AAOS. Mr. McGowan at the time this guideline was being developed was Medical Research Librarian, Research and Scientific Affairs Department, AAOS.
Dr. Richmond or a member of his immediate family serves as a board member, owner, officer, or committee member of Arthroscopy Association of North America, American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, Eastern Orthopaedic Association, and New England Baptist Hospital; serves as a paid consultant to or is an employee of Lifenet, Mitek, Stryker, Serica, and Wyeth; has received research or institutional support from Arthrex, DJ Orthopaedics, and Smith & Nephew; and has stock or stock options held in Serica. Dr. Hunter or a member of his immediate family has received research or institutional support from DJ Orthopaedics, Eli Lilly, Merck, Pfizer, Stryker, Wyeth, AstraZeneca, and NIH. Dr. Irrgang or a member of his immediate family serves as a board member, owner, officer, or committee member of Orthopaedic Section, American Physical Therapy Association, and has received research or institutional support from Biomet, DePuy, Smith & Nephew, Stryker, and Synthes. Dr. Jones or a member of his immediate family has received research or institutional support from Biomimetic, DePuy, Regen Biologics, Small Bone Innovations, Stryker, TissueLink, ARS Arthro AG, Diapedia LLC, King Pharmacy, Arthrosurface, and Apopharma. Dr. Levy or a member of his immediate family serves as a paid consultant to or is an employee of Valpo Orthotec. Dr. Watters or a member of his immediate family serves as a board member, owner, officer, or committee member of Bone and Joint Decade, USA, North American Spine Society, Intrinsic Therapeutics, Work Loss Data Institute, and American Board of Spine Surgery; serves as a paid consultant to or is an employee of Blackstone Medical, Medtronic Sofamor Danek, Stryker, Instrinsic Therapeutics, and McKessen Health Care Solutions; and has stock or stock options held in Intrinsic Therapeutics. Dr. Haralson or a member of his immediate family serves as a paid consultant to or is an employee of Medtronic and Medtronic Sofamor Danek, and has stock or stock options held in Orthofix and Allmeds. Ms. Wies or a member of her immediate family has stock or stock options held in Shering Plough. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Marx, Dr. Snyder-Mackler, Dr. Turkelson, Mr. Boyer, Ms. Anderson, Mr. St. Andre, Mr. Sluka, and Mr. McGowan.
This clinical practice guideline was approved by the American Academy of Orthopaedic Surgeons.
The clinical practice guideline was explicitly developed to include only treatments less invasive than knee replacement (ie, arthroplasty). Patients with symptomatic osteoarthritis of the knee are to be encouraged to participate in self-management educational programs and to engage in self-care, as well as to lose weight and engage in exercise and quadriceps strengthening. The guideline recommends taping for short-term relief of pain as well as analgesics and intra-articular corticosteroids, but not glucosamine and/or chondroitin. Patients need not undergo needle lavage or arthroscopy with débridement or lavage. Patients may consider partial meniscectomy or loose body removal or realignment osteotomy, as conditions warrant. Use of a free-floating interpositional device should not be considered for symptomatic unicompartmental osteoarthritis of the knee. Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental osteoarthritis of the knee. The work group was unable either to recommend or not recommend the use of braces with either valgus- or varus-directing forces for patients with medial unicompartmental osteoarthritis; the use of acupuncture or of hyaluronic acid; or osteotomy of the tibial tubercle for isolated symptomatic patellofemoral osteoarthritis.
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