Recommendation 1: For patients with symptomatic knee osteoarthritis, participation in a self-management program that includes strength training, low-intensity aerobic exercise, neuromuscular training, and participation in physical activity consistent with national guidelines is recommended.
Recommendation level: Strongly recommended Meaning: Clinicians should follow this recommendation unless a clear and convincing alternative is available.
Recommendation 2: For patients with symptomatic knee osteoarthritis, weight loss is recommended if body mass index exceeds 25.
Recommendation level: Moderate Recommendation implication: Clinicians should follow this recommendation, but may adjust the treatment plan if there is an alternative approach that meets the patient’s preference.
Recommendation 3a: We do not recommend the use of acupuncture for patients with symptomatic knee osteoarthritis.
Grade of Recommendation: Although we did not perform a harmfulness analysis, we still strongly recommend it.
Implication: Clinicians should follow this recommendation unless a clear and convincing alternative is available.
Recommendation 3b: We neither endorse nor discourage the use of physical therapy (including electrical stimulation) for patients with symptomatic knee osteoarthritis.
Recommendation level: Indeterminate meaning: Physicians should decide whether to use this treatment with “indeterminate” outcomes based on their own experience, but should always follow the latest research evaluating the benefit/benefit ratio of such treatments to aid clinical decision making. The patient’s wishes are the key determinant of treatment.
Recommendation 3c: We neither endorse nor oppose the use of massage for patients with symptomatic knee osteoarthritis.
Recommendation level: Uncertainty of meaning: Physicians should decide whether to use this treatment with “uncertain” outcomes based on their own experience, but should always follow the latest research evaluating the benefit-loss ratio of this type of treatment to aid in clinical decision making. The patient’s wishes are a key determinant of treatment.
Recommendation 4: We neither endorse nor discourage the use of valgus stress braces (to keep the medial compartment of the knee free of weight) in patients with symptomatic osteoarthritis of the knee.
Recommendation level: Uncertainty of meaning: Physicians should decide whether to use this treatment with “uncertain” outcomes based on their own experience, but should always be aware of the latest research evaluating the benefit/loss ratio of this type of treatment to aid clinical decision making. The patient’s wishes are a key determinant of treatment.
Recommendation 5: Lateral wedge inserts are not recommended for patients with symptomatic osteoarthritis of the knee.
Recommendation Grade: Moderate Recommendation Implication: Clinicians should follow this recommendation, but may adjust the treatment plan if there is an alternative approach that meets the patient’s preference.
Recommendation 6: We do not recommend the use of glucosamine and chondroitin for patients with symptomatic knee osteoarthritis.
Grade of Recommendation: Although we did not perform a harmfulness analysis, we still strongly recommend it.
Implication: Clinicians should follow this recommendation unless a clear and convincing alternative is available.
Recommendation 7a: For patients with symptomatic knee osteoarthritis, we recommend oral or topical NSAIDs or tramadol.
Grade of recommendation: Strongly recommended.
Meaning: Clinicians should follow this recommendation unless a clear and convincing alternative is available.
Recommendation 7b: We neither endorse nor discourage the use of paracetamol, opioids, and other analgesic management in patients with symptomatic knee osteoarthritis.
Recommendation level: Uncertainty of meaning: Physicians should decide whether to use this treatment with “uncertain” outcomes based on their own experience, but should always follow the latest research evaluating the benefit-loss ratio of such treatments to aid clinical decision making. The patient’s wishes are the key determinant of treatment.
Recommendation 8: We neither endorse nor oppose the use of intra-articular glucocorticoid injections in patients with symptomatic knee osteoarthritis Recommendation level: Uncertain Implications: Physicians should decide whether to use this treatment with “uncertain” outcomes based on their own experience, but should always follow the latest research evaluating the benefit/benefit ratio of such treatments to help in clinical decision making. Clinical decision making. The patient’s wishes are a key determinant of treatment.
Recommendation 9: We do not recommend hyaluronic acid for patients with symptomatic knee osteoarthritis.
Grade of Recommendation: This guideline is strongly recommended despite the absence of a harmfulness analysis.
Implication: Clinicians should follow this recommendation unless a clear and convincing alternative is available.
Recommendation 10: We neither endorse nor discourage the use of intra-articular injections of growth factors and/or platelet-rich plasma in patients with symptomatic osteoarthritis of the knee.
Grade of Recommendation: Uncertain Implications: Physicians should decide whether to use this treatment with “uncertain” outcomes based on their own experience, but should always follow the latest research evaluating the benefit/benefit ratio of such treatments to aid in clinical decision making. The patient’s wishes are a key determinant of treatment.
Recommendation 11: Syringe lavage is not recommended for patients with symptomatic knee osteoarthritis.
Recommendation Grade: Moderate Recommendation Implication: Clinicians should follow this recommendation, but may adjust the treatment plan as appropriate if there is an alternative approach that meets the patient’s preference.
Recommendation 12: We do not recommend arthroscopic lavage and/or debridement for patients with a primary diagnosis of symptomatic knee osteoarthritis.
Grade of Recommendation: Although no harmfulness analysis was performed, this guideline still strongly recommends it.
Implications: Clinicians should follow this recommendation unless a clear and convincing alternative is available.
Recommendation 13: We neither favor nor oppose arthroscopic partial meniscectomy in patients with osteoarthritis of the knee combined with meniscal rupture.
Recommendation level: Uncertainty: Physicians should decide whether to use this treatment with “uncertain” results based on their own experience, but should always follow the latest studies evaluating the benefit-loss ratio of this type of treatment to aid in clinical decision making. The patient’s wishes are the key determinant of treatment.
Recommendation 14: In patients with symptomatic medial knee osteoarthritis, physicians may be able to perform a proximal tibial valgus osteotomy.
Grade of Recommendation: Limited Implications: Physicians should decide whether to use this recommendation based on their own experience, but should be highly concerned about the most recent studies that argue against this treatment. The patient’s wishes are the key determinant of treatment.
Recommendation 15: In patients with symptomatic medial compartment knee osteoarthritis, this working group recommends against the use of free-floating (non-fixed) spacer devices due to a lack of credible evidence.
RECOMMENDATION GRADE: Expert consensus implication: Although they may be preferred, the decision to follow this recommendation is primarily up to the physician, but the patient’s wishes are the key determinant of treatment.