AAOS Appropriate Use Criteria OAK

AAOS Appropriate Use Criteria Summary for Non-Arthroplasty Treatment of Osteoarthritis of the Knee

Sanders JO, Murray J, Gross L. J am Acad Orthop Surg 2014;22:256-260.

For the mobile application for OAK AUC visit:

H&P (Adapted from table 1 of JAAOS article)

Age	Young Middle-aged Elderly
Function-limiting pain	Function-limiting pain at moderate to long distances: walker moderate to long distances greater than one-quarter mile Function-limiting pain at short distances: limiting activity to two city blocks, the equivalent of walking the length of a shopping mall Pain at rest or at night
Mechanical symptoms	Yes No
Aggravating factors	Walking Stair climbing/descending Constant
Alleviating factors	Rest Nothing
Activities of daily living	No interruption Interrupted Able/unable to take on/off socks & shoes
Prior treatments	Tylenol, ibuprofen, other meds Bracing PT Injections (type, when) Prior surgeries
Range of motion	Full range ext/flexion Lack of full extension (>5 deg flexion contracture) and/or flexion <110 deg
Joint line tenderness to palpation	Yes/no and location(s) if present
Hip/groin pain with passive ROM	Yes/no
Lower extremity neurovascular exam	With comparison to contralateral limb
Ligamentous instability (not to include antalgic giving way)	No ligamentous instability Ligamentous instability
Limb alignment	Varus/valgus and/or patellofemoral malalignment
Imaging (joint space in most involved compartment)	Mild to moderate: joint space narrowing visible on imaging without complete loss of joint space Severe: complete loss of joint space
Pattern of arthritic involvement (medial tibiofemoral, lateral tibiofemoral, or patellofemoral)	Predominantly one compartment More than one compartment

Appropriate Non-Arthroplasty Treatments of Osteoarthritis of the Knee (Adapted from Table 2)

Self-management programs, including lower extremity and core strengthening, low-impact aerobic exercises, and engaging in physical activity consistent with national guidelines, along with patient education about activity modification and the variable progression of the disease.
Prescribed physical therapy, which may include ROM, strengthening, and aerobic exercise programs; neuromuscular education; modalities
Appropriate use of ambulatory aids
Hinged knee brace and/or unloading brace (varus or valgus)
Nonsteroidal anti-inflammatory drugs (oral or topical)
Narcotic medicine for refractory pain (oral or transcutaneous opioids): monitored, intermittent, or low dose in conjunction with other therapies
Tramadol
Acetaminophen
Intra-articular corticosteroids (I would argue that HA and stem cell injections are options as well)
Arthroscopic partial meniscectomy or loose body removal
Realignment osteotomy