Level V Evidence
Did the American Academy of Orthopaedic Surgeons Osteoarthritis Guidelines Miss the Mark?

https://doi.org/10.1016/j.arthro.2013.10.007Get rights and content

Abstract

The American Academy of Orthopaedic Surgeons (AAOS) 2013 guidelines for knee osteoarthritis recommended against the use of viscosupplementation for failing to meet the criterion of minimum clinically important improvement (MCII). However, the AAOS's methodology contained numerous flaws in obtaining, displaying, and interpreting MCII-based results. The current state of research on MCII allows it to be used only as a supplementary instrument, not a basis for clinical decision making. The AAOS guidelines should reflect this consideration in their recommendations to avoid condemning potentially viable treatments in the context of limited available alternatives.

Section snippets

Commentary

The most recent AAOS CPG for knee OA raised controversy by “strongly recommending” against the use of viscosupplementation.9 This negative shift from the 2008 “inconclusive” recommendations followed changes in CPG methodology rather than an evidence trend. Furthermore, the significant limitations of the AAOS methodology called into question the guidelines' verdict and highlighted the profound impact that unfavorable recommendations may have on multiple stakeholders. We aim to discuss the

References (18)

There are more references available in the full text version of this article.

Cited by (0)

The authors report the following potential conflict of interest or source of funding: R.R.B. has received a grant from DePuy and payment for an education presentation from Sanofi.

View full text