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Evidence-Based Orthopaedics   |    
The American Academy of Orthopaedic Surgeons Evidence-Based Guideline onTreatment of Osteoarthritis of the Knee, 2nd Edition
David S. Jevsevar, MD, MBA; Gregory Alexander Brown, MD, PhD; Dina L. Jones, PT, PhD; Elizabeth G. Matzkin, MD; Paul A. Manner, MD, FRCSC; Pekka Mooar, MD; John T. Schousboe, MD, PhD; Steven Stovitz, MD; James O. Sanders, MD; Kevin J. Bozic, MD, MBA; Michael J. Goldberg, MD; William Robert Martin, III, MD; Deborah S. Cummins, PhD; Patrick Donnelly, MA; Anne Woznica, MLIS; Leeaht Gross, MPH
View Disclosures and Other Information

Disclaimer: AAOS convened a multidisciplinary volunteer Work Group to develop this clinical practice guideline based on a systematic review of the current scientific and clinical information as well as accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be used as a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s clinical circumstances.

The complete AAOS evidence-based orthopaedics guideline can be found at http://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf



Disclosure: The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. The disclosure information for the Work Group members is found in Appendix XII, page 1005, of the full guideline document at htttp://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 16;95(20):1885-1886
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    David Jevsevar, MD, MBA, Kevin J. Bozic, MD, MBA
    Posted on November 15, 2013
    The Role of the AAOS in Aggregating Evidence and Defining Quality in Orthopaedics
    David Jevsevar, MD, MBA (Chair, AAOS Evidence Based Quality and Value Committee), Kevin J. Bozic, MD, MBA (Chair, AAOS Council on Research and Quality)

    While we understand Dr. Hardy’s concerns, we would like to clarify the methodology used in developing AAOS Clinical Practice Guidelines (CPGs). Our CPGs adhere to the Institute of Medicine standards for evidence-based analysis. Our recommendations are based on a systematic review of all available literature. The process is unbiased, objective, and inclusive, incorporating input and feedback from all relevant stakeholders. When high quality evidence is not available, the strength of recommendations must necessarily reflect the limitations in the evidence base. 
    Intra-articular corticosteroid injections have long been a mainstay of conservative treatment for patients with symptomatic osteoarthritis of the knee. Unfortunately, the literature in this area is wanting. There is a relative paucity of high quality studies that evaluate patient outcome with respect to duration of benefit, technique, type of corticosteroid, and dosage. Further research in this area is necessary.
    While some of what we do as orthopaedists may lack high quality evidence, it doesn’t necessarily follow that there is no patient benefit. We do believe that it is important, however, to point out that the lack of high quality evidence does not impugn the AAOS CPG methodology.
    It is our hope that by synthesizing and distilling large bodies of evidence into succinct clinical practice guidelines, AAOS CPGs will make it easier for orthopaedic surgeons and their patients to weigh the evidence when deciding on the most appropriate treatment for a particular condition. However, in addition to considering the evidence, orthopaedic surgeons and their patients must also bear in mind patient preferences and values, as well as the clinician’s judgment and experience, when formulating an appropriate treatment plan.

    Philip R. Hardy, MD
    Posted on October 25, 2013
    Just Stop
    Jacksonville Orthopaedic Institute, Jacksonville, FL, USA

    There is something seriously wrong with your methodology. If you can't recommend for or against the use of corticosteroids in the management of osteoarthritis, you basically invalidate the rest of your conclusions. You need to just stop.

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