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Did the American Academy of Orthopaedic Surgeons osteoarthritis guidelines miss the mark?
Raveendhara R Bannuru1, Elizaveta E Vaysbrot2, Louis F McIntyre3
1Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, U.S.A.; Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, U.S.A..
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.
Insights
The American Academy of Orthopaedic Surgeons guidelines incorrectly dismissed viscosupplementation for knee osteoarthritis. Methodological flaws in interpreting minimum clinically important improvement (MCII) led to this flawed recommendation.
Area of Science:
- Orthopedics
- Rheumatology
- Clinical Practice Guidelines
Background:
- The 2013 American Academy of Orthopaedic Surgeons (AAOS) guidelines recommended against viscosupplementation for knee osteoarthritis.
- This recommendation was based on the failure to meet the minimum clinically important improvement (MCII) criterion.
- Concerns exist regarding the AAOS's methodology in assessing MCII-based results.
Purpose of the Study:
- To critically evaluate the AAOS's 2013 guidelines concerning viscosupplementation for knee osteoarthritis.
- To assess the appropriate use of minimum clinically important improvement (MCII) in clinical decision-making.
- To advocate for a revised guideline approach that considers research limitations and treatment alternatives.
Main Methods:
- Review of the AAOS 2013 guidelines methodology for knee osteoarthritis treatment.
- Analysis of the application and interpretation of minimum clinically important improvement (MCII) data.
- Evaluation of current research standards for MCII as a clinical decision-making tool.
Main Results:
- The AAOS methodology exhibited significant flaws in obtaining, displaying, and interpreting MCII-based results.
- Current research indicates MCII should serve as a supplementary tool, not the sole basis for clinical decisions.
- The guidelines' condemnation of viscosupplementation may be premature due to methodological limitations.
Conclusions:
- The AAOS 2013 guidelines' recommendation against viscosupplementation for knee osteoarthritis requires re-evaluation.
- Clinical decision-making should not solely rely on MCII, especially given methodological concerns.
- Updated guidelines should acknowledge MCII's limitations and consider viable treatment options for osteoarthritis.
