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ACR Appropriateness Criteria® Chronic Knee Pain: Update 2026.

, Cyrus P Bateni¹, Alice S Ha²

¹University of California Davis Health, Sacramento, California.

Journal of the American College of Radiology : JACR

|June 24, 2026

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Chronic knee pain evaluation requires imaging when physical exams are inconclusive. This guide details appropriate imaging for various knee pain causes, including osteoarthritis and soft tissue issues.

Area of Science:

Orthopedics
Radiology
Musculoskeletal Medicine

Background:

Chronic knee pain is a common primary care complaint.
Osteoarthritis is the most frequent cause, but other etiologies exist.
Physical examination alone is insufficient for diagnosis.

Purpose of the Study:

To outline appropriate imaging strategies for chronic knee pain.
To guide the use of additional imaging beyond initial radiographs.
To address imaging for specific conditions like soft tissue abnormalities and insufficiency fractures.

Main Methods:

Evidence-based guideline development by the American College of Radiology.
Systematic analysis of peer-reviewed literature.
Adaptation of methodologies like Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Keywords:

AUC Appropriate Use Criteria Appropriateness Criteria CT MRI chronic imaging knee pain radiographs

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Main Results:

Radiographs are the first-line imaging modality for chronic knee pain.
Specific criteria guide the need for further imaging when osteoarthritis is present.
A structured approach is provided for evaluating other knee pain causes.

Conclusions:

Appropriate imaging is crucial for diagnosing chronic knee pain accurately.
Guidelines help determine the necessity of advanced imaging techniques.
This approach ensures optimal patient management for diverse knee pathologies.