Hyaluronic acid joint injections for knee OA: Appropriate Use Criteria

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  • For knee osteoarthritis (KOA), hyaluronic acid (HA) may be appropriate in a number of clinical scenarios.
  • The authors’ Appropriate Use Criteria (AUC) contradicts a previous guideline from the American Academy of Orthopaedic Surgeons (AAOS) that recommended not using HA for KOA.

Why this matters

  • HA injection is a popular nonoperative option for KOA.
  • There is little evidence-based clinical guidance, and practice varies widely.
  • The 2013 AAOS review-based clinical practice guideline recommended not using HA.
  • Yet other reviews found more favorable results.
  • The authors believe the AAOS guideline did not reflect real-world effects of HA.


  • Multidisciplinary workgroup reviewed 100 studies and combined that with expert opinion and evidence-based guidelines, including recent European articles, to develop AUC.
  • AU...