AAOS Issues New Treatment Criteria for Carpal Tunnel, Knee Osteoarthritis

The American Academy of Orthopaedic Surgeons (AAOS) board of directors has approved new Appropriate Use Criteria (AUC) designed to augment clinical practice guidelines for the management of carpal tunnel syndrome (CTS) and the surgical management of osteoarthritis of the knee.

Appropriate Use Criteria for the Management of Carpal Tunnel Syndrome offers 135 diagnostic scenarios intended to aid orthopaedic surgeons as well as other clinicians in their efforts to determine whether a patient has carpal tunnel syndrome. The criteria outlines optimal treatment, ranging from non-operative options such as a splint or steroid injection, to surgery, for those with CTS. The AUC scenarios include patient-reported pain and impairment, and whether or not an examination and/or electrodiagnostic testing has been performed, and the outcome of this testing.
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The new criteria contain "valuable information in how to approach and manage the patient with new symptoms suspicious for CTS, and with low-to-moderate symptoms, ie, a patient [for whom] a primary care doctor may do the initial work-up and conservative treatment prior to referral," said Robert H. Quinn, MD, AUC Section Leader on the Committee on Evidence-Based Quality and Value.

Appropriate Use Criteria for the Surgical Management of Osteoarthritis of the Knee examines 3 types of surgical treatment for these patients: total knee replacement (TKR), unicompartmental knee replacement, and realignment osteotomy, which cuts and reshapes either the tibia or femur to relieve pressure on the knee joint. This AUC also details scenarios in which each of these options is appropriate.

In total, the knee osteoarthritis AUC includes 864 scenarios that consider pain, knee instability, patient age, knee alignment and extension, the number of knee compartments affected, and the direction that the distal segment of the joint points, according to AAOS. The criteria generally recommend total knee replacement in older patients, while suggesting that unicompartmental surgery and realignment osteotomy is often appropriate for younger patients and those with more limited osteoarthritis.

Naturally, younger patients with knee osteoarthritis will have to live with the treatment for a longer time, said Quinn, adding that a key goal of treatment is to preserve as much of the normal anatomy as possible, for as long as possible.

—Mark McGraw

References

AAOS. Appropriate use criteria for the management of carpal tunnel syndrome. AAOS. http://www.orthoguidelines.org/go/auc/default.cfm?auc_id=224989&actionxm=Terms. Accessed December 14, 2016.

AAOS. Appropriate use criteria for the surgical management of osteoarthritis of the knee. AAOS. http://www.orthoguidelines.org/go/auc/default.cfm?auc_id=224986&actionxm=Terms. Accessed December 14, 2016.