LAUSR

The Arthroscopy Association of Canada (AAC) recently published guidelines pertaining to arthroscopic surgery as a treatment for osteoarthritis (OA) of the knee. This was in response to recent public interest surrounding the utility and cost-effectiveness of arthroscopic surgery in this setting. As part of these guidelines, the AAC recommends a 6to 9-month trial of “appropriate and comprehensive nonoperative treatment.” A key component of nonoperative strategies are intra-articular injections. The injections available in Canada include corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), and cellular-based therapies, including bone marrow aspirate concentrate (BMAC). In light of emerging evidence, the AAC endeavored to synthesize the most relevant and up-to-date data pertaining to the use of these agents in the treatment of knee OA. Based on the highest quality available evidence as well as the expert opinion of experienced clinicians, recommendations to help guide clinical practice are proposed. The grading of recommendations is categorized according to the scale developed by Wright et al and subsequently expanded by Stevens et al (Table 1). It is understood that the ultimate decision-making process will involve the treating clinician as well as the patient and will take into consideration all associated risks and benefits. CORTICOSTEROIDS