Guideline Video

Guideline Resources

  • Management of Ankle Osteoarthritis
  • American Academy of Orthopaedic Surgeons
  • June 10, 2026
  • Summary
  • Full-text

Video Transcription

Just published June 10th, 2026, the American Academy of Orthopaedic Surgeons’ newest guideline on Management of Ankle Osteoarthritis.

The purpose of this guideline is to improve the care of patients with ankle osteoarthritis by promoting treatment decisions informed by the best available evidence.

In today’s rapid update, we’ll just be going over a summary of the key recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Intra-Articular Hyaluronic Acid

Intra-articular hyaluronic acid alone is not recommended for the treatment of symptomatic ankle osteoarthritis or OA, however, there may be a benefit for short term improvement in pain and function when combined with corticosteroid.

Next the section on Intra-articular Platelet-Rich Plasma 

Intra-articular platelet-rich plasma is not routinely suggested for the treatment of symptomatic ankle osteoarthritis. 

On to the section on Intra-Articular Corticosteroid (Monotherapy)

In the absence of sufficient evidence, it is the opinion of the workgroup that intra-articular corticosteroid injections are an option for short-term symptomatic relief in patients with symptomatic ankle osteoarthritis.

Then the section on Intra-Articular Stem Cell Therapy

In the absence of sufficient evidence, it is the opinion of the workgroup that there is no reliable evidence regarding intra-articular stem cell therapy for symptomatic ankle osteoarthritis. 

Now the section on Skilled Physical Therapy

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with mild to moderate symptomatic ankle osteoarthritis who wish to avoid surgical intervention, the use of skilled physical therapy may improve patient-reported outcomes and potentially affect disease progression.

For the section on Home Exercise Programs

In patients with mild to moderate symptomatic ankle osteoarthritis who wish to avoid surgical intervention, group education and exercise including a home exercise program, may improve satisfaction, pain, and global rating of change. 

On to the section on Opioids

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with symptomatic ankle osteoarthritis, prescription opioids should not be used in the management of OA. 

Next the section on NSAIDs/Acetaminophen

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with symptomatic ankle osteoarthritis the use of NSAIDs and/or acetaminophen may be used for initial symptomatic relief, when no other medical contraindications exist. 

Moving on to the section on Durable Medical Equipment

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with symptomatic ankle OA, durable medical equipment may improve patient reported outcomes, and affect progression of OA symptoms, or need for invasive intervention. 

Then the section on Weight Reduction

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with symptomatic ankle osteoarthritis, weight reduction may improve patient reported outcomes and affect progression of OA symptoms.

Now for the section on Surgical Treatment for OA (Arthroscopic Debridement, Periarticular Osteotomy, Arthroplasty)

In the absence of sufficient evidence, it is the opinion of the workgroup that, in patients with symptomatic ankle osteoarthritis who have failed nonoperative care and desire joint preservation, arthroscopic debridement, or periarticular realignment osteotomy, are options that may improve patient-reported outcomes and/or delay progression to joint-sacrificing procedures. 

Then for the section on Surgical Treatment for End Stage Ankle OA

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients with end-stage ankle OA, who have failed non-operative treatment, either Ankle Arthrodesis or Total Ankle Arthroplasty can be utilized to improve patient reported outcomes. 

For the section on Postoperative Physical Therapy

In the absence of sufficient evidence, it is the opinion of the workgroup that postoperative physical therapy may improve patient reported outcomes, range of motion, return to work/activity, strength, and gait restoration. 

And last the section on Tranexamic Acid

In the absence of sufficient evidence, it is the opinion of the workgroup that in patients undergoing total ankle arthroplasty or ankle arthrodesis for end stage ankle OA, perioperative tranexamic acid may reduce complications, improve patient outcomes, and decrease perioperative blood-loss. 

And there you have it. Make sure to check out the full guideline from the American Academy of Orthopaedic Surgeons and other related clinical decision support tools at guidelinecentral.com.

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