The American Academy of Orthopaedic Surgeons (AAOS) just released a new, evidence-based clinical practice guideline on managing osteoarthritis in the ankle. The guideline, Management of Ankle Osteoarthritis, features two sets of guidance: recommendations and options. The AAOS defines recommendations as statements made with sufficient evidence to create a directional statement. Options are defined as statements where there is little or no evidence on a topic. 

The two main recommendations featured in Management of Ankle Osteoarthritis are outlined below. They relate to intra-articular hyaluronic acid and intra-articular platelet-rich plasma. An additional twelve option statements are also provided in the guideline, and outlined below, including statements on home exercise programs, opioids, NSAIDs/acetaminophen, and more.

Below we’ve divided the statements into their respective sections, for your convenience. Consult the full-text version of the guideline for the complete rundown of each statement.

Recommendations from the 2026 AAOS Guideline on Ankle Osteoarthritis
  • Intra-Articular Hyaluronic Acid: Intra-articular hyaluronic acid alone is not recommended for the treatment of symptomatic ankle osteoarthritis, however, there may be a benefit for short term improvement in pain and function  when combined with corticosteroid.
  • Intra-Articular Platelet-Rich Plasma (PRP): Intra-articular platelet-rich plasma is not routinely suggested for the treatment of symptomatic ankle osteoarthritis.
Options from the 2026 AAOS Guideline on Ankle Osteoarthritis
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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 (Fusion) or Total Ankle Arthroplasty (Replacement) can be utilized to improve patient reported outcomes.
  • 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.
  • 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 TXA may reduce complications, improve patient outcomes, and decrease perioperative blood-loss.

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