Management of knee osteoarthritis – a joint effort with patients ACG

This ACE Clinical Guideline (ACG) provides evidence-based recommendations on the assessment and non-surgical management of knee osteoarthritis (OA) in adults. Specifically, the ACG covers clinical assessment, mainstay management strategies, pharmacological treatment, involvement of allied health professionals, adjunctive treatments and considerations for specialist referral. The knee OA ACG annex includes validated assessment tools for knee OA, supplementary guidance on flare management and medication tables.

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Management of knee osteoarthritis – a joint effort with patients (Apr 2026) [PDF]

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ACG survey and feedback

We invite all readers of the ACGs to complete this survey. The survey aims to understand the impact of the guideline on clinical confidence, decision-making, and practice. Results will contribute to informing future guidelines and implementation support for you. Your responses will remain confidential and will be analysed in aggregate to safeguard your privacy. The survey takes approximately 10–15 minutes to complete and will remain open for four weeks until 23 May 2026. We highly encourage you to complete the survey after reading the ACG.

ACG recommendations

1.Assess the patient’s pain level, functional capacity, quality of life, psychosocial factors and response to previous treatments (if applicable) to create an individualised management plan.

2.Provide patient education, exercise programmes and weight management as mainstay strategies for all patients with knee OA, tailoring advice based on individual patient profile.

3.To complement or support adherence to mainstay strategies for knee OA:

a)Offer a topical NSAID 

b)Consider prescribing short courses of an oral NSAID if topical NSAIDs are ineffective or unsuitable

4.Consider referring patients with knee OA to relevant allied health professionals for additional non-pharmacological strategies (e.g. supervised exercise, walking aids).

5.Consider intra-articular corticosteroid injections for short-term symptom relief alongside mainstay strategies for knee OA if symptoms persist despite NSAID treatment and/or allied health professional support.

6.Consider acupuncture as adjunctive therapy for patients with knee OA who have not responded adequately to conventional therapies (e.g. exercise, NSAIDs) or prefer alternative treatments.

7.For patients with knee OA whose persistent symptoms significantly impact function and quality of life, discuss referral options for surgical or advanced pain management.

ACG annex

Click below to see the list of references and other information.

Knee OA ACG Annex (Apr 2026) [PDF]

ACG references and Expert Group details

Management of knee osteoarthritis – a joint effort with patients references (Apr 2026) [PDF]

Knee OA ACG Annex references (Apr 2026) [PDF]

Knee OA ACG EG composition and other details (Apr 2026) [PDF]

ACG EtR framework

The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values, acceptability and other considerations.

Knee OA EtR framework with summary of findings