ACR Updates Appropriateness Criteria for Chronic Knee Pain Imaging (2026)

Updated ACR Appropriateness Criteria confirm radiographs as the first-line imaging for chronic knee pain. Additional imaging (MRI, etc.) is outlined for specific scenarios including confirmed osteoarthritis, osteochondral lesions, subchondral insufficiency fracture, and soft-tis…

• Evidence-based guideline (GRADE methodology) developed by a multidisciplinary ACR expert panel, reviewed annually; covers osteoarthritis, patellofemoral maltracking, tendon/meniscus/ligament pathology, and subchondral insufficiency fracture.
• Radiographs remain the recommended initial modality; the document specifies clinical scenarios where advanced imaging (e.g., MRI) is appropriate after radiographs, rather than as a first step.
• Where peer-reviewed literature is lacking or equivocal, expert consensus serves as the primary evidentiary source — a recognized limitation of appropriateness criteria methodology.

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