Knee osteoarthritis: pathophysiology and current treatment modalities

Figures & data

Table 1 Knee osteoarthritis management recommendations from societies

Societies recommendations
Treatment	OARSI	ACR	AAOS
Exercise (land and water based)	Appropriate	Strong recommendation	Strong recommendation
Transcutaneous electrical nerve stimulation (TENS)	Uncertain	Conditional recommendation	Inconclusive
Weight control	Appropriate	Strong recommendation	Moderate recommendation
Chondroitin or Glucosamine	Not appropriate for disease modification, Uncertain	Recommended against use	Recommended against use
Acetaminophen	Without comorbidities: appropriate	Conditional recommendation	Inconclusive
Duloxetine	Appropriate	No recommendation	No recommendation
Oral NSAIDs	Without comorbidities: appropriate With comorbidities: not appropriate	Conditional recommendation	Strong recommendation
Topical NSAIDs	Appropriate	Conditional recommendation	Strong recommendation
Opioids	Uncertain	No recommendation	Recommended only tramadol
Intra-articular corticosteroids	Appropriate	Conditional recommendation	Inconclusive
Intra-articular viscosupplementation	Uncertain	No recommendation	Recommended against use

Note: Data from these studies.^13–15

Abbreviations: OARSI, Osteoarthritis Research Society International; ACR, American College of Rheumatology; AAOS, American Academy of Orthopedic Surgeons; TENS, transcutaneous electrical nerve stimulation; NSAIDs, non steroidal antiinflamatory drug.

Table 2 Different exercise modalities for knee OA

Aerobic/endurance	Exercise modalities	Balance/proprioceptive	Stretching
	Resistance/strength training
Include activities like walking, climbing stairs, and cycling. They can decrease joint tenderness while improving functional status and respiratory capacity. Cycling is especially attractive to patients given the low impact profile.^Citation16,Citation18 One study showed a reduction of 10–12% on the physical disability and the knee pain questionnaires.^Citation16	Isometric, isotonic, isokinetic, and dynamic modalities have been studied. Most of them targeting quadriceps, hip abductors, hamstrings, and calf muscles. They improve strength, physical function, and pain levels, with similar efficacy and outcomes than aerobic exercises.	This includes modalities such as Tai Chi, using slow and gentle movements to adopt different weight baring postures while using breathing techniques.	This group will specifically help with patient’s range of motion and flexibility.

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