Skip to main content

Advertisement

Log in

Non-surgical Treatment Recommendations for Knee Osteoarthritis

  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Osteoarthritis (OA) of the knee is a common disease with associated direct and indirect costs having a significant societal impact. This review is conducted to discuss various treatment options for knee OA, highlight the most recent evidence regarding efficacy, and devise clinical recommendations to meet the needs of the patients.

Recent Findings

Pharmacologically, options tend to be limited. Simple analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are widely used, with efficacy and safety being questioned. Mild opioids can be considered, although strong opioids are discouraged and need to be incorporated with great caution. Therapeutic exercises and weight loss have been the cornerstone of knee OA management. Symptomatic relief can be achieved with intra-articular steroids, hyaluronic acid, and orthobiologics injections as well. More recently, genicular nerve neurotomy has been introduced to the treatment algorithm and shown promising results, although some refinement of the technique is likely needed in the future.

Summary

A proper and astute approach is adopting a comprehensive treatment program encompassing multimodal and multidisciplinary modalities. Future direction should focus on the clinical success of such effort in terms of pain and function improvement, patient satisfaction, and reduction in a financial burden to the health care system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Martel-Pelletier J, Boileau C, Pelletier J-P, Roughley PJ. Cartilage in normal and osteoarthritis conditions. Best Pract Res Clin Rheumatol. 2008;22(2):351–84. https://doi.org/10.1016/j.berh.2008.02.001.

    Article  CAS  PubMed  Google Scholar 

  2. Ong KL, Runa M, Lau E, Altman R. cost-of-illness of knee osteoarthritis: potential cost savings by not undergoing arthroplasty within the first 2 years. Clin Econ Outcomes Res. 2019;11:245–55. https://doi.org/10.2147/ceor.s170119.

    Article  Google Scholar 

  3. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–89. https://doi.org/10.1016/j.joca.2019.06.011.

    Article  CAS  Google Scholar 

  4. Bruyère O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, Pelletier J-P, Rannou F, Rizzoli R, Roth R, Uebelhart D, Cooper C, Reginster J-Y. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Semin Arthritis Rheum. 2019;49(3):337–50. https://doi.org/10.1016/j.semarthrit.2019.04.008.

    Article  PubMed  Google Scholar 

  5. Raposo F, Ramos M, Lúcia Cruz A. Effects of exercise on knee osteoarthritis: a systematic review. Musculoskelet Care. 2021;19(4):399–435. https://doi.org/10.1002/msc.1538.

    Article  Google Scholar 

  6. Wang T-J, Lee S-C, Liang S-Y, Tung H-H, Wu S-FV, Lin Y-P. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. J Clin Nurs. 2011;20(17–18):2609–22. https://doi.org/10.1111/j.1365-2702.2010.03675.x.

    Article  PubMed  Google Scholar 

  7. Wang C, Schmid CH, Iversen MD, Harvey WF, Fielding RA, Driban JB, Price LL, Wong JB, Reid KF, Rones R, McAlindon T. Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis. Ann Intern Med. 2016;165(2):77. https://doi.org/10.7326/m15-2143.

    Article  PubMed  PubMed Central  Google Scholar 

  8. DeVita P, Aaboe J, Bartholdy C, Leonardis JM, Bliddal H, Henriksen M. Quadriceps-strengthening exercise and quadriceps and knee biomechanics during walking in knee osteoarthritis: a two-centre randomized controlled trial. Clin Biomech. 2018;59:199–206. https://doi.org/10.1016/j.clinbiomech.2018.09.016.

    Article  Google Scholar 

  9. Liao C-D, Lin L-F, Huang Y-C, Huang S-W, Chou L-C, Liou T-H. Functional outcomes of outpatient balance training following total knee replacement in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2014;29(9):855–67. https://doi.org/10.1177/0269215514564086.

    Article  PubMed  Google Scholar 

  10. Kabiri S, Halabchi F, Angoorani H, Yekaninejad S. Comparison of three modes of aerobic exercise combined with resistance training on the pain and function of patients with knee osteoarthritis: a randomized controlled trial. Phys Ther Sport. 2018;32:22–8. https://doi.org/10.1016/j.ptsp.2018.04.001.

    Article  PubMed  Google Scholar 

  11. Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R, Danneskiold-Samsøe B. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2005. https://doi.org/10.1002/14651858.cd005523.

    Article  Google Scholar 

  12. Lim WB, Al-Dadah O. Conservative treatment of knee osteoarthritis: a review of the literature. World J Orthop. 2022;13(3):212–29. https://doi.org/10.5312/wjo.v13.i3.212.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, MizusakiImoto A, Toupin-April K, Westby M, Álvarez Gallardo IC, Gifford W, Laferrière L, Rahman P, Loew L, de Angelis G, Cavallo S, Shallwani SM, Aburub A’, Bennell KL, van der Esch M, Simic M, McConnell S, Harmer A, Kenny GP, Paterson G, Regnaux JP, Lefevre-Colau MM, McLean L. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs. Clin Rehabil. 2017;31(5):612–24. https://doi.org/10.1177/0269215517691085.

    Article  PubMed  Google Scholar 

  14. •• Goh S-L, Persson MS, Stocks J, Hou Y, Welton NJ, Lin J, Hall MC, Doherty M, Zhang W. Relative efficacy of different exercises for pain, function, performance and quality of life in knee and hip osteoarthritis: Systematic review and network meta-analysis. Sports Med. 2019;49(5):743–61. https://doi.org/10.1007/s40279-019-01082-0. This article reviewed the efficacy of different exercise programs for hip and knee OA.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dong R, Wu Y, Xu S, Zhang L, Ying J, Jin H, Wang P, Xiao L Tong P. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?. Medicine 2018;97(52). https://doi.org/10.1097/md.0000000000013823

  16. Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JAN, Bierma-Zeinstra SMA. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.cd004020.pub3.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Squyer E, Stamper DL, Hamilton DT, Sabin JA, Leopold SS. Unloader knee braces for osteoarthritis: do patients actually wear them? Clin Orthop Relat Res. 2013;471(6):1982–91. https://doi.org/10.1007/s11999-013-2814-0.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, deVita P, Hunter DJ, Lyles MF, Eckstein F, Guermazi A, Loeser RF. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis Care Res. 2018;70(11):1569–75. https://doi.org/10.1002/acr.23608.

    Article  Google Scholar 

  19. Gersing AS, Schwaiger BJ, Nevitt MC, Zarnowski J, Joseph GB, Feuerriegel G, Jungmann PM, Guimaraes JB, Facchetti L, McCulloch CE, Link TM. Weight loss regimen in obese and overweight individuals is associated with reduced cartilage degeneration: 96-month data from the osteoarthritis initiative. Osteoarthr Cartil. 2019;27(6):863–70. https://doi.org/10.1016/j.joca.2019.01.018.

    Article  CAS  Google Scholar 

  20. Aaboe J, Bliddal H, Messier SP, Alkjær T, Henriksen M. Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis. Osteoarthr Cartil. 2011;19(7):822–8. https://doi.org/10.1016/j.joca.2011.03.006.

    Article  CAS  Google Scholar 

  21. Miceli-Richard C. Paracetamol in osteoarthritis of the knee. Ann Rheum Dis. 2004;63(8):923–30. https://doi.org/10.1136/ard.2003.017236.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Leopoldino AO, Machado GC, Ferreira PH, Pinheiro MB, Day R, McLachlan AJ, Hunter DJ, Ferreira ML. Paracetamol versus placebo for knee and hip osteoarthritis. Cochrane Database Syst Rev 2019;2019(8). https://doi.org/10.1002/14651858.cd013273

  23. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Reston J. American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220–33. https://doi.org/10.1002/art.41142.

    Article  PubMed  Google Scholar 

  24. Ostergaard M, Halberg P. Intra-articular corticosteroids in arthritic disease. BioDrugs. 1998;9(2):95–103. https://doi.org/10.2165/00063030-199809020-00002.

    Article  CAS  PubMed  Google Scholar 

  25. •• Najm A, Alunno A, Gwinnutt JM, Weill C, Berenbaum F. Efficacy of intra-articular corticosteroid injections in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Joint Bone Spine. 2021;88(4):105198. https://doi.org/10.1016/j.jbspin.2021.105198. This study reviewed efficacy of IACI for knee OA.

    Article  CAS  PubMed  Google Scholar 

  26. He W, Kuang M, Zhao J, Sun L, Lu B, Wang Y, Ma J, Ma X. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg. 2017;39:95–103. https://doi.org/10.1016/j.ijsu.2017.01.087.

    Article  PubMed  Google Scholar 

  27. Chernchujit B, Tharakulphan S, Apivatgaroon A, Prasetia R. Accuracy comparisons of intra-articular knee injection between the new modified anterolateral approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion. Asia-Pac J Sports Med Arthrosc Rehabil Technol. 2019;17:1–4. https://doi.org/10.1016/j.asmart.2019.02.001.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sibbitt WL, Kettwich LG, Band PA, Chavez-Chiang NR, DeLea SL, Haseler LJ, Bankhurst AD. Does ultrasound guidance improve the outcomes of ARTHROCENTESIS and corticosteroid injection of the knee? Scand J Rheumatol. 2011;41(1):66–72. https://doi.org/10.3109/03009742.2011.599071.

    Article  CAS  PubMed  Google Scholar 

  29. Fang WH, Chen XT, Vangsness CT. Ultrasound-guided knee injections are more accurate than blind injections: a systematic review of randomized controlled trials. Arthrosc Sports Med Rehabil 2021;3(4). https://doi.org/10.1016/j.asmr.2021.01.028

  30. Amber KT, Landy DC, Amber I, Knopf D, Guerra J. Comparing the accuracy of ultrasound versus fluoroscopy in Glenohumeral injections: a systematic review and meta-analysis. J Clin Ultrasound. 2014;42(7):411–6. https://doi.org/10.1002/jcu.22154.

    Article  PubMed  Google Scholar 

  31. Cole BJ, Schumacher RH. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13(1):37–46. https://doi.org/10.5435/00124635-200501000-00006.

    Article  PubMed  Google Scholar 

  32. Yavuz U, Sökücü S, Albayrak A, Öztürk K. Efficacy comparisons of the intraarticular steroidal agents in the patients with knee osteoarthritis. Rheumatol Int. 2011;32(11):3391–6. https://doi.org/10.1007/s00296-011-2188-0.

    Article  CAS  PubMed  Google Scholar 

  33. Pyne D, Ioannou Y, Mootoo R, Bhanji A. Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone HEXACETONIDE and methylprednisolone acetate. Clin Rheumatol. 2004;23(2):116–20. https://doi.org/10.1007/s10067-003-0841-z.

    Article  PubMed  Google Scholar 

  34. Lomonte AB, de Morais MG, de Carvalho LO, Zerbini CA. Efficacy of triamcinolone hexacetonide versus methylprednisolone acetate intraarticular injections in knee osteoarthritis: a randomized, double-blinded, 24-week study. J Rheumatol. 2015;42(9):1677–84. https://doi.org/10.3899/jrheum.150297.

    Article  CAS  PubMed  Google Scholar 

  35. Petersen SK, Andreasen RA, Hansen IMJ. SAT0565 the frequency of septic arthritis after arthrocentesis and intra articular glucocorticoid injection is low. Poster Presentations. 2017. https://doi.org/10.1136/annrheumdis-2017-eular.1333.

    Article  Google Scholar 

  36. Yamamoto T, Schneider R, Iwamoto Y, Bullough PG. Rapid destruction of the hip joint in osteoarthritis. Ann Rheum Dis. 2008;67(12):1783–4. https://doi.org/10.1136/ard.2007.085019.

    Article  CAS  PubMed  Google Scholar 

  37. Choudhry MN, Malik RA, Charalambous CP. Blood glucose levels following intra-articular steroid injections in patients with diabetes. JBJS Rev. 2016;4(3). https://doi.org/10.2106/jbjs.rvw.o.00029

  38. Habib GS, Bashir M, Jabbour A. Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee. Ann Rheum Dis. 2008;67(12):1790–1. https://doi.org/10.1136/ard.2008.089722.

    Article  CAS  PubMed  Google Scholar 

  39. Stout A, Friedly J, Standaert CJ. Systemic absorption and side effects of locally injected glucocorticoids. PM&R. 2019;11(4):409–19. https://doi.org/10.1002/pmrj.12042.

    Article  Google Scholar 

  40. Sytsma TT, Greenlund LK, Greenlund LS. Joint corticosteroid injection associated with increased influenza risk. Mayo Clin Proc Innov Qual Outcomes. 2018;2(2):194–8. https://doi.org/10.1016/j.mayocpiqo.2018.01.005.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yang X, Li L, Ren X, Nie L. Do preoperative intra-articular injections of corticosteroids or hyaluronic acid increase the risk of infection after total knee arthroplasty? A meta-analysis. Bone Joint Res. 2022;11(3):171–9. https://doi.org/10.1302/2046-3758.113.bjr-2021-0350.r1.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Raynauld J-P, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, Uthman I, Khy V, Tremblay J-L, Bertrand C, Pelletier J-P. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370–7. https://doi.org/10.1002/art.10777.

    Article  CAS  PubMed  Google Scholar 

  43. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis. JAMA. 2017;317(19):1967. https://doi.org/10.1001/jama.2017.5283.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Ghosh P, Guidolin D. Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthritis Rheum. 2002;32(1):10–37. https://doi.org/10.1053/sarh.2002.33720.

    Article  CAS  PubMed  Google Scholar 

  45. Strauss EJ, Hart JA, Miller MD, Altman RD, Rosen JE. Hyaluronic acid viscosupplementation and osteoarthritis. Am J Sports Med. 2009;37(8):1636–44. https://doi.org/10.1177/0363546508326984.

    Article  PubMed  Google Scholar 

  46. Watterson JR, Esdaile JM. Viscosupplementation: therapeutic mechanisms and clinical potential in osteoarthritis of the knee. J Am Acad Orthop Surg. 2000;8(5):277–84. https://doi.org/10.5435/00124635-200009000-00001.

    Article  CAS  PubMed  Google Scholar 

  47. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993;39:3–9.

    CAS  PubMed  Google Scholar 

  48. Forrester JV, Balazs EA. Inhibition of phagocytosis by high molecular weight hyaluronate. Immunology. 1980;40(3):435–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Ghosh P. The role of hyaluronic acid (hyaluronan) in health and disease: interactions with cells, cartilage and components of synovial fluid. Clin Exp Rheumatol. 1994;2(1):75–82.

    Google Scholar 

  50. Echigo R, Mochizuki M, Nishimura R, Sasaki N. Suppressive effect of hyaluronan on chondrocyte apoptosis in experimentally induced acute ostaoarthritis in dogs. J Vet Med Sci. 2006;68(8):899–902. https://doi.org/10.1292/jvms.68.899.

    Article  CAS  PubMed  Google Scholar 

  51. Medical Advisory Secretariat. Intra-articular viscosupplementation with hylan g-f 20 to treat osteoarthritis of the knee: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5(10):1–66.

    PubMed Central  Google Scholar 

  52. Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, Berger AA, Kassem H, Kaye AD, Sherman WF, Abd-Elsayed A. A comprehensive review of viscosupplementation in osteoarthritis of the knee. Orthopedic Rev 2021;13(2). https://doi.org/10.52965/001c.25549

  53. Richardson C, Plaas A, Block JA. Intra-articular hyaluronan therapy for symptomatic knee osteoarthritis. Rheum Dis Clin North Am. 2019;45(3):439–51. https://doi.org/10.1016/j.rdc.2019.04.011.

    Article  PubMed  Google Scholar 

  54. Altman RD, Bedi A, Karlsson J, Sancheti P, Schemitsch E. Product differences in intra-articular hyaluronic acids for osteoarthritis of the knee. Am J Sports Med. 2016;44(8):2158–65. https://doi.org/10.1177/0363546515609599.

    Article  PubMed  Google Scholar 

  55. Vincent P. Intra-articular hyaluronic acid in the symptomatic treatment of knee osteoarthritis: a meta-analysis of single-injection products. Curr Ther Res. 2019;90:39–51. https://doi.org/10.1016/j.curtheres.2019.02.003.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005. https://doi.org/10.1002/14651858.cd005321.

    Article  PubMed  Google Scholar 

  57. Miller LE, Fredericson M, Altman RD. Hyaluronic acid injections or oral nonsteroidal anti-inflammatory drugs for knee osteoarthritis: systematic review and meta-analysis of randomized trials. Orthop J Sports Med. 2020;8(1):232596711989790. https://doi.org/10.1177/2325967119897909.

    Article  Google Scholar 

  58. Rutjes AWS, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee. Ann Intern Med. 2012;157(3):180. https://doi.org/10.7326/0003-4819-157-3-201208070-00473.

    Article  PubMed  Google Scholar 

  59. McGrory BJ, Weber KL, Jevsevar DS, Sevarino K. Surgical management of osteoarthritis of the knee. J Am Acad Orthop Surg. 2016;24(8). https://doi.org/10.5435/jaaos-d-16-00159

  60. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88. https://doi.org/10.1016/j.joca.2014.01.003.

    Article  CAS  Google Scholar 

  61. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–74. https://doi.org/10.1002/acr.21596.

    Article  CAS  Google Scholar 

  62. Coşkun HS, Yurtbay A, Say F. Platelet rich plasma versus autologous conditioned serum in osteoarthritis of the knee: clinical results of a five-year retrospective study. Cureus. 2022. https://doi.org/10.7759/cureus.24500.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Crane DM, Oliver KS, Bayes MC. Orthobiologics and knee osteoarthritis. Phys Med Rehabil Clin N Am. 2016;27(4):985–1002. https://doi.org/10.1016/j.pmr.2016.07.004.

    Article  PubMed  Google Scholar 

  64. O’Connell B, Wragg NM, Wilson SL. The use of PRP injections in the management of knee osteoarthritis. Cell Tissue Res. 2019;376(2):143–52. https://doi.org/10.1007/s00441-019-02996-x.

    Article  PubMed  Google Scholar 

  65. Magalon J, Chateau AL, Bertrand B, Louis ML, Silvestre A, Giraudo L, Veran J, Sabatier F. Depa classification: a proposal for standardising PRP use and a retrospective application of available devices. BMJ Open Sport Exercise Med 2016;2(1). https://doi.org/10.1136/bmjsem-2015-000060

  66. •• Delanois RE, Sax OC, Chen Z, Cohen JM, Callahan DM, Mont MA. Biologic therapies for the treatment of knee osteoarthritis: an updated systematic review. J Arthroplasty. 2022. https://doi.org/10.1016/j.arth.2022.05.031. This article reviewed efficacy of Orthobiologic injections for knee OA.

    Article  PubMed  Google Scholar 

  67. Pas HIMFL, Winters M, Haisma HJ, Koenis MJJ, Tol JL, Moen MH. Stem cell injections in knee osteoarthritis: a systematic review of the literature. Br J Sports Med. 2017;51(15):1125–33. https://doi.org/10.1136/bjsports-2016-096793.

    Article  PubMed  Google Scholar 

  68. Dulic O, Rasovic P, Lalic I, Kecojevic V, Gavrilovic G, Abazovic D, Maric D, Miskulin M, Bumbasirevic M. Bone marrow aspirate concentrate versus platelet rich plasma or hyaluronic acid for the treatment of knee osteoarthritis. Medicina. 2021;57(11):1193. https://doi.org/10.3390/medicina57111193.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Choi W-J, Hwang S-J, Song J-G, Leem J-G, Kang Y-U, Park P-H, Shin J-W. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152(3):481–7. https://doi.org/10.1016/j.pain.2010.09.029.

    Article  PubMed  Google Scholar 

  70. Zachary L McCormick, MD, Jaymin Patel, MD, Aaron Conger, DO, Clark C Smith, MD, MPH The Spine Intervention 'Society’s Patient Safety Committee, The Safety of Genicular Nerve Radiofrequency Ablation, Pain Medicine. 2021;22(2)

  71. El-Hakeim EH, Elawamy A, Kamel EZ, Goma SH, Gamal RM, Ghandour AM, Osman AM, Morsy KM. Fluoroscopic guided radiofrequency of genicular nerves for pain alleviation in chronic knee osteoarthritis: a single-blind randomized controlled trial. Pain Physician.

  72. Liu J, Wang T, Zhu ZH. Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2022;17(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Hunter C, Davis T, Loudermilk E, Kapural L, DePalma M. Cooled radiofrequency ablation treatment of the genicular nerves in the treatment of osteoarthritic knee pain: 18- and 24-month results. Pain Pract. 2020;20(3):238–46.

    Article  PubMed  Google Scholar 

  74. Chen AF, Khalouf F, Zora K, DePalma M, Kohan L, Guirguis M, Beall D, Loudermilk E, Pingree M, Badiola I, Lyman J. Cooled radiofrequency ablation compared with a single injection of hyaluronic acid for chronic knee pain. J Bone Joint Surg. 2020;102(17):1501–10. https://doi.org/10.2106/jbjs.19.00935.

    Article  PubMed  Google Scholar 

  75. Fonkoue L, Behets C, Steyaert A, Kouassi JEK, Detrembleur C, Cornu O. Anatomical study of the descending genicular artery and implications for image-guided interventions for knee pain. Clin Anat. 2020;34(4):634–43. https://doi.org/10.1002/ca.23680.

    Article  PubMed  Google Scholar 

  76. Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M. Anatomical study of the innervation of anterior knee joint capsule. Reg Anesth Pain Med. 2018;43(4):407–14. https://doi.org/10.1097/aap.0000000000000778.

    Article  PubMed  Google Scholar 

  77. Le PU. Is genicular nerve radiofrequency ablationsafe? A literature review and anatomicalstudy. July 2016. 2016; 5;19(5;19). https://doi.org/10.36076/ppj/2019.19.e679

  78. • Kim JH, Shustorovich A, Arel AT, Downie SA, Cohen SP, Kim SY. Genicular nerve anatomy and its implication for new procedural approaches for knee joint denervation: a cadaveric study. Pain Med. 2021;23(1):144–51. https://doi.org/10.1093/pm/pnab238. This study showed the anatomic course of genicular nerves and proposed a new target for genicular RFA procedure.

    Article  Google Scholar 

  79. Fonkoue L, Steyaert A, Kouame J-EK, Bandolo E, Lebleu J, Fossoh H, Behets C, Detrembleur C, Cornu O. A comparison of genicular nerve blockade with corticosteroids using either classical anatomical targets vs revised targets for pain and function in knee osteoarthritis: a double-blind, randomized controlled trial. Pain Med. 2021;22(5):1116–26. https://doi.org/10.1093/pm/pnab014.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Soo Y. Kim.

Ethics declarations

Ethics Approval

This article does not contain any studies with human or animal subjects performed by any of the authors.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.H., Ugur, E. & Kim, S.Y. Non-surgical Treatment Recommendations for Knee Osteoarthritis. Curr Phys Med Rehabil Rep 11, 335–343 (2023). https://doi.org/10.1007/s40141-023-00408-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-023-00408-4

Keywords

Navigation