Special thanks to star physical therapist Antara Quiñones of Alpine Physical Therapy for providing this write up on a recent article from the Journal of American Academy of Orthopedic Surgery.
Every 5 years or so the American Academy of Orthopedic Surgeons (AAOS), along with a cohort of other professions (like physicians and physical therapists) publish a guideline to treat certain conditions based on the latest and greatest evidence. These guidelines offer a quick look into what’s proven to work, what does not work, and what still needs to be further investigated. Below are the items that the AAOS recommends for the most up to date treatment of knee arthritis.
People with knee arthritis should:
1. Routinely take part in a strengthening program, neuromuscular education (or using techniques to restore balance, improve coordination and fine tune awareness of where your leg is in space), perform low-impact aerobic exercises, and keep physically fit to national standards in regards to heart health and body weight.
2. Maintain a body mass index (BMI) of less than 25.
3. Use nonsteroidal anti-inflammatory drugs (oral or topical) or tramadol to help with symptom management.
The following are NOT recommended for treatment of knee arthritis:
2.Lateral wedge insoles are not supported in the literature. This being said, however the recommendation is moderate and patient preference should be kept in mind.
3. The use of glucosamine and chondroitin.
4. The injection of hyaluronic acid into the knee joint.
5. Performing an arthroscopy with lavage and/or debridement in which the fluid of the knee joint is removed, the joint is washed, and any loose bodies or debris are removed.
6. The use of needle lavage where saline is injected into the joint and then removed in attempts to wash the joint and remove inflammatory factors and debris.
7. The use of free-floating (not cemented or screwed into place) interpositional devices in the inner knee compartment to alleviate pain and mimic meniscus function. (This was a general consensus recommendation due to the lack of research available for these devices.)
Evidence is inconclusive for the following due to either lack of available evidence or inconsistencies in the studies that have occurred. Practitioners should be on the lookout for future evidence, but in the meantime decisions regarding their use should be influenced by their clinical judgment and patient preference.
1. The use of physical agents, such as electrical stimulation and ultrasound.
2. Manual therapy.
3. Valgus knee brace (to unload the inner knee compartment).
4. The use of acetaminophen, opioids, or pain patches.
5. The use of injections into the knee joint of corticosteroid.
6. The use of growth factor injections and/or platelet rich plasma.
7. A valgus-producing proximal tibial osteotomy, or bone shaving that changes the direction of forces across the knee joint to relieve pressure at the inner knee.
As the evidence changes and our knowledge evolves, it is good to keep the AAOA standards in mind and to be on the look out for future recommendations.
David S. Jevsevar, M.D., MBA. Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition. Journal of American Academy of Orthopedic Surgery. September 2013. Vol 21, No 9. Pp 571-576.
For more information, visit our topic module on Knee Osteoarthritis by clicking here.
Brent Dodge is the founding owner of Alpine Physical Therapy and is a board certified orthopedic specialist. He holds additional certifications in Functional Dry Needling, Manual Physical Therapy, and Strength and Conditioning.
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