Knee
Table 3. Nonpharmacologic Recommendations for the
Management of Knee Osteoarthritis (OA)
The ACR strongly recommends that patients with knee OA should do the following:
• Participate in cardiovascular (aerobic) and/or resistance land-based exercise
• Participate in aquatic exercise
• Lose weight (for persons who are overweight)
The ACR conditionally recommends that patients with knee OA should do the following:
• Participate in self-management programs • Be instructed in the use of thermal agents
• Receive manual therapy in combination
with supervised exercise
• Receive walking aids, as needed
• Participate in tai chi programs
• Receive psychosocial interventions • Use medially directed patellar taping
• Wear medially wedged insoles if they have
lateral compartment OA
• Be treated with traditional Chinese
acupuncture
a
• Wear laterally wedged subtalar strapped
insoles if they have medial compartment OA
• Be instructed in the use of transcutaneous
electrical stimulation
a
The ACR has no recommendations regarding the following:
• Participation in balance exercises, either
alone or in combination with strengthening
exercises
• Receiving manual therapy alone
• Wearing knee braces
• Wearing laterally wedged insoles • Using laterally directed patellar taping
a
ese modalities are conditionally recommended only when the patient with knee OA has chronic
moderate to severe pain and is a candidate for total knee arthroplasty but either is unwilling to undergo the
procedure, has comorbid medical conditions, or is taking concomitant medications that lead to a relative
or absolute contraindication to surgery or a decision by the surgeon not to recommend the procedure.
Table 4. Pharmacologic Recommendations for the Initial
Management of Knee Osteoarthritis (OA)
a
The ACR conditionally recommends that patients with knee OA should use one of the
following:
• Acetaminophen • Tramadol
• Oral or Topical NSAIDs • Intraarticular corticosteroid injections
The ACR conditionally recommends that patients with knee OA should NOT use the
following:
• Chondroitin sulfate • Topical capsaicin • Glucosamine
The ACR has no recommendation regarding:
• the use of intraarticular hyaluronates, duloxetine, and opioid analgesics
a
No strong recommendations were made for the initial pharmacologic management of knee OA.
