Conservative treatment of acute knee osteoarthritis: A review of the Cochrane Library

ObjectiveTo analyze conservative treatment of knee pain in patients with osteoarthritis.MethodsA Cochrane Library search related to knee osteoartritis was analyzed. Five main strategies for the conservative treatment of knee osteoartritis have been reviewed: medical treatment, physical medicine and rehabilitation, intra-articular injections, and acupuncture.ResultsRegarding medical treatment, non-steroidal antiinflammatory drugs (ibuprofen, diclofenac, arthrotec, celecoxib, naproxen, rofecoxib) were superior to acetaminophen. The benefits of tramadol or tramadol/paracetamol, non-tramadol opioids, glucosamine, diacerine, and doxycicline were small. Herbal topical treatment with preparations from medical plants seemed to improve pain. Concerning oral herbal therapy, Piascidine ad extracts of Boswellia serrata had a short-term effect on osteoarthritis symptoms. Regarding physical medicine and rehabilitation, there was limited evidence that a brace had additional beneficial effect compared with medical treatment alone. Land-based therapeutic exercise and aquatic exercise had at least a small short term benefit. Therapeutic ultrasound may be beneficial (low quality of evidence). The effectiveness of transcutaneous electrostimulation for pain relief has not been demonstrated. Electrical stimulation therapy may provide significant improvements. Regarding intra-articular injections, viscosupplementation seemed to be an effective treatment for pain relief in the short-term (months). The short-term (weeks) benefit of intra-articular corticosteroids in the management of knee osteoarthritis has been demonstrated. The benefits of acupuncture were small. Self-management education programs resulted in no or small benefits on pain relief.ConclusionsFive main strategies for the conservative treatment of knee osteoarthritis exist that must be used before indicating surgical treatment: medical treatment, physical medicine and rehabilitation, intra-articular injections, acupuncture, and self-management education programs.