What supportive care is recommended for tricompartmental knee osteoarthritis (OA) with medial meniscal degeneration?

From the Guidelines

Supportive care for tricompartmental knee osteoarthritis with medial meniscal degeneration should begin with non-surgical interventions, prioritizing weight management, physical therapy, and pain management with acetaminophen or NSAIDs, as recommended by the 2019 American College of Rheumatology/Arthritis Foundation guideline 1. The management of tricompartmental knee osteoarthritis with medial meniscal degeneration requires a comprehensive approach, focusing on reducing morbidity, mortality, and improving quality of life.

Key Interventions

• Weight management: losing weight can reduce knee load and alleviate symptoms, as each pound lost reduces knee load by four pounds 1.
• Physical therapy: focusing on quadriceps and hamstring strengthening exercises, initiated 2-3 times weekly for at least 6 weeks, complemented by low-impact aerobic activities like swimming or cycling for 30 minutes, 3-5 times weekly 1.
• Pain management: starting with acetaminophen 650-1000mg every 6 hours (not exceeding 3000mg daily) or NSAIDs like ibuprofen 400-600mg three times daily with food (if no contraindications exist) 1.
• Topical NSAIDs: such as diclofenac 1% gel applied to the affected knee four times daily can provide localized relief with fewer systemic effects 1.
• Assistive devices: like a cane held in the hand opposite to the affected knee can reduce joint load by 20-30% 1.
• Intra-articular corticosteroid injections: may provide temporary relief for 1-3 months, though these should be limited to 3-4 injections yearly 1. These interventions work by reducing inflammation, strengthening supporting musculature, decreasing mechanical load on the damaged compartments, and improving joint biomechanics.

Additional Considerations

• Patient education: providing information tailored to the individual's needs, including disease management, exercise, and weight loss, is crucial for effective management 1.
• Regular follow-up: with a healthcare professional to monitor progress, adjust treatment plans, and address any concerns or questions 1.
• Multidisciplinary approach: involving physical therapists, occupational therapists, and other healthcare professionals to provide comprehensive care 1.

From the Research

Supportive Care for Tricompartmental Knee Osteoarthritis (OA) with Medial Meniscal Degeneration

• The recommended supportive care for tricompartmental knee OA with medial meniscal degeneration includes:
  • Control of body weight 2
  • Therapeutic physical exercise 2, 3, 4
  • Drug treatment (oral non-steroidal anti-inflammatory drugs, paracetamol, opioids) 2
  • Mechanical aids (walking aids, braces, orthoses) 2
  • Education and self-management programs to empower patients to better manage their condition 3
• Intra-articular injections, such as corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP), may be considered for short-term pain alleviation 2, 5
• Physical therapy (PT) and exercise regimens, including manual therapy, stretching, strengthening, and neuromuscular functional training, can be used to treat OA or meniscal tear 4
• A home exercise program (HEP) that addresses major muscle groups and allows patients to perform and progress exercises without PT supervision can be beneficial 4
• Surgical referral for knee joint replacement can be considered for patients with end-stage OA after using all appropriate conservative options 3, 6