Early knee osteoarthritis management should first address mechanical joint overload

Abstract

Early knee osteoarthritis poses a therapeutic dilemma to the musculoskeletal clinician. Despite the recent interest in arthroscopic and injectable regenerative therapies intended to repair or restore a focal target such as cartilage, meniscus, or subchondral bone, none have been shown to slow disease progression. A likely cause of these disappointing treatment outcomes is the failure to address chronic and excessive loading of the knee joint. A growing body of evidence suggests that first-line therapies for early knee osteoarthritis should emphasize unloading the knee joint since any potential therapeutic benefit of regenerative therapies will likely be attenuated by excessive mechanical demand at the knee joint. Minimally invasive medical devices such as patient-specific interpositional implants and extracapsular joint unloading implants are currently in development to address this clinical need.

Early-stage knee OA induced by MIA and MMT compared in the murine model via histological and topographical approaches

“…Current strategies for the management of the disease include mechanical approaches ranging from simple distractors to total arthroplasty. Since early management of the pathology is known to increase the benefits 5 , we sought to determine whether the onset of the pathology could be comparably reproduced using two induction methods, MIA and MMT. First, the Mankin-modified score allows us to confirm that the rate of OA progression under the two techniques is comparable at 4 weeks post-induction.…”

Mechanical Stimulation Increases Knee Meniscus Gene RNA-level Expression in Adipose-derived Stromal Cells

“…Because of the knee’s dependence on mechanical loading in function and development, mechanical strain may stimulate stem cells to differentiate into mechanoresponsive cells. 2 Mechanical effects on bone marrow MSCs have been studied extensively with inconclusive results. 17 – 19 Here, we investigate the effects of mechanical stimulation on the differentiation of human ASCs toward a meniscus phenotype.…”

Non-operative treatment options for knee osteoarthritis: current concepts

“…In these patients, the early stages of OA management must focus on the biomechanical behaviour of the knee 17. Specific braces apply an opposing valgus force to reduce overload on the medial knee compartment, while foot orthoses change the mechanical axis of the leg by enhancing the valgus correction of the calcaneus 18.…”

“…Although current OARSI guidelines3 recommend only biomechanical interventions (orthoses and braces), knee load profiles during routine daily activities should be considered for the early knee OA management 17. The knee adduction moment during walking has been identified as a factor promoting the progression of OA.…”