Conservative Management of Degenerative Knee Disease

Introduction to Conservative Measures

• Activity modification is recommended for patients with degenerative knee disease, as part of conservative management 1
• Structured exercise therapy/physical therapy programs, including range of motion exercises, weight-bearing exercises, and low-impact aerobic activities, should be implemented as part of conservative management 1, 2, 3, 4

Pain Management

• Acetaminophen (up to 4,000 mg/day) and oral NSAIDs, considering patient's comorbidities and risk factors, can be used for pain management, while topical NSAIDs are particularly recommended for patients ≥75 years, as recommended by the American College of Rheumatology and British Medical Journal guidelines 1, 5
• Intra-articular corticosteroid injections are effective for acute pain relief, according to the American College of Rheumatology, with 19 high-quality and 6 moderate-quality studies supporting their use 5
• Tramadol may be considered as an alternative if first-line treatments fail to provide adequate relief, as recommended by the American College of Rheumatology 5

Surgical Interventions

• The American College of Surgeons, as reported by the BMJ, strongly recommends against arthroscopic knee surgery in patients with degenerative knee disease, noting that it provides no important benefit compared to conservative management 1
• Surgical intervention should only be considered when conservative management has failed after 6-8 weeks, symptoms significantly impact quality of life, and patient has true mechanical symptoms (especially locked knee), according to the British Medical Journal guidelines and the American Academy of Orthopaedic Surgeons 1, 6
• Arthroscopic partial meniscectomy may be considered for degenerative tears that have failed conservative management, although the British Medical Journal guidelines (2017) indicate limited benefit for most degenerative tears, with high-quality evidence showing no significant benefit over conservative treatment for most degenerative meniscal tears 1, 7, 8
• Meniscal repair has an 80% success rate at 2 years, and is best for younger patients, peripheral tears, horizontal or longitudinal tears, and reducible tears, as recommended by the British Medical Journal guidelines 1

Post-Surgical Rehabilitation and Follow-Up

• Post-surgical rehabilitation is crucial for optimal outcomes, particularly following meniscal repair, with a focus on bracing and non-weight bearing for 4-6 weeks, as recommended by the British Medical Journal guidelines and the National Institute for Health and Care Excellence 1
• Regular assessment of pain levels and functional improvement is recommended, with consideration of progression of physical therapy as tolerated, and repeat imaging only if symptoms significantly worsen or change in character, as recommended by the British Medical Journal guidelines and the National Institute for Health and Care Excellence 1

Special Considerations

• Initial management for patients with chondrocalcinosis of the menisci in the knee should focus on conservative treatment, including acetaminophen, oral or topical NSAIDs, and intra-articular corticosteroid injections, as recommended by the American College of Rheumatology 5
• Radiography is the initial imaging method of choice for suspected chondrocalcinosis, effectively demonstrating calcifications in the menisci, according to the American College of Radiology 9

Recommendations and Level of Evidence