Knee Osteoarthritis

Contents:
1. Description
2. Anatomy and Pathological Process
3. Physical Therapy Treatments
4. References

Description of knee osteoarthritis:

According to JAMA more than 10 million Americans are affected with knee
osteoarthritis.(1) Most commonly affecting a population age 45 and greater this condition
occurs as the cartilage in the knee wears away eventually causing bone on bone contact
between joint surfaces. Most common complaints include joint swelling, joint stiffness,
and pain. Knee osteoarthritis can be diagnosis via radiographs indicating boney cysts,
narrowing joint space, and scelrosing of the bone.

Anatomy and Pathological Process:

The knee joint consists of both approximation of the proximal tibia and the distal end of
the femur. The cartilage located on the ends of the femur and tibia contain an extra
cellular matrix that contains type 2 protoglycans that function by drawing fluid into the
joint causing increased shock absorption and proper joint nutrition.(2) There is some
evidence to support that as the aging process occurs the type 2 collagen fibers decrease in
size and therefore less fluid an nutrition gets into the joint surfaces eventually leading to
decreased protection along boney surfaces.

Conservative Treatment:
Ottawa Panel of evidence suggests the use of therapeutic exercises or exercises with
manual therapy to be most beneficial for patients with knee OA (grade of evidence A, B,
and C+). (3) Cliborne et al. found short term benefits with hip mobilizations to decrease
knee pain with functional tests including squatting. (4) Another article by Currier et al.
developed a CPR for patients with knee pain to indicate those patients have knee OA, and
which patients are likely to have short term benefits from hip mobilizations. Currier
reports the “5 clinical prediction rules for this study include: 1. hip and groin parasthesia
2. groin pain 3.passive knee flexion less than 122 degrees 4.passive hip IR less than 17
degrees 5.Pain with hip distraction”.(5) If the patient has 2 variables then the positive
likely hood ratio is 12.9. Deyle et al. found that knee mobilization gave statically
improvements in WOMAC and 6 minute walk tests for both 4 week, 8 week, and 1 year
follow up.(6)

References:

1. Sharon Parmet, MS, Writer; Cassio Lynm, MA, Illustrator; Richard M. Glass,
MD, Osteoarthritis of the Knee.JAMA. 2003;289(8):1068
2. S.R Goldring, M.B. Goldring. Clinical aspects, pathology and pathophysiology
of osteoarthritis. J Musculoskelet Neuronal Interact 2006; 6(4):376-378.

3. No authors listed. Ottawa panel evidence-based clinical practice guidelines for

therapeutic exercises and manual therapy in the management of osteoarthritis.
Phys Ther. 2005 Sep; 85 (9):907-71.

4. Cliborne Amy, Rhon Dan, Judd Coy, Fee Terrance, Matekel Robert, Whitman
Julie, Roberts Maj. Clinical hip tests and a functional squat test in patients with
knee osteoarthritis: Reliability, Prevalence of Positive Test Findings, and Short-
Term Response to Hip Mobilization. J Orthop Sports Phys Ther. 2004;34(11):676-
685. doi:10.2519/jospt.2004.1432

5. Linda L Currier, Paul J Froehlich, Scott D Carow, Ronald K McAndrew,

Amy V Cliborne, Robert E Boyles, Liem T Mansfield and Robert S Wainner.
Development of a Clinical Prediction Rule to Identify Patients With Knee Pain
and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable
Short-Term Response to Hip Mobilization. PHYS THER
Vol. 87, No. 9, September 2007, pp. 1106-1119

6. Deyle Gail, Henderson Nancy, Matekel Robert, Ryder Micahel, Garber

Matthew, Allison Stephen. Effectiveness of Manual Physical therapy and
Exercise in Osteoarthritis of the Knee A Randomized, Controlled Trial

Links:

http://www.annals.org/content/132/3/173.1.full.pdf+html

http://www.jospt.org/issues/articleID.393,type.14/article_detail.asp

http://ptjournal.apta.org/cgi/reprint/87/9/1106
http://www.guideline.gov/summary/summary.aspx?doc_id=7785&nbr=4490&ss=15