Knee bracing most beneficial among non-drug therapies for knee OA, meta-analysis finds

Study details: This network meta-analysis synthesized data from 139 randomized trials involving 9,644 patients to compare the effectiveness of 12 non-pharmacologic treatments for knee osteoarthritis (KOA). Interventions included knee bracing, hydrotherapy, exercise, orthotic devices, and various physical modalities such as laser therapy, transcutaneous electrical nerve stimulation (TENS), and ultrasound. Outcomes were measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for pain, function, stiffness, and total scores, as well as a visual analog scale (VAS) for pain at rest and during activity.

Results: Knee bracing was most likely to provide the best improvement in WOMAC pain, function, and stiffness scores, as well as VAS-activity. Hydrotherapy ranked highest for total WOMAC and VAS-rest, while exercise consistently ranked among the top three interventions across all domains. High-intensity laser therapy and extracorporeal shock wave therapy also showed benefit, but ultrasound consistently ranked lowest for efficacy. Surface under the cumulative ranking curve (SUCRA) analysis confirmed knee bracing, hydrotherapy, and exercise as the most effective overall.

Clinical impact: For patients with KOA, knee brace use should be strongly considered as a first-line non-pharmacologic intervention, with hydrotherapy and exercise as additional highly effective options. These findings support prioritizing these modalities in individualized, multimodal management strategies for KOA, especially when pharmacologic or intra-articular therapies are contraindicated or insufficient.

Source:

Chen X, et al. (2025, June 18). PLoS One. Clinical efficacy of different therapeutic options for knee osteoarthritis: A network meta-analysis based on randomized clinical trials. https://pubmed.ncbi.nlm.nih.gov/40531843/