Knee Osteoarthritis

Understanding Knee Osteoarthritis and Evidence-Informed Management

Knee osteoarthritis is one of the most common musculoskeletal conditions affecting adults worldwide. It is a progressive condition involving the entire joint, including cartilage, bone, synovium (joint lining), ligaments, menisci and surrounding muscles.

Although often described as “wear and tear,” current research recognises osteoarthritis as a complex biological process involving mechanical loading, inflammation, tissue remodelling and changes within the local joint environment.

Many people continue to remain active with knee osteoarthritis, and management is aimed at improving pain, function and quality of life while supporting long-term joint health.

What Happens in Knee Osteoarthritis?

A healthy knee relies on the coordinated function of several structures.

These include:

Articular cartilage
Menisci
Subchondral bone
Joint capsule
Synovium
Ligaments
Muscles and tendons surrounding the knee

In osteoarthritis, changes occur across the whole joint rather than affecting cartilage alone.

These changes may include:

Gradual cartilage degeneration
Thickening and remodelling of subchondral bone
Inflammation of the synovial lining
Meniscal degeneration
Reduced muscle strength
Changes in joint mechanics

Symptoms develop differently from one individual to another and do not always correlate with imaging findings.

Common Symptoms

People with knee osteoarthritis may experience:

Pain during weight-bearing activities
Morning stiffness lasting less than 30 minutes
Swelling
Reduced walking tolerance
Difficulty climbing stairs
Pain after prolonged sitting
Reduced confidence with movement
Progressive loss of function

Symptoms often fluctuate, with periods of improvement and exacerbation.

Why Does the Knee Become Painful?

Articular cartilage itself contains very few nerve endings.

Pain usually arises from other structures within the joint, including:

Synovium
Subchondral bone
Joint capsule
Ligaments
Surrounding muscles
Peripheral nerves

Changes within these tissues contribute to inflammation, altered biomechanics and increased sensitivity of the nervous system.

This helps explain why pain severity is not always proportional to the amount of cartilage loss seen on X-rays or MRI.

How Is Knee Osteoarthritis Diagnosed?

Diagnosis begins with a comprehensive clinical assessment.

This may include:

Medical history
Physical examination
Functional assessment
Assessment of strength and movement patterns
Review of previous imaging
Diagnostic musculoskeletal ultrasound where appropriate

X-rays remain useful for demonstrating structural osteoarthritis, while MRI may provide additional information about cartilage, menisci, ligaments and bone marrow lesions in selected patients.

Management decisions are based on the overall clinical picture rather than imaging alone.

Evidence-Informed Management

Current international guidelines recommend a combination of treatments rather than relying on a single intervention.

Management may include:

Patient education
Weight management where appropriate
Progressive strengthening exercises
Aerobic exercise
Activity modification
Manual therapy where clinically appropriate
Walking aids or bracing in selected cases
Medication where appropriate
Image-guided procedures for carefully selected patients

Treatment is individualised according to symptoms, function, goals and overall health.

Where Do Orthobiologics Fit?

Orthobiologic procedures may be considered for selected patients whose symptoms persist despite appropriate conservative management.

Depending on the individual circumstances, these may include:

Platelet-Rich Plasma (PRP)
Bone Marrow Aspirate (BMA)
Bone Marrow Aspirate Concentrate (BMAC)

These procedures are intended to support the biological environment within the joint and should be considered as one component of a broader management plan.

Current evidence is strongest for PRP in selected patients with mild to moderate knee osteoarthritis, while research into BMA and BMAC continues to evolve.

The Importance of Rehabilitation

Regardless of whether injections are used, rehabilitation remains central to successful management.

A rehabilitation program may include:

Quadriceps strengthening
Hip strengthening
Balance training
Walking programs
Flexibility exercises
Progressive functional loading

Improving muscle strength and movement quality helps reduce stress on the joint and supports long-term function.

When Might Surgery Be Considered?

Many people manage knee osteoarthritis successfully without surgery.

For individuals with advanced structural disease, severe pain and substantial loss of function despite appropriate non-surgical management, referral to an orthopaedic surgeon may be appropriate to discuss surgical options.

The decision is individual and based on symptoms, functional limitations and patient goals rather than imaging findings alone.

Frequently Asked Questions

Does osteoarthritis mean my knee is wearing out?

Not necessarily.

Osteoarthritis is now recognised as a disease affecting the whole joint rather than simply the gradual wearing away of cartilage.

Can exercise make arthritis worse?

Appropriately prescribed exercise is considered one of the most effective treatments for knee osteoarthritis and is recommended by international clinical guidelines.

Are injections suitable for everyone?

No.

Image-guided injections, including orthobiologic procedures, are considered only after a comprehensive assessment and discussion of current evidence, potential benefits and alternative treatment options.

Is surgery always inevitable?

No.

Many people successfully manage knee osteoarthritis for years through education, rehabilitation, lifestyle modification and, where appropriate, selected procedural interventions.

Ashmore Osteopathic Group

Most Frequently Asked-Knee Osteoarthritis