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What Nonoperative Approaches for Knee OA Do You Use in Recreational vs Advanced Athletes?

Treatment depends on OA factors:

Nonoperative approaches for any patient with OA depends upon a stepwise approach, which often depends upon the degree of arthritis, its location, the patient’s range of knee motion and the patient’s tibiofemoral or patellofemoral alignment. One of the important issues to recognize is we need to treat the patient and not the radiographs. This overview refers to patients with more diffuse arthritis changes and not athletes with focal articular cartilage changes that may be candidates for surgical treatment. One of the key elements in treating these patients is to ensure they are appropriately rehabilitated. If a patient is weaker, especially the quadriceps muscles, then the patient would have less effective absorption of forces with impact. Restoring strength can be key to avoiding joint overload. The next issue is to determine if they need a “boost” to overcome any underlying symptoms, such as an effusion causing mild synovitis or plica irritation, with a corticosteroid or even a biologics injection (usually reserved for cases where a steroid injection did not work initially).

Patients who may have ipsilateral compartment arthritis, such as after a meniscectomy, should have their alignments checked with long leg radiographs. If they are malaligned, then medial or lateral compartment braces can be effective to allow them to return to impact activities or skiing. Similarly, bracing or taping of the arthritic patellofemoral joint, although less effective than treating malalignment of the tibiofemoral joint, can be trialed to try and increase their function.

Probably the most important thing to recognize is that one should not overtreat an athlete with OA initially. Often recreational athletes present with moderate arthritis who may have been functioning well enough with it until recently. Our goal should be to educate them and try to teach them to cross-train to try and allow them to participate in the sports that they love. After the above program fails, then one can search for potential surgical options.

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