400 Section - Rehabilitation Approaches to Knee Osteoarthritis: Comparing PM&R Guidance With Orthopedic Specialty Guidelines

Knee osteoarthritis (OA) is managed by multiple specialties, each using different sources of clinical guidance. Orthopedic societies utilize formal clinical guidelines, while PM&R relies on endorsed external guidelines and educational summaries. These differences may influence treatment. This project compared rehabilitation-focused guidelines with orthopedic guidelines for knee OA across ten treatment domains to identify areas of alignment, differences, and gaps.

Design:

A review of national and international knee OA guidelines was performed. Rehabilitation sources included AAPM&R-Endorsed Guidelines, the AAPM&R-KnowledgeNow Knee OA article, and AAPM&R orthobiologics guidance. Orthopedic sources included, AAOS Non-Arthroplasty, AAOS-Surgical Management, ACR/Arthritis Foundations, OARSI Non-Surgical Management Guideline, and the ESCEO review. Recommendations were compared across ten domains: exercise and physical therapy (PT), weight management, bracing/assistive devices, physical-modalities (e.g., TENS, heat/ice, ultrasound), pharmacologics, corticosteroid injections, hyaluronic acid, platelet-rich-plasma and orthobiologics, genicular radiofrequency ablation, and surgical referral thresholds.

Results:

Across sources, exercise and PT were consistently recommended first. Orthopedic guidelines provided graded recommendations for pharmacologics, specifically topical/oral NSAIDs, and offered clear criteria for corticosteroid injections and surgery. Rehabilitation-focused guidance emphasized strengthening, neuromuscular training, functional mobility, and individualized bracing/assistive devices. Physical-modalities appeared more often in rehabilitation sources, which also discussed platelet-rich-plasma and genicular radiofrequency ablation more frequently. No independent PM&R-authored knee OA guideline was identified.

Conclusion:

While both specialties share similar first-line knee OA recommendations, the difference lies in their areas of emphasis. PM&R places stronger focus on function and individualized multimodal, non-surgical management while orthopedics focuses on structured pathways for medications, injections, and surgery. The absence of PM&R specific guidelines highlights an opportunity for development. Differences in the level of supporting evidence across specialties also highlight the need for additional research to strengthen PM&R focused recommendations. A combined rehabilitation and orthopedic recommendation could also offer more comprehensive guidance. Future work may look at how primary-care guidance fits into this multidisciplinary picture as well.