Noise emanating from the knee upon movement (crepitus) is one of the primary symptoms of knee osteoarthritis (OA). Exercise and education are key components of evidence-based guideline recommendations for prevention and treatment of OA. However, there is limited evidence if these approaches alter knee crepitus. Exercise professionals are faced with client concerns of crepitus during exercise; providing reassurance to the contrary may help exercise adherence. Thus, we aimed to determine if knee crepitus improves with exercise or education, either alone or combined, in healthy individuals or in people with early or established OA.
We conducted a systematic review and meta-analysis. Electronic databases (CINAHL, Embase, PsycINFO, PubMed, and SportDISCUS) were searched from inception to 1 July 2022 for studies of adults (>18 years) with OA or reporting knee crepitus who undertook exercise or education compared to control. Risk of bias was appraised using the Cochrane Risk of Bias tool (v2). Data was analysed using a random-effects meta-analysis.
12 studies were included, with data from seven contributing to the meta-analysis. All included studies measured crepitus using the KOOS subscale following varying supervised and unsupervised exercise interventions (aquatic, resistance (weights, body weight, theraband), stretching, circuit, aerobic (cycle, treadmill, arm crank)) for 30–60 minutes at moderate to vigorous intensity, 3–7 days/week over 12–52 weeks. Across 379 participants (n=201 exercise, n=184 control, 82% female), mean crepitus at baseline was 2.0 on a 5-point scale. There was no difference in the effect of exercise compared to control on crepitus (MD: 0.01; 95% CI −0.023, 0.021). The remaining five studies, excluded from the meta-analysis due to exercising controls, had similar characteristics. Risk of bias ranged from low to high, with bias introduced due to issues with randomization, reporting of results, noted deviations from intended interventions and missing outcome data.
Based on studies with mixed risk of bias, knee crepitus is unlikely to change in individuals with established OA following exercise. Thus, Exercise Physiologists can provide reassurance to people who are concerned about their noisy joints that exercise should not exacerbate symptoms.
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