Exercise on Crepitus in Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Abstract

Background Crepitus is one of the primary symptoms of knee osteoarthritis (OA). Exercise and education are key components of evidence-based recommendations for management of OA. However, evidence if these approaches alter knee crepitus is limited. We aimed to determine if knee crepitus improves with exercise either alone or combined with education in healthy adults or people with early or established OA. Methods Five electronic databases (Embase, CINAHL, PsycINFO, PubMed, and SportDISCUS) were searched from inception to July 1, 2022, for studies of adults with knee crepitus who undertook exercise compared to nonexercise control. Data were analyzed using a random-effects meta-analysis. Risk of bias was appraised using the Cochrane tool. Results Seven studies of adults with established knee OA were included. All studies measured crepitus with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale following varied exercise interventions, 3 of which included education. Compared with control, no effect of exercise on modifying knee crepitus was found (mean difference −0.01 (95% confidence interval = −0.23, 0.21) on the 0–4 KOOS subscale). Two studies were at low risk of bias. The others had some concern (n = 3) or high risk of bias (n = 2). Conclusion Based on studies with mixed risk of bias, knee crepitus is unlikely to change in individuals with established OA following exercise. Thus, exercise-based practitioners can provide reassurance to people who are concerned about crepitus that exercise should not exacerbate crepitus. Authors of future studies could explore the impact of crepitus on patient’s beliefs about and engagement with exercise.