Best Evidence-Based Treatments for Knee Osteoarthritis
Knee osteoarthritis has more marketed treatments than almost any other condition, and far fewer well-supported ones. This list follows the American College of Rheumatology guideline in order: the strongest recommendations first, then the conditional ones, then what it advises against.
Published by Innovare Tx · Facts last checked September 23, 2026 · Educational information, not medical advice.
How we chose this list
- Ordered by the strength of the American College of Rheumatology recommendation for knee osteoarthritis.
- Where the ACR's 2026 update summary (posted September 14, 2026) changed a 2019 grade, both are stated.
- The ACR guideline does not grade surgery; knee replacement is included from NIAMS and AAOS patient guidance.
- Educational only. Which of these fits your knee depends on your examination, your other health conditions and your preferences.
1. Exercise
Exercise is strongly recommended for knee osteoarthritis in the 2019 ACR/Arthritis Foundation guideline and again in the 2026 update. The guideline does not name one best type: walking, cycling, strength training, water exercise and neuromuscular training were all studied. OARSI, an international osteoarthritis research society, lists structured land-based exercise as a core treatment for the knee.
The version that makes a difference is a program: specific exercises, progressed on a schedule, and rechecked. Start slowly and stop if pain builds during a session or the knee swells afterward.
- ACR 2019: strong. ACR 2026: strong
- OARSI 2019: core treatment for knee osteoarthritis
- The ACR 2026 summary advises referral to physical therapy when function is limited
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026) · Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019
2. Weight loss, if you are overweight or obese
Weight loss is strongly recommended for people with knee osteoarthritis who are overweight or obese. The 2019 guideline notes that losing 5% or more of body weight can be associated with meaningful change, with further benefit as weight loss continues. OARSI lists dietary weight management, together with exercise, as a core treatment.
The ACR's 2026 update adds a new conditional recommendation for GLP-1 receptor agonist medicines in people with knee osteoarthritis and obesity, in combination with diet and exercise. Whether any medication is appropriate for you is a prescribing decision made with a clinician.
- ACR 2019: strong. ACR 2026: strong
- Benefit described from about a 5% change in body weight
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026) · Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019
3. Education and self-management programs
Learning how osteoarthritis behaves and how to manage flares, activity and pain is strongly recommended in the 2019 guideline and is a good practice statement in the 2026 update. NIAMS lists learning about osteoarthritis as one of the first steps in treatment.
Examples include structured self-management classes and programs such as the Arthritis Foundation's Walk With Ease walking program. Cognitive behavioral therapy is a separate, conditional recommendation.
- ACR 2019: strong. ACR 2026: good practice statement
- OARSI 2019: core treatment (arthritis education)
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026) · NIAMS (NIH): Osteoarthritis, Diagnosis, Treatment, and Steps to Take · Arthritis Foundation: Walk With Ease
4. Topical NSAIDs
Anti-inflammatory gels or creams applied to the skin over the knee are strongly recommended for knee osteoarthritis by the ACR in both 2019 and 2026. The 2026 update also conditionally recommends trying topical NSAIDs before oral ones. OARSI gives topical NSAIDs its highest level of recommendation for the knee.
Topical products are absorbed into the body in smaller amounts than tablets, but they are still medicines. Check with a pharmacist or clinician if you take blood thinners or have kidney disease.
- ACR 2019: strong. ACR 2026: strong
- OARSI 2019: Level 1A for knee osteoarthritis
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026) · Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019
5. Oral NSAIDs
Anti-inflammatory tablets such as ibuprofen and naproxen are strongly recommended in the ACR guideline. They also carry real risks: the AAOS notes they should be used with caution, or avoided, by people with conditions such as coronary artery disease, heart failure and chronic kidney disease, and OARSI does not recommend them for people with cardiovascular disease or frailty.
Use the lowest dose for the shortest time that works, and ask a clinician before taking them regularly.
- ACR 2019: strong. ACR 2026: strong
- Not suitable for everyone; ask about heart, kidney and stomach risks
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026) · AAOS OrthoInfo: Arthritis of the Knee · Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019
6. Corticosteroid injection into the knee
A corticosteroid (cortisone) injection into the joint is strongly recommended for knee osteoarthritis by the ACR in 2019 and 2026. Its effect is temporary. NIAMS notes that your doctor decides how many injections you should have and how often, and the AAOS notes that your doctor may recommend limiting them to three or four a year per joint.
If you need injections every few months to get by, it is worth reviewing the rest of the plan with your clinician.
- ACR 2019: strong. ACR 2026: strong
- Effect is temporary; frequency is limited
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026) · NIAMS (NIH): Osteoarthritis, Diagnosis, Treatment, and Steps to Take · AAOS OrthoInfo: Arthritis of the Knee
7. Canes and knee braces
In 2019 the ACR strongly recommended a cane for people whose knee osteoarthritis limits walking, and strongly recommended tibiofemoral (unloader) bracing. The 2026 update summary makes cane and mobility-aid use a good practice statement and grades both tibiofemoral and patellofemoral braces as conditional recommendations.
A brace or cane makes load more manageable while you build strength. The right brace depends on which part of the knee is worn, so it is worth having it chosen by someone who has examined the knee.
- Cane: ACR 2019 strong; ACR 2026 good practice statement
- Braces: ACR 2019 strong (tibiofemoral); ACR 2026 conditional
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026)
8. Mind-body and hands-on options: tai chi, yoga, acupuncture, heat or cold, taping, massage
The ACR's 2026 update conditionally recommends tai chi (strong in 2019), yoga, cognitive behavioral therapy, locally applied heat or cold, therapeutic taping and acupuncture for knee osteoarthritis. Massage moved from a conditional recommendation against in 2019 to a conditional recommendation for in 2026.
Conditional means the benefit is likely to be smaller or less certain, so preference, cost and access matter more. These tend to work best alongside an exercise program, not instead of one.
- All conditional in the ACR 2026 update
- Tai chi was strong in 2019 and is conditional in 2026
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026)
9. Other conditional medicines and procedures
For knee osteoarthritis, the ACR's 2026 update conditionally recommends acetaminophen, duloxetine, topical capsaicin and radiofrequency ablation (a procedure that targets the nerves carrying pain from the knee). Each has its own trade-offs and suits some people better than others.
Ask about side effects and interactions before starting any of these, especially if you take several medicines already.
- All conditional in the ACR 2026 update
Checked on: Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020 · American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026)
10. Knee replacement, for advanced osteoarthritis
When other treatments are not helping and the joint damage is extensive, partial or total knee replacement is an option. NIAMS notes that age, pain, how much arthritis limits your life, disability and occupation all shape the decision. The ACR guideline covers non-surgical care and does not grade surgery.
This is a decision to make with an orthopedic surgeon. Innovare Tx does not perform knee surgery; when an evaluation points toward a surgical opinion, we refer to orthopedic surgery.
- Discussed with an orthopedic surgeon
- Not graded in the ACR guideline
Checked on: NIAMS (NIH): Osteoarthritis, Diagnosis, Treatment, and Steps to Take · AAOS OrthoInfo: Arthritis of the Knee
PRP, PPP, BMAC, and A2M are autologous procedures prepared from your own blood or bone marrow. They are considered investigational and are not FDA-approved for the treatment of any specific orthopedic condition, including osteoarthritis. Individual results are not guaranteed. Any decision to pursue an orthobiologic procedure should be made with your provider after a clinical evaluation.
What the guideline recommends against
Some of the most heavily marketed knee products sit on the ACR's list of things it advises against. The grades below are for knee osteoarthritis in the 2026 update summary; changes from 2019 are noted.
- Glucosamine, chondroitin and combination products: strongly recommended against (also strongly against in 2019)
- Platelet-rich plasma (PRP): strongly recommended against (the 2019 wording: "Platelet-rich plasma treatment is strongly recommended against in patients with knee and/or hip OA")
- Hydroxychloroquine, bisphosphonates and TNF inhibitors: strongly recommended against
- Hyaluronic acid (gel) injections: conditionally recommended against (also in 2019; other guideline bodies take a different view)
- TENS: conditionally recommended against (strongly against in 2019)
- Wedged shoe insoles: conditionally recommended against
- Opioids, vitamin D, fish oil, colchicine, botulinum toxin injections and dextrose prolotherapy: conditionally recommended against
Where orthobiologic procedures fit
Innovare Tx offers autologous orthobiologic procedures (PRP, PPP, BMAC and A2M) prepared from your own blood or bone marrow. They are investigational, they are not FDA-approved for the treatment of any specific orthopedic condition, including osteoarthritis, and they are not among the ACR's recommended treatments. The ACR strongly recommends against PRP for knee osteoarthritis, in 2019 and again in 2026. They are also not covered by insurance.
We state that plainly because you should hear it before, not after, a conversation about them. Whether any procedure is appropriate for you is a decision made with your provider after a clinical evaluation, and the guideline-recommended care above comes first in our Knee Program.
Frequently asked questions
Sources
- Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020
- American College of Rheumatology: 2026 Update of the Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand (summary, posted September 14, 2026)
- American College of Rheumatology: Osteoarthritis Guideline page
- Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019
- NIAMS (NIH): Osteoarthritis, Diagnosis, Treatment, and Steps to Take
- AAOS OrthoInfo: Arthritis of the Knee
Related guides
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ReadBest Knee Braces for Arthritis
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ReadBest Questions to Ask Before PRP Therapy
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ReadTalk it through with a clinician
A list is a starting point. Book an evaluation at our Addison clinic, or call and we will verify your insurance before you come in.