Chinese expert consensus in non-surgical management of knee osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2024.02.001

Abstract

Abstract:

Knee osteoarthritis (KOA) is the most common degenerative disease afflicting the middle-aged and elderly, manifesting as pain, deformity, and dysfunction caused by knee joint degeneration. The prevalence of KOA in China is reported to be 8.1%, compared to 12.1% in Europe and the United States. Due to the lack of optimal treatment for KOA, which imposes a huge economic burden on patients, their families and the social healthcare system. The treatment of KOA is usually divided into non-pharmacological, pharmacological and surgical interventions, while clinically non-surgical interventions have achieved significant results in the treatment of KOA. To provide decision aids for orthopaedic surgeons and researchers in the non-surgical treatment of KOA, Joint Surgery Group of Chinese Medical Association have widely consulted domestic orthopaedic experts, fully searched domestic and international literature and combined with the current situation of KOA treatment in China to develop this expert consensus, which aims to provide guidelines and recommendations for the non-surgical treatment of KOA.

Key words: Osteoarthritis, knee, Conservative therapy, Practice guideline, Evidence-based medicine

Joint Surgery Group of Chinese Medical Association,, Senior Department of Orthopedics, The Forth Medical Centre of Chinese PLA General Hospital,, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation. Chinese expert consensus in non-surgical management of knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 151-159.

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References 93

[1]	Sharma L. Osteoarthritis of the knee[J]. N Engl J Med, 2021, 384(1): 51－59.
[2]	Zhang Y, Xu L, Nevitt MC, et al. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: the Beijing Osteoarthritis Study[J]. Arthritis Rheum, 2001, 44(9): 2065－2071.
[3]	Nevitt MC, Xu L, Zhang Y, et al. Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study[J]. Arthritis Rheum, 2002, 46(7): 1773－1779.
[4]	Osani MC, Vaysbrot EE, Zhou M, et al. Duration of symptom relief and early trajectory of adverse events for oral nonsteroidal antiinflammatory drugs in knee osteoarthritis: asystematic review and meta-analysis[J]. Arthritis Care Res, 2020, 72(5): 641－651.
[5]	Mazzei DR, Ademola A, Abbott JH, et al. Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review[J]. Osteoarthritis Cartilage, 2021, 29(4): 456－470.
[6]	Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis[J]. Osteoarthritis Cartilage, 2019, 27(11): 1578－1589.
[7]	Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee[J]. Arthritis Care Res, 2020, 72(2): 149－162.
[8]	Patten RK, Tacey A, Pile R, et al. Digital self-management interventions for osteoarthritis: a systematic scoping review of intervention characteristics, adherence and attrition[J/OL]. Arch Public Health, 2022, 80(1): 103. DOI: 10.1186/s13690-022-00854-x.
[9]	Salwana Kamsan S, Kaur Ajit Singh D, Tan MP, et al. Systematic review on the contents and parameters of self-management education programs in older adults with knee osteoarthritis[J/OL]. Australas J Ageing, 2021, 40(1): e1－e12. DOI: 10.1111/ajag.12844.
[10]	Goff AJ, de Oliveira Silva D, Ezzat AM, et al. Knee osteoarthritis education interventions in published trials are typically unclear, not comprehensive enough, and lack robust development: ancillary analysis of a systematic review[J]. J Orthop Sports Phys Ther, 2022, 52(5): 276－286.
[11]	Coleman S, Briffa NK, Carroll G, et al. Effects of self-management, education and specific exercises, delivered by health professionals, in patients with osteoarthritis of the knee[J/OL]. BMC Musculoskelet Disord, 2008, 9: 133. DOI: 10.1186/1471-2474-9-133.
[12]	Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)[J]. Semin Arthritis Rheum, 2019, 49(3): 337－350.
[13]	Coudeyre E, Sanchez K, Rannou F, et al. Impact of self-care programs for lower limb osteoarthritis and influence of patients' beliefs[J]. Ann Phys Rehabil Med, 2010, 53(6－7): 434－450.
[14]	Dias RC, Dias JMD, Ramos LR. Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee[J]. Physiother Res Int, 2003, 8(3): 121－130.
[15]	Alkatan M, Baker JR, Machin DR, et al. Improved function and reduced pain after swimming and cycling training in patients with osteoarthritis[J]. J Rheumatol, 2016, 43(3): 666－672.
[16]	Rewald S, Lenssen AFT, Emans PJ, et al. Aquatic cycling improves knee pain and physical functioning in patients with knee osteoarthritis: arandomized controlled trial[J]. Arch Phys Med Rehabil, 2020, 101(8): 1288－1295.
[17]	Esculier JF, Krowchuk NM, Li LC, et al. What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada？[J/OL]. PLoS One, 2018, 13(10): e0204872. DOI: 10.1371/journal.pone.0204872.
[18]	Oka Y, Murata K, Ozone K, et al. Treadmill exercise after controlled abnormal joint movement inhibits cartilage degeneration and synovitis[J/OL]. Life, 2021, 11(4): 303. DOI: 10.3390/life11040303.
[19]	Bartholdy C, Juhl C, Christensen R, et al. The role of muscle strengthening in exercise therapy for knee osteoarthritis: a systematic review and meta-regression analysis of randomized trials[J]. Semin Arthritis Rheum, 2017, 47(1): 9－21.
[20]	李静雅，程亮. 太极拳和抗阻训练对膝关节骨性关节炎老人症状及运动能力的影响[J]. 中国康复医学杂志，2019, 34(11): 1304－1309.
[21]	Cheung C, Wyman JF, Bronas U, et al. Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial[J]. Rheumatol Int, 2017, 37(3): 389－398.
[22]	Duman I, Taskaynatan MA, Mohur H, etal. Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis[J]. Rheumatol Int, 2012, 32(12): 3793－3798.
[23]	Takacs J, Krowchuk NM, Garland SJ, et al. Dynamic balance training improves physical function in individuals with knee osteoarthritis: apilot randomized controlled trial[J]. Arch Phys Med Rehabil, 2017, 98(8): 1586－1593.
[24]	Lee HG, An J, Lee BH. The effect of progressive dynamic balance training on physical function, the ability to balance and quality of life among elderly women who underwent a total knee arthroplasty: adouble-blind randomized control trial[J/OL]. Int J Environ Res Public Health, 2021, 18(5): 2513. DOI: 10.3390/ijerph18052513.
[25]	膝骨关节炎运动治疗临床实践指南编写组. 膝骨关节炎运动治疗临床实践指南[J]. 中华医学杂志，2020, 100(15): 1123－1129.
[26]	Raposo F, Ramos M, Cruz AL. Effects of exercise on knee osteoarthritis: a systematic review[J]. Musculoskeletal Care, 2021, 19(4): 399－435.
[27]	Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise[J]. Med Sci Sports Exerc, 2011, 43(7): 1334－1359.
[28]	Johnson MI, Paley CA, Jones G, et al. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study)[J/OL]. BMJ Open, 2022, 12(2): e051073. DOI: 10.1136/bmjopen-2021-051073.
[29]	Chen H, Wang Z, Zhang X, etal. Effects of low-intensity pulsed ultrasound on knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Clin Rehabil, 2022, 36(9): 1153－1169.
[30]	Gladwell PW, Cramp F, Palmer S. Matching the perceived benefits of Transcutaneous Electrical Nerve Stimulation (TENS) for chronic musculoskeletal pain against Patient Reported Outcome Measures using the International Classification of Functioning, Disability and Health (ICF)[J]. Physiotherapy, 2020, 106: 128－135.
[31]	Wang Y, Li S, Zhang Y, et al. Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: a systematic review and meta-analysis of 32 randomized controlled trials[J]. Phys Ther Sport, 2021, 48: 177－187.
[32]	The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edition. East Melbourne, Vic: RACGP, 2018.
[33]	Dantas LO, Moreira RFC, Norde FM, et al. The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials[J]. Clin Rehabil, 2019, 33(8): 1310－1319.
[34]	Jones A, Silva PG, Silva AC, et al. Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial[J]. Ann Rheum Dis, 2012, 71(2): 172－179.
[35]	Van Ginckel A, Hinman RS, Wrigley TV, et al. Impact of cane use on bone marrow lesion volume in people with medial knee osteoarthritis (CUBA trial)[J]. Phys Ther, 2017, 97(5): 537－549.
[36]	Hinman RS, Wrigley TV, Metcalf BR, et al. Unloading shoes for self-management of knee osteoarthritis: arandomized trial[J]. Ann Intern Med, 2016, 165(6): 381－389.
[37]	Paterson KL, Bennell KL, Campbell PK, et al. The effect of flat flexible versus stable supportive shoes on knee osteoarthritis symptoms: arandomized trial[J]. Ann Intern Med, 2021, 174(4): 462－471.
[38]	Yu L, Wang Y, Yang J, et al. Effects of orthopedic insoles on patients with knee osteoarthritis: a meta-analysis and systematic review[J/OL]. J Rehabil Med, 2021, 53(5): jrm00191. DOI: 10.2340/16501977-2836.
[39]	Trombini-Souza F, Matias AB, Yokota M, et al. Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: a randomized controlled trial[J]. Clin Biomech, 2015, 30(10): 1194－1201.
[40]	Nigg BM, Emery C, Hiemstra LA. Unstable shoe construction and reduction of pain in osteoarthritis patients[J]. Med Sci Sports Exerc, 2006, 38(10): 1701－1708.
[41]	Hewlett J, Kenney J. Innovations in functional and rehabilitative knee bracing[J/OL]. Ann Transl Med, 2019, 7(Suppl 7): S248. DOI: 10.21037/atm.2019.03.34.
[42]	Ornetti P, Fortunet C, Morisset C, et al. Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis[J]. Ann Phys Rehabil Med, 2015, 58(3): 126－131.
[43]	Gueugnon M, Fournel I, Soilly AL, et al. Effectiveness, safety, and cost-utility of a knee brace in medial knee osteoarthritis: the ERGONOMIE randomized controlled trial[J]. Osteoarthritis Cartilage, 2021, 29(4): 491－501.
[44]	Cudejko T, van der Esch M, van den Noort JC, et al. Decreased pain and improved dynamic knee instability mediate the beneficial effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis[J]. Arthritis Care Res, 2019, 71(8): 1036－1043.
[45]	Nelson AE, Allen KD, Golightly YM, et al. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U．S. bone and joint initiative[J]. Semin Arthritis Rheum, 2014, 43(6): 701－712.
[46]	Duivenvoorden T, Brouwer RW, van Raaij TM, et al. Braces and orthoses for treating osteoarthritis of the knee[J/OL]. Cochrane Database Syst Rev, 2015, 2015(3): CD004020. DOI: 10.1002/14651858.CD004020.pub3.
[47]	Fan Y, Li Z, Zhang H, et al. Valgus knee bracing may have no long-term effect on pain improvement and functional activity in patients with knee osteoarthritis: a meta-analysis of randomized trials[J/OL]. J Orthop Surg Res, 2020, 15(1): 373. DOI: 10.1186/s13018-020-01917-x.
[48]	Williams S, Whatman C, Hume PA, etal. Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness[J]. Sports Med, 2012, 42(2): 153－164.
[49]	Melese H, Alamer A, Hailu Temesgen M, etal. Effectiveness of kinesio taping on the management of knee osteoarthritis: asystematic review of randomized controlled trials[J]. J Pain Res, 2020, 13: 1267－1276.
[50]	Mao HY, Hu MT, Yen YY, et al. Kinesio taping relieves pain and improves isokinetic not isometric muscle strength in patients with knee osteoarthritis-asystematic review and meta-analysis[J/OL]. Int J Environ Res Public Health, 2021, 18(19): 10440. DOI: 10.3390/ijerph181910440.
[51]	Hayati M, Yazdi Z, Abbasi M. Comparison of non-steroidal anti-inflammatory drugs and knee kinesio taping in early osteoarthritis pain: a randomized controlled trial[J]. J Bodyw Mov Ther, 2019, 23(3): 666－670.
[52]	Wageck B, Nunes GS, Bohlen NB, et al. Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial[J]. J Physiother, 2016, 62(3): 153－158.
[53]	Kaya Mutlu E, Mustafaoglu R, Birinci T, etal. Does kinesio taping of the knee improve pain and functionality in patients with knee osteoarthritis？：arandomized controlled clinical trial[J]. Am J Phys Med Rehabil, 2017, 96(1): 25－33.
[54]	Hochberg MC, Fort JG, Svensson O, et al. Fixed-dose combination of enteric-coated naproxen and immediate-release esomeprazole has comparable efficacy to celecoxib for knee osteoarthritis: two randomized trials[J]. Curr Med Res Opin, 2011, 27(6): 1243－1253.
[55]	Simon LS, Grierson LM, Naseer Z, et al. Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo, DMSO vehicle and oral diclofenac for knee osteoarthritis[J]. Pain, 2009, 143(3): 238－245.
[56]	Schnitzer TJ, Hochberg MC, Marrero CE, et al. Efficacy and safety of naproxcinod in patients with osteoarthritis of the knee: a 53-week prospective randomized multicenter study[J]. Semin Arthritis Rheum, 2011, 40(4): 285－297.
[57]	Case JP, Baliunas AJ, Block JA. Lack of efficacy of acetaminophen in treating symptomatic knee osteoarthritis: a randomized, double-blind, placebo-controlled comparison trial with diclofenac sodium[J]. Arch Intern Med, 2003, 163(2): 169－178.
[58]	Nakata K, Hanai T, Take Y, et al. Disease-modifying effects of COX-2 selective inhibitors and non-selective NSAIDs in osteoarthritis: a systematic review[J]. Osteoarthritis Cartilage, 2018, 26(10): 1263－1273.
[59]	Nissen SE, Yeomans ND, Solomon DH, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis[J]. N Engl J Med, 2016, 375(26): 2519－2529.
[60]	Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: Bayesian meta-analysis of individual patient data[J/OL]. BMJ, 2017, 357: j1909. DOI: 10.1136/bmj.j1909.
[61]	Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors[J]. JAMA, 2001, 286(8): 954－959.
[62]	Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial[J]. JAMA, 2018, 319(9): 872－882.
[63]	Solomon DH, Rassen JA, Glynn RJ, et al. The comparative safety of analgesics in older adults with arthritis[J]. Arch Intern Med, 2010, 170(22): 1968－1976.
[64]	Hassamal S, Miotto K, Dale W, etal. Tramadol: understanding the risk of serotonin syndrome and seizures[J]. Am J Med, 2018, 131(11): 1382.e1－1381382.e6.
[65]	Toupin April K, Bisaillon J, Welch V, et al. Tramadol for osteoarthritis[J/OL]. Cochrane Database Syst Rev, 2019, 5(5): CD005522. DOI: 10.1002/14651858.CD005522.pub3.
[66]	Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: united States, 2002－2012[J]. Natl Health Stat Report, 2015(79): 1－16.
[67]	Hughes R, Carr A. A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee[J]. Rheumatology, 2002, 41(3): 279－284.
[68]	Kwoh CK, Roemer FW, Hannon MJ, et al. Effect of oral glucosamine on joint structure in individuals with chronic knee pain: a randomized, placebo-controlled clinical trial[J]. Arthritis Rheumatol, 2014, 66(4): 930－939.
[69]	Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis[J]. N Engl J Med, 2006, 354(8): 795－808.
[70]	Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT[J]. Ann Rheum Dis, 2010, 69(8): 1459－1464.
[71]	Fransen M, Agaliotis M, Nairn L, et al. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens[J]. Ann Rheum Dis, 2015, 74(5): 851－858.
[72]	Roth SH, Shainhouse JZ. Efficacy and safety of a topical diclofenac solution (pennsaid) in the treatment of primary osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled clinical trial[J]. Arch Intern Med, 2004, 164(18): 2017－2023.
[73]	Baer PA, Thomas LM, Shainhouse Z. Treatment of osteoarthritis of the knee with a topical diclofenac solution: a randomised controlled, 6-week trial[ISRCTN53366886][J/OL]. BMC Musculoskelet Disord, 2005, 6: 44. DOI: 10.1186/1471-2474-6-44.
[74]	Conaghan PG, Dickson J, Bolten W, etal. A multicentre, randomized, placebo- and active-controlled trial comparing the efficacy and safety of topical ketoprofen in Transfersome gel (IDEA-033) with ketoprofen-free vehicle (TDT 064) and oral celecoxib for knee pain associated with osteoarthritis[J]. Rheumatology, 2013, 52(7): 1303－1312.
[75]	Rother M, Lavins BJ, Kneer W, etal. Efficacy and safety of epicutaneous ketoprofen in Transfersome (IDEA-033) versus oral celecoxib and placebo in osteoarthritis of the knee: multicentre randomised controlled trial[J]. Ann Rheum Dis, 2007, 66(9): 1178－1183.
[76]	Altman RD, Manjoo A, Fierlinger A, et al. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review[J/OL]. BMC Musculoskelet Disord, 2015, 16: 321. DOI: 10.1186/s12891-015-0775-z.
[77]	Maheu E, Bannuru RR, Herrero-Beaumont G, et al. Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: results of an extensive critical literature review[J]. Semin Arthritis Rheum, 2019, 48(4): 563－572.
[78]	Miller LE, Bhattacharyya S, Parrish WR, et al. Safety of intra-articular hyaluronic acid for knee osteoarthritis: systematic review and meta-analysis of randomized trials involving more than 8, 000 patients[J]. Cartilage, 2021, 13(1_suppl): 351S－363S.
[79]	Najm A, Alunno A, Gwinnutt JM, et al. Efficacy of intra-articular corticosteroid injections in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J/OL]. Joint Bone Spine, 2021, 88(4): 105198. DOI: 10.1016/j.jbspin.2021.105198.
[80]	McLarnon M, Heron N. Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis[J/OL]. BMC Musculoskelet Disord, 2021, 22(1): 550. DOI: 10.1186/s12891-021-04308-3.
[81]	Deyle GD, Allen CS, Allison SC, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee[J]. N Engl J Med, 2020, 382(15): 1420－1429.
[82]	McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: arandomized clinical trial[J]. JAMA, 2017, 317(19): 1967－1975.
[83]	Wang CP, Lee WC, Hsieh RL. Effects of repeated co-injections of corticosteroids and hyaluronic acid on knee osteoarthritis: aprospective, double-blind randomized controlled trial[J]. Am J Med, 2022, 135(5): 641－649.
[84]	Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis[J]. Nat Rev Rheumatol, 2013, 9(12): 721－730.
[85]	Bennell KL, Paterson KL, Metcalf BR, et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain and medial tibial cartilage volume in patients with knee osteoarthritis: the RESTORE randomized clinical trial[J]. JAMA, 2021, 326(20): 2021－2030.
[86]	Migliorini F, Driessen A, Quack V, et al. Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis[J]. Arch Orthop Trauma Surg, 2021, 141(9): 1473－1490.
[87]	Smith PA. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial[J]. Am J Sports Med, 2016, 44(4): 884－891.
[88]	王琬茹，任志雄，陈璐，等. 中医外治法治疗骨关节炎疗效的Meta分析[J]. 实用中医内科杂志，2022, 36(8): 79－82, 166－168.
[89]	Vas J, Méndez C, Perea-Milla E, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial[J/OL]. BMJ, 2004, 329(7476): 1216. DOI: 10.1136/bmj.38238.601447.3A.
[90]	Shi GX, Tu JF, Wang TQ, et al. Effect of electro-acupuncture (EA) and manual acupuncture (MA) on markers of inflammation in knee osteoarthritis[J]. J Pain Res, 2020, 13: 2171－2179.
[91]	谢洪波. 推拿配合功能锻炼治疗膝关节骨性关节炎的临床观察[J]. 南京中医药大学学报，2017, 33(4): 367－370.
[92]	杜沂岚，朱海燕，周富，等. 温针灸结合推拿手法治疗膝关节骨性关节炎96例临床疗效观察[J]. 四川中医，2021, 39(2): 189－194.
[93]	时明伟，周斌，周运峰. 点穴配合调整手法治疗膝关节骨性关节炎30例[J]. 河南中医，2020, 40(12): 1906－1910.

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