Controversies in treatment of early osteoarthritis of the knee

Osteoarthritis of the knee (knee OA) is a common disease with a relatively high prevalence and incidence among middle-old population and it is one of the main causes of walking-related disability in older adults. Early knee OA is an important issue nowadays since many younger patients struggle with the disabling effect of pain too and treatments are extremely varied. Such condition is characterized by cartilage loss, subchondral bone changes, synovial inflammation and meniscal degeneration. Notions about early OA changed greatly over the past few decades thanks to the use of MRI and ultrasound (allowing direct visualization of lesions and the early detection of pre-radiographic structural changes) and the widespread use of arthroscopy that permits direct visualization not only of the peri-articular bone but also of the cartilage, menisci, synovial membrane, ligaments and fat pad.