Nearly 10,000 patients later, the best knee-arthritis treatments are the simple ones

Knee osteoarthritis is one of the most common sources of chronic pain in the world, and the menu of treatments for it is long, confusing, and full of gadgets. Laser therapy, therapeutic ultrasound, electrical stimulation, kinesiology tape, custom insoles, braces, water exercises, plain old exercise — clinics offer all of them, often at very different prices. So which does the evidence favor?

A new network meta-analysis pooled the evidence to find out, and the researchers reported a refreshingly unglamorous answer: the options that ranked highest in the pooled data are among the cheapest and least high-tech on the list.

What the study did

Researchers combined 139 randomized clinical trials involving nearly 10,000 people with knee osteoarthritis, comparing 12 different approaches head-to-head for their effect on pain, stiffness, and physical function. Pooling trials this way — a network meta-analysis — is useful precisely because no single trial can test everything at once. By stitching together many studies that each compared a couple of options, researchers can rank treatments against one another even when they were never all tested in the same room. The work was published in the open-access journal PLOS One on September 14, 2026.

What the analysis found worked

Three findings stand out, and none of them involves an expensive machine.

The analysis found that knee braces ranked highly across the board — for reducing pain and stiffness and for improving how well the joint functions. A brace is a mechanical, low-cost, low-risk intervention, and the pooled data repeatedly placed it at or near the top of the rankings.

Water-based exercise (hydrotherapy) was reported as especially effective for pain. Exercising in warm water lets people move the joint while the water supports their weight, which makes it possible to work the knee without the load that hurts on dry land. For pain specifically, the pooled trials rated it a standout.

Regular exercise was associated with consistent benefits for both pain and function, according to the analysis. It’s the least surprising result and maybe the most notable one, because it’s the one option on the list a person can start on their own, without cost.

What the analysis found didn’t

The counterpoint is just as useful. Therapeutic ultrasound — a common clinic offering where sound waves are applied to the joint — repeatedly ranked near the bottom of the comparisons, the study found. It’s a more “high-tech” intervention that patients often assume must be doing something, and the pooled evidence suggests it contributed relatively little for knee osteoarthritis compared with the simpler options.

That contrast is the real headline of the analysis. The researchers’ data suggests it’s not that nothing helps; it’s that the options the analysis ranked highest and the ones that look most impressive are not the same list.

Why this matters for a very common problem

Knee osteoarthritis affects an enormous number of people, and the cost and accessibility of treatment matter as much as raw efficacy. A finding that braces, water exercise, and ordinary movement outranked pricier, tech-heavier options in this analysis isn’t just academically tidy — it suggests that some of the cheapest, most widely available options are also among the ones the pooled evidence rates highest.

Two honest caveats belong here. First, “ranks highest across many trials” is a statement about averages, not a promise about any one person; osteoarthritis varies, and what the data associates with benefit for one knee may show less benefit for another. Second, a network meta-analysis is not a substitute for a clinician’s individualized assessment — it is a reason for a more informed conversation with one, particularly where a currently used treatment is among those the pooled evidence ranked near the bottom.

The overall pattern the researchers describe runs against the usual instinct that newer and more technical must mean better. For one of the most widespread pain conditions there is, the analysis of nearly 10,000 patients’ worth of trial data points to the simple options ranking highest: bracing, exercise, and — where available — exercise in water.

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