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A comprehensive meta-analysis involving 9,644 patients with knee osteoarthritis ranked the knee brace best for osteoarthritis relief, according to findings.

A comprehensive network meta-analysis of 139 randomized trials involving 9,644 patients with knee osteoarthritis (KOA) ranked the knee brace at the top of the conservative care hierarchy, according to results published in PLOS One.

“While existing research has primarily focused on comparing physical therapy with other treatment options, there is a paucity of studies that directly assess the comparative efficacy of different physical therapy approaches,” wrote study author Yuan Luo of the First People’s Hospital of Neijiang, and colleagues.

The authors compared 12 modalities—ranging from laser therapies to lateral-wedged insoles—using standardized Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, function, and stiffness scores, as well as resting and activity visual analog scale (VAS) scores. Across WOMAC pain, function, and stiffness, the knee brace consistently held first place, edging out exercise and hydrotherapy; ultrasound and short-wave diathermy repeatedly landed at the bottom, according to findings.

Hydrotherapy Shines for Relief at Rest

Pain scores told a nuanced story, according to the authors. In terms of VAS at rest, hydrotherapy—which utilizes buoyancy and warmth to unload joints—ranked highest, followed by high-intensity and low-level laser therapy. During activity, however, the knee brace reclaimed top ranking, followed by low-level laser therapy and exercise.

“Overall, based on SUCRA [Surface Under the Cumulative Ranking Curve] results, the knee brace had the highest probability of being the most effective technique,” the researchers noted, “followed by hydrotherapy and exercise.”

The authors cited improved biomechanics, enhanced proprioception, and reduced inflammatory signaling as likely mechanisms behind the superiority of the knee brace. Additionally, the noted buoyant immersion temperatures of 33.5°C to 35.5°C appeared pivotal to the analgesic effect of hydrotherapy.

Modality-Specific Strengths Highlighted

Beyond rank ordering, the analysis highlighted modality-specific strengths that can guide tailored care, according to the authors. Hydrotherapy may be an attractive first-line option for patients whose primary goal is pain relief, whereas brace-based off-loading is optimal when functional gains and stiffness reduction are paramount. Exercise remains a versatile adjunct, offering broad improvements across pain, mobility, and quality-of-life domains.

“Our findings provide clinicians with a data-driven framework to individualize conservative therapy for KOA,” the authors concluded, urging future trials to explore combination strategies and cost-effectiveness.