The Efficacy of Closed Versus Open Kinetic Chain Exercise in Knee Osteoarthritis—A Systematic Review and Meta‐Analysis

Background/Purpose Despite the prevalence of knee osteoarthritis, no consensus exists in the most effective exercise type for improving patient clinical outcomes. Therefore, we conducted a systematic review to compare the effectiveness of closed and open kinetic chain exercises (CKC and OKC) in reducing pain, increasing physical function and improving quality of life (QoL) in people with knee OA. Methods We searched PubMed, MEDLINE, EMBASE, CINAHL, PEDro, Scopus and Cochrane from inception to April 2024. Studies were included if they compared pain, physical function and QoL outcomes via a randomised controlled trial design in people with knee osteoarthritis. The Pedro Scale was used to assess the risk of bias, and the GRADE approach was used to determine the certainty of evidence. Outcomes were pooled in a random effects meta‐analysis. 13 randomised controlled trials evaluating the efficacy of CKC versus OKC exercises in the short term (≤ 13 weeks) were included. Results Low‐certainty evidence found that CKC exercises were superior to OKC exercises in the short term for improving pain (standardised mean difference (SMD) −0.18, 95% CI –0.37 to < 0.00; p = 0.048) and self‐reported physical function (SMD –0.24, 95% CI –0.44 to −0.03, p = 0.022), with very low‐certainty evidence of no difference in QoL outcomes (SMD –0.25, 95% CI –0.81 to 0.30, p = 0.370). Discussion To reduce pain and improve physical function in individuals with knee osteoarthritis in the short term, physiotherapists should prescribe CKC exercises. However, there is a paucity of information outlining the effects of these CKC versus OKC in the medium to long term. Study Registration Number PROSPERO (CRD42023470739)