Pulsed Electromagnetic Fields in Knee Osteoarthritis: A Translational Review

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Abstract
Pulsed electromagnetic field (PEMF) therapy has attracted interest in knee osteoarthritis (OA) because it can influence cellular signaling and tissue responses through a noninvasive physical stimulus. However, PEMF is not a uniform intervention, and differences in waveform, field strength, applicator geometry, treatment schedule, and biological context complicate comparisons across studies. This narrative review examines the biophysical basis, experimental mechanisms, and clinical evidence for PEMF in knee OA, with attention to rehabilitation and orthobiologic applications. Preclinical studies describe effects involving calcium-dependent signaling, adenosine receptors, inflammatory regulation, metabolic activity, mesenchymal stromal cell paracrine function, and tissue-specific remodeling. Clinical findings are less consistent, since selected PEMF protocols and related pulsed electromagnetic exposures have improved pain, function, or knee extensor strength in individual trials, whereas others showed no added benefit over sham treatment or exercise alone. Human evidence has not established cartilage regeneration or structural disease modification. Translation is further limited by incomplete exposure reporting and substantial heterogeneity between devices. PEMF may therefore be best investigated as an adjuvant therapy directed toward defined biological or clinical targets. Future trials should combine reproducible exposure characterization with appropriate controls, patient selection, and outcomes that distinguish symptom relief, functional adaptation, and structural change.

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