{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:02:20Z","timestamp":1773392540232,"version":"3.50.1"},"reference-count":136,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Context<\/jats:title><jats:p>Osteoarthritis (OA) of the knee is common and is associated with other chronic diseases and early mortality. OA is often described as a \u201cwound that does not heal\u201d because a local innate immune response gets dysregulated. Tai Chi is an aerobic mind-body practice that is recommended in national and international clinical practice guidelines as a treatment for OA of the knee. This review addressed two questions: What causes immune dysregulation in the knee? and Why is Tai Chi an effective treatment?<\/jats:p><\/jats:sec><jats:sec><jats:title>Recent findings<\/jats:title><jats:p>There is now a good understanding of what causes OA of the knee at the cellular level. OA begins in the synovium from a phenotypic shift in synovial macrophages in response to tissue damage. The synovial macrophages release inflammatory cytokines, as part of the first phase of the normal healing and repair process. Cytokines communicate to other cells that there has been damage. This stimulates chondrocytes, osteoblasts, and fibroblasts to release inflammatory cytokines as well. When tissue damage is repetitive, there is repetitive release of inflammatory cytokines, and the normal healing process stops. The most common cause of tissue damage is from abnormal biomechanical forces on the knee that arise from trauma, injury, and misalignment. Tissue damage is made worse when there is systemic low-grade inflammation associated with other chronic conditions. Pain and stiffness often result in decreased physical activity, which leads to muscle weakness, progressive instability of the joint, and an increased risk of falls, further injuring the knee. Tai Chi improves alignment, optimizes the biomechanical forces on the knee, strengthens the lower limbs, and decreases systemic inflammation. Tai Chi improves balance and decreases the risk of falls and further injury. There is clinical and experimental evidence to suggest that by removing the causes of cell dysregulation, Tai Chi enables the normal healing and repair process to resume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Knee OA is a wound that does not heal primarily because repetitive adverse forces on the knee cause synovial macrophages and then local chondrocytes, osteocytes and fibroblasts to dysregulate and stop the normal healing and repair process. Tai Chi mitigates adverse forces on the knee and stabilizes the joint, creating the conditions whereby the normal healing and repair process can resume. Further research is needed.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1208326","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T12:06:59Z","timestamp":1701086819000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Why osteoarthritis of the knee is called \u201ca wound that does not heal\u201d and why Tai Chi is an effective treatment"],"prefix":"10.3389","volume":"10","author":[{"given":"Patricia","family":"Huston","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.dhjo.2017.04.010","article-title":"Prevalence and causes of work disability among working-age U.S. adults, 2011-2013, NHIS","volume":"11","author":"Theis","year":"","journal-title":"Disabil Health J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"246","DOI":"10.15585\/mmwr.mm6609e1","article-title":"Vital signs: prevalence of doctor diagnosed arthritis and arthritis-attributable activity limitation\u2014United States, 2013-2015","volume":"66","author":"Barbour","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1001\/jama.2020.22171","article-title":"Diagnosis and treatment of hip and knee osteoarthritis: a review","volume":"325","author":"Katz","year":"2021","journal-title":"JAMA"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1002\/acr.24151","article-title":"Knee osteoarthritis, potential mediators, and risk of all-cause mortality: data from the osteoarthritis initiative","volume":"73","author":"Wang","year":"2021","journal-title":"Arthritis Care Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1097\/BOR.0b013e32830aba34","article-title":"Innate immune system activation in osteoarthritis: is osteoarthritis a chronic wound?","volume":"20","author":"Scanzello","year":"2008","journal-title":"Curr Opin Rheumatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/1759720X12467868","article-title":"Role of inflammation in the pathogenesis of osteoarthritis:latest findings and interpretations","volume":"5","author":"Sokolove","year":"2013","journal-title":"Ther Adv Musculoskelet Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"12309","DOI":"10.1002\/jcp.28020","article-title":"Epigenetics in osteoarthritis: novel spotlight","volume":"234","author":"Fathollahi","year":"2019","journal-title":"J Cell Physiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.joca.2021.10.010","article-title":"Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? 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