Treating Knee Pain

​The American Association of Family Physicians recently published a study on the Nonsurgical Management of Knee Pain in Adults. This is what it said:

The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients.

Here are nonsurgical recommendations:​

  • Oral analgesics-most commonly nonsteroidal anti-inflammatory drugs and acetaminophen-are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain.
  • The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. (As primary care)
  • In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective.
  • Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome.
  • Weight loss should be encouraged for all patients with osteoarthritis
  • Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy.
  • Foot orthoses can be helpful for anterior knee pain.
  • Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis.

And all the way at the bottom:

Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis.1​

​Regenerative Injections – Platelet rich Plasma and Stem Cells

Following a physical examination and a discussion of the realistic goals that a patient wants to achieve with treatment for their knee pain, we may recommend a healing program centered on Stem Cells, Platelet Rich Plasma, or Prolotherapy. Sometimes a combination of treatments.

Stem Cells

We get many emails a day from people who are interested in stem cell therapy to repair their joint damage. An emailer is typically someone who has had a surgery with less than hoped for results. This could be a patient who had a previous arthroscopic procedure or even a knee replacement and does not wish to have these procedures done to their other knee.

Stem Cell Therapy presents an exciting alternative to these patients. Stem cells taken from your bone are undifferentiated cells, meaning that they are featureless and thus have the the potential to become other, more specialized types of cells, such as cells that rebuild cartilage or soft tissue. In theory these cells upon contact with damage joint surfaces or other damaged tissue are able to determine which types of cells are damaged and in turn become new cell tissue.

In the hands of an experienced doctor, familiar with joint injections Stem Cell Therapy can be an ideal treatment for repairing the knee cartilage. Research agrees: “Since the cartilage is composed primarily of chondrocytes (a specialized cartilage cell) bone marrow-derived mesenchymal stem cells with its ability to morph into these cartilage cells appear to be ideally suited for therapeutic use in cartilage regeneration.” 2

Platelet Rich Plasma

Numerous studies are being published on Platelet Rich Plasma therapy. PRP has been shown to stimulate and enhance tissue healing,3 improve bone and soft tissue defect healing and cartilage repair,4 and stop the progression of knee osteoarthritis.5

Platelet-rich plasma (PRP) enhances tissue regeneration. In one research study exploring PRP’s effectiveness in treating degenerative lesions of articular cartilage of the knee, 100 patients (15 who had both knees treated,” showed PRP injections to be safe and has the potential to reduce pain and improve knee function and quality of life in younger patients with low degree of articular degeneration.

In another study, PRP was found to be an an effective and safe method in the treatment of the initial stages of knee osteoarthritis… (in the treatment of degenerative lesions of articular cartilage of the knee)”

Prolotherapy

There is a long history of medical citations on the effectiveness of prolotherapy for knee pain, most recently form June 2015 in which University of Wisconsin School of Medicine and Public Health researchers concluded that Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee osteoarthritis that did not respond to other conservative treatments.6

Learn more about these treatments
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1. Jones BQ, Covey CJ, Sineath MH Jr. Nonsurgical Management of Knee Pain in Adults. Am Fam Physician. 2015 Nov 15;92(10):875-83.

2. Gupta PK, Das AK, Chullikana A, Majumdar AS. Stem Cell Res Ther. 2012 Jul 9;3(4):25. [Epub ahead of print]

3. Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-Rich Therapies in the Treatment of Orthopaedic Sport Injuries. Sports Medicine: 1 May 2009 – Volume 39 – Issue 5 – pp 345-354 doi: 10.2165/00007256-200939050-00002

4. Sun Y, Feng Y, Zhang CQ, Chen SB, Cheng XG.The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int Orthop. 2010 Apr;34(4):589-97. Epub 2009 May 12.

5. Gobbi A, et al. Platelet-Rich Plasma Treatment in Symptomatic Patients With Knee Osteoarthritis. Preliminary Results in a Group of Active Patients. Sports Health: A Multidisciplinary Approach March/April 2012 vol. 4 no. 2 162-172

6. Rabago D, et al. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Complement Ther Med. 2015 Jun;23(3):388-95. doi: 10.1016/j.ctim.2015.04.003. Epub 2015 Apr 8.​