Treatments to considerbefore opting for surgery

Knee arthroscopy is frequently recommended to investigate or repair defects in the knee joint. It isn’t usually considered an urgent procedure.

There are alternatives you can consider in conjunction with your doctor and physiotherapist. Some knee injuries settle down over time. For example, a minor meniscal tear may heal by itself in about 6 weeks or cause only minor or intermittent symptoms that respond to physiotherapy.

Knee arthroscopy is not effective for degenerative knee conditions like osteoarthritis. In this case the following alternatives might be helpful:

Physiotherapy and exercise

Strengthening exercises can be effective at reducing pain and increasing function. A graded exercise program under the guidance of a healthcare professional is recommended. Aquatic exercise, like swimming, aqua aerobics or hydrotherapy, is particularly gentle on the joints. 

Knee brace

Depending on the type of knee injury, your doctor may recommend a brace to support your knee while it heals. Knee braces may have a hinge to allow some bending and extending of the joint. It may not be advisable for all knee injuries. Some people with anterior cruciate ligament injuries choose to wear a knee brace when exercising or playing sport to prevent further injury.

Weight loss (if you’re overweight)

For each kilo of weight you lose, you reduce the load on your knee joint by 4 kilos. No wonder losing excess weight can improve things! Weight loss of 5% or more has been shown to dramatically reduce joint pain.

If your knee problem is due to osteoarthritis, you may benefit from our 18-week Healthy Weight for Life weight loss program for people living with the condition. It includes activity and portion-controlled eating plans, online tracking plus support via phone, SMS and email. The program is free to eligible HCF members with hospital cover.

The Healthy Weight for Life program can also be used to improve your fitness before knee arthroscopy.

Walking with a stick

Walking with a stick on the opposite side to your affected knee can reduce the load transmitted through the joint, reducing pain and improving function. A physiotherapist can help you learn how to use a stick for maximum benefit.

Topical medications

Rubbing a pain-relieving gel into the area around your painful knee can relieve pain and carries less risk of side effects compared to oral medications. Commonly available analgesic gels contain ibuprofen, diclofenac or methyl salicylate. 

Oral medications

There are several oral medications that can help reduce knee pain and improve function. Chances are you’ve already tried paracetamol. 

Your doctor may also have recommended or prescribed a non-steroidal anti-inflammatory agent (NSAID). Common NSAIDs have the generic names aspirin, meloxicam, celecoxib, ibuprofen, mefenamic acid, diclofenac, naproxen, piroxicam and ketoprofen. They can cause gastric side effects and you should consult your doctor before trying them if you have any other health conditions.

More powerful analgesics containing opioids such as codeine, oxycodone, morphine or tramadol can be prescribed but they’re not recommended for long-term use due to their side effects, toxicity and potential for addiction.

Other medications and procedures

A corticosteroid injected into a painful knee can help reduce swelling and stiffness on a temporary basis.

Hyaluronic acid, also called hyaluronan, is an injectable substance that's also been proven effective in knees with osteoarthritis. Hyaluronic acid can help to restore the shock-absorbing effect of the fluid within the knee, which can reduce pain. Most people experience the greatest amount of relief with hyaluronic acid 6–12 weeks after beginning treatment, although it isn't permanent.

Radiofrequency neurotomy (also known as radiofrequency ablation) is a relatively new procedure in which signals from the pain-transmitting nerves are interrupted, resulting in pain relief. While it doesn’t fix the underlying problem, it can bring pain relief that lasts between 6 months and 2 years. It’s normally done as a day surgery procedure and typically has a very short recovery period.

Non evidence-based treatments

You may have heard about the following treatments, but, to date, evidence of their effectiveness is lacking.

Supplements like glucosamine and chondroitin are commonly used by people with osteoarthritis, but there isn't currently enough evidence to support their use.

Platelet-rich plasma injection is used to relieve osteoarthritis pain. Blood is collected from your arm and spun in a centrifuge to extract the platelet rich plasma. It’s then injected into the joint. There is little evidence it's effective at relieving joint pain. 

Stem cell therapy is a treatment for knee osteoarthritis where your own stem cells are harvested (usually from fatty tissue) then extracted and injected into the joint. In the joint, stem cells can theoretically turn into cartilage cells to replace those damaged by osteoarthritis.

Stem cell therapy is still in its infancy, and relatively unproven, but a number of practitioners already offer it in Australia. It's currently expensive. A simpler, off-the-shelf stem cell product is currently undergoing clinical trials in Australia.

Experimental treatments should only be tried under strict medical supervision, such as in the context of a clinical trial. HCF doesn't cover experimental treatments or procedures. Before undertaking any procedure or taking any new medication, be sure to consult your regular healthcare practitioner.