Non-Surgical Knee Treatments

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries. Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Injuries to the knee can be caused by degenerative diseases such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair the mobility as well as the quality of life of the patients. All these conditions require appropriate treatment to restore to normal activities. It may be surgical or non-surgical. The non-operative orthopaedic treatment options include non-pharmacological and pharmacological interventions. They are aimed at providing symptomatic relief and improving the quality of life of the patients. They can be used as a treatment option to treat certain conditions or to decrease pain as well as promoting functioning and quality of life after the surgical treatment.

Non-Pharmacological Intervention

Non-pharmacological interventions may range from simple lifestyle modification, physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:

  • Weight reduction and physical exercise – The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of the knee conditions.

    The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered over weight and BMI over 30 is considered as obese.

    Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore, rigorous exercises are not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.

  • Thermotherapy – Thermotherapy involves application of hot or cold packs at the affected area. There is some evidence to support the use of cold therapy in providing symptomatic relief. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension or who are pregnant should use it with caution.
  • Acupuncture – This method involves insertion of sterile needles into specific acupuncture points or pressure points. It is believed that insertion of needles at specific points restores the flow of “qi”, a form of energy and thereby relieves the pain.A modification in acupuncture is electro-acupuncture where the needles are stimulated by an electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and offers pain relief however may have certain risks if treated by untrained professionals.
  • Patellar taping – Patellar taping is used as a short-term treatment particularly when performing normal activities deteriorates the knee condition. The principle behind the treatment is stabilization of knee joint by altering the distribution of stress and joint pressure. The response depends on the strapping technique used and the time for which it is strapped.
  • Massage therapy – It is one of the oldest methods of treatment and reduces pain by increasing the circulation of blood and lymph as well by reduction of muscle tension or because of the therapeutic effect of the touch.

Pharmacological Interventions

Pharmacological interventions include management of pain using medicinal preparations such as pain-relieving capsules or injections.

  • Non-steroidal anti-inflammatory drugs – These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the knee. Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must have extreme care while using them. They cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.
  • Orthobiologic injections - Biologic therapy includes innovative treatments that enhance the body’s natural capacity to heal. It is a type of regenerative medicine that uses various technologies to harvest the natural healing resources of the body such as stem cells, platelets and growth factors and targets their activity towards areas that need healing. These regenerative substances are present in various tissues and are usually obtained from the bone marrow, blood and fat. Biologic therapy is used to treat various medical and orthopaedic ailments. It enhances the body’s ability to heal injuries including broken bones, and injured muscle, tendon, and ligaments. It can slow down degeneration, reduce pain, improve movement and delay the need for surgery.

    Biologic therapy is an emerging field with a tremendous potential for growth and new applications.

  • Other treatments – Your physician may recommend the use of braces and orthoses, prescribe chondroitin sulphate, electromagnetic therapy, vitamin supplements, herbal and other dietary therapies. Therapeutic ultrasound has very less scientific proof of being effective.

Though there is little scientific evidence for various non-surgical techniques, in offering symptomatic pain relief, they were found to be effective in certain cases and are considered to possess minimal side effects. Discuss with your physician about these therapeutic options before initiating the treatment.