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Non-Surgical Knee Treatments

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons and muscle that make joint movement possible but, at the same time, render it more susceptible to various kinds of injury. Knee problems may arise if any of these structures get injured by overuse or during sports activity. Injuries to the knee can be caused by degenerative disease such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair mobility as well as the quality of life of patients. All of these conditions require appropriate treatment (surgical or non-surgical) to restore normal activity. 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 patients. They can be used as a treatment option to treat certain conditions and to decrease pain as well as promoting function and quality of life after a surgical treatment.

Non- pharmacological intervention

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

  • Weight reduction and physical exercise – The lifestyle changes resulting in weight loss in an obese individual and doing appropriate physical exercise can play an important role in prevention and management of knee conditions.

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

Some very energetic exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore rigorous exercises is not ideal for all patients and must be individualized for every patient and carried out under the supervision of a trained professional.

  • Transcutaneous electrical nerve stimulation – The transcutaneous electrical nerve stimulation (TENS) method involves the use of low-voltage electric impulses to relieve pain. It is believed to provide pain relief by inhibiting the conduction of pain impulses reaching receptors in the brain and spinal cord. It should not be used by patients who have a pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.
  • Thermotherapy– Thermotherapy involves application of hot or cold packs on the affected area. There is evidence to support the use of cold therapy in providing symptomatic relief. It is contraindicated in individuals with thermoregulatory impairments. Individuals who have 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 by some that insertion of needles at specific points restore 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 may offer pain relief, however it may have risks if one is treated by untrained professionals.
  • Patellar taping – Patellar taping can be used as a short term treatment. The principle behind the treatment is stabilization of the 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 touch.

Pharmacological interventions

Pharmacological interventions include management of pain using medicinal preparations such as oral medication or injections.

  • Paracetamol
  • Non-steroidal anti-inflammatory drugs – These are known as NSAIDs and are effective in reducing pain and inflammation within the knee. Side effects and restrictions apply.
  • Weak and strong opioids – Opioids are prescribed when the use of more simple medication does not offer symptomatic pain relief, if other treatments have intolerable side effects or in whom surgery is delayed or contraindicated and pain control is still a problem. Though they offer pain relief, they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise they may cause withdrawal effects.
  • Disease modifying anti-rheumatic drugs and biological agents – Disease modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of inflammatory disease and may also offer symptomatic relief. Biological agents may be based on antibodies against the disease causing agents manufactured using genetic engineering technology. These agents are only recommended in individuals with severe inflammatory conditions and would be prescribed by a Rheumatologist.
  • Other treatments – Your physician may recommend the use of braces and orthoses, walking aids, prescribe glucosamine and chondroitin sulphate, electromagnetic therapy, vitamin supplements, herbal and other dietary therapies.

Although there is a paucity of scientific evidence for some non-surgical techniques, they have a role in offering symptomatic relief, and may be effective in certain cases. Discuss these therapeutic options with your General Practitioner before initiating any treatment.

RCS Logo British Orthopaedic AssociationRoyal College of Surgeons of EdinburghOTSISBritish Association for knee surgeryISOAMDU LogoOTSIS