What Your Doctor May Not Tell You About Knee Treatment Options

If you have been diagnosed with a knee condition, whether osteoarthritis, a meniscal tear, or chronic tendinopathy, your doctor has likely discussed the standard treatment pathway: physiotherapy, anti-inflammatory medication, corticosteroid injections, and ultimately knee replacement surgery if conservative measures fail. What your doctor may not have discussed, however, is the expanding field of regenerative medicine and how it may fit into your treatment plan. This guide explores the full spectrum of knee treatment options, including those that may not be widely available or routinely discussed in your home country.

The Standard Treatment Pathway for Knee Conditions

The conventional approach to knee pain management follows a well-established hierarchy that most orthopaedic surgeons and general practitioners will recommend:

Lifestyle modification and physiotherapy. Weight management, activity modification, and targeted strengthening exercises form the foundation of knee pain management. For many patients with mild symptoms, this approach provides adequate relief and should always be the starting point. Evidence consistently shows that exercise-based rehabilitation improves pain and function in knee osteoarthritis.

Oral medication. Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are commonly prescribed for pain management. These provide symptomatic relief but do not address the underlying cause of degeneration. Long-term NSAID use carries risks including gastrointestinal complications and cardiovascular effects that should be weighed against the benefits.

Corticosteroid injections. Intra-articular corticosteroid injections can provide effective short-term pain relief by reducing inflammation within the knee joint. However, repeated injections have been associated with accelerated cartilage degradation in some studies, which means this approach has limitations as a long-term strategy. Current guidelines generally recommend limiting the frequency and number of corticosteroid injections.

Hyaluronic acid injections. Also known as viscosupplementation, these injections aim to improve joint lubrication. Clinical evidence is mixed, with some patients reporting symptomatic benefit lasting several months and others noticing little difference. They are generally considered safe but may not be covered by insurance in all jurisdictions.

Arthroscopic surgery. Procedures such as meniscal trimming or debridement are sometimes recommended, though evidence for their effectiveness in degenerative knee conditions has been questioned in recent years. Several large randomised trials, including the landmark FIDELITY trial, have found that arthroscopic surgery for degenerative knee conditions offers no significant benefit over sham surgery or physiotherapy alone. Despite this evidence, arthroscopic procedures remain commonly performed.

Total or partial knee replacement. For end-stage knee osteoarthritis, joint replacement surgery remains the definitive treatment. It is highly effective for pain relief and functional restoration, but involves significant recovery time (typically three to six months for full recovery), the risks associated with major surgery, and an implant with a finite lifespan of typically 15 to 25 years. For younger patients, this finite lifespan means the possibility of revision surgery later in life.

Where Regenerative Medicine Fits In

Regenerative therapies occupy a space between conservative management and surgery. They are designed for patients who have not achieved adequate relief from physiotherapy and medication but who may not yet require, or wish to avoid, surgical intervention. This treatment gap represents a significant unmet need that regenerative medicine can address.

The key regenerative options for knee conditions include:

Platelet-Rich Plasma (PRP)

PRP therapy involves concentrating growth factors from your own blood and injecting them directly into the knee joint under image guidance. Multiple systematic reviews and meta-analyses have demonstrated that PRP provides superior pain relief compared to hyaluronic acid and saline injections for knee osteoarthritis, with effects lasting six to twelve months in many patients.

PRP is widely available and represents a lower-risk entry point into regenerative treatment. However, the quality of PRP preparation varies significantly between clinics, which can affect outcomes. Not all PRP is created equal, the concentration method, the platelet count achieved, and whether leukocytes are included can all influence therapeutic efficacy.

Stem Cell Therapy

Mesenchymal stem cell therapy involves introducing cells, either from your own tissue (autologous) or from donor sources (allogeneic), into the knee joint. These cells secrete growth factors and anti-inflammatory molecules that modulate the joint environment and support tissue repair.

Clinical evidence for stem cell therapy in knee osteoarthritis continues to strengthen, with several randomised controlled trials showing significant improvements in pain and function compared to control treatments. Some studies have also reported evidence of cartilage regeneration on follow-up MRI, though this finding is not universal. The strongest evidence exists for patients with mild to moderate osteoarthritis, where regenerative potential is greatest.

Exosome Therapy

Exosomes are tiny vesicles secreted by cells that carry biological signals capable of modulating inflammation and promoting repair. Exosome therapy is an emerging regenerative approach that offers some of the benefits of cell-based therapy without introducing whole cells. Early clinical evidence is encouraging, though the field is still developing. The acellular nature of exosome therapy means it generally involves even less downtime than cell-based approaches.

Why Your Doctor May Not Mention Regenerative Options

There are several legitimate reasons why your primary care physician or orthopaedic surgeon may not discuss regenerative therapies:

Regulatory restrictions. In many countries, including Australia, Singapore, and parts of the Middle East, certain regenerative therapies are restricted under national medical regulations. Physicians understandably focus on treatments that are available within their regulatory framework. A doctor cannot recommend a treatment they are not permitted to provide.

Training and familiarity. Regenerative medicine is a specialised field, and many general practitioners and conventional orthopaedic surgeons have limited exposure to it during their training. A physician who is unfamiliar with a treatment is unlikely to recommend it, which is actually a responsible approach; it is better to say “I don’t know enough about this to comment” than to provide uninformed guidance.

Evidence standards. Some physicians adhere strictly to treatments supported by large-scale, long-term randomised controlled trials and may view the regenerative medicine evidence base as insufficiently mature. While this is a valid perspective, it is worth noting that the evidence for many conventional treatments, including arthroscopic surgery for degenerative knees, has also been questioned by the same standards.

Financial and institutional factors. In some healthcare systems, surgical intervention generates significantly more revenue than non-surgical alternatives. Whilst we do not suggest that individual physicians are motivated by financial considerations, institutional incentives and referral patterns can influence which treatments are prominently offered within a given system.

Time constraints. In many healthcare settings, consultation times are limited. Discussing the full range of treatment options, including emerging therapies, may simply not be feasible within a standard appointment.

How to Have the Conversation with Your Doctor

If you are interested in exploring regenerative treatment options, consider the following approach when discussing this with your doctor:

Ask specifically about non-surgical alternatives, including regenerative therapies such as PRP and stem cell treatment. Request a referral to a physician who specialises in regenerative or musculoskeletal medicine for a second opinion. Ask your doctor to explain the evidence for and against each treatment option they recommend, including the limitations of their recommended approach. Bring information about regenerative therapies you have researched and ask for your doctor’s professional perspective. Be open to the possibility that your doctor may have valid reasons for not recommending certain treatments in your case.

A good doctor will welcome your questions and provide an honest, balanced assessment, even if regenerative medicine is outside their area of expertise.

Evaluating Regenerative Treatment for Your Knee

If you decide to explore regenerative options, ensure that you:

Obtain a clear diagnosis through appropriate imaging. MRI is generally more informative than X-ray for assessing cartilage, meniscal, and soft tissue structures within the knee. Understand the severity of your condition and where it falls on the spectrum from mild to end-stage. Consult with a physician who specialises in regenerative medicine and can provide an evidence-based recommendation tailored to your specific pathology. Set realistic expectations, regenerative treatment can provide meaningful improvement but does not guarantee a return to a pristine knee joint. Consider the timing, the earlier you explore regenerative options in the degenerative process, the greater the potential for meaningful benefit.

The Importance of Informed Decision-Making

You deserve to know about all reasonable treatment options before making decisions about your knee health. The conventional treatment pathway is well-established and effective for many patients, but it is not the only path available. Regenerative medicine offers an evidence-based, minimally invasive alternative that may be appropriate for patients who fall between conservative management and surgery.

The most important thing you can do is become an informed, proactive participant in your own healthcare. Ask questions, seek specialist opinions, and make decisions based on a complete understanding of your options, not simply the options presented to you by default.