Current Events in Knee Pain Research
As we have mentioned in our Patient’s Guide to Knee Pain, there is good evidence that appropriate manual therapy and exercise prescription can help with various types of knee pain such as osteoarthritis, ligament strains and tendon problems. If the knee is severely damaged the surgery may be indicated to help stabilise the knee or repair the damage. Over the years the techniques that are employed to help people recover from knee injuries have improved greatly. In the past some knee injuries would be the end of an athlete’s career but now surgical techniques and the subsequent rehabilitation programmes tend to mean that athletes, and the average person are much more likely to make a full recovery (1). As our understanding of knee pain and how it may be alleviated progresses there will be new techniques available that may perform better than our current options, this article is intended to give you an idea of current events in the treatment of knee pain with most of the focus on osteoarthritis and cartilage injuries.
Firstly, what isn’t considered as good an idea as it used to be is arthroscopic surgery (2).
You may have heard of this as ‘getting the knee cleaned out’, this is where a surgeon will insert a small camera, called an arthroscope through a tiny incision made in the knee to see inside the joint. If they can see damage to a structure, such as a tear in the cartilage (meniscus) of the knee they may repair it via instruments contained in the arthroscope. In the past this has been regarded as a successful and relatively simple procedure to carry out (3). Recently there has been a large scale review of the research conducted (4) that concludes that there is a minimal short term (3-6 month) benefit but no long term benefit in arthroscopic surgery over other more conservative methods such as exercise. At the time the press reported that this heralded a radical shift in thinking (2) but as the research is relatively new it has not yet been examined in the context of other research so has not yet resulted in a change in general guidelines. This means that currently, arthroscopic surgery may still be recommended for people suffering from knee pain, but the evidence for its use in the future may be weakening.
When medication is used as a treatment for knee osteoarthritis traditionally most drugs have been targeted at reducing the pain in the joint (5). More recently there have been medications targeted at trying to regenerate the cartilage that has been damaged and reduce the changes seen in the bone. These have included the use of injections designed to stimulate fibroblasts (tissue growing cells) which will produce new cartilage. The initial results have shown that subjects receiving the injection lost less cartilage over 12 months than those who received a placebo (6). In a similar way other research has shown that by injecting the knee with substances that contain high concentrations of chemicals known as ‘growth factors’ they can slow cartilage loss, reduce pain and improve function when measured after 6 months (7). Development of these approaches may lead to medication that is able to stop the progression of knee arthritis and let people maintain mobility and function for much longer.
Another approach that is being researched at present is ‘tissue engineering’.
This is where a combination of an implant, called a scaffold, and cartilage producing cells (chondrocytes) that have been removed from the cartilage of the person who will have the therapy. The scaffold itself is designed so the cells will begin to proliferate and restore the cartilage and subsequently the function of the knee (5). This technique has been used extensively in people who have had knee cartilage injuries (8), however the long term outcomes for osteoarthritis of the knee, in terms of pain, function and patient satisfaction have so far been varied meaning it may be some time before it can be widely used in this group (5).
Stem cells therapy can also be used to help regrow the tissue lost in people who have osteoarthritis of the knee.
Stem cells are ‘undifferentiated’ cells which given the right conditions will become chondrocytes which are capable of producing new cartilage. One advantage of using stem cells over chondrocytes is that the stem cells are easily taken from the joint fluid of the knee as opposed to the already damaged cartilage of the knee. The stem cells are then evaluated in the lab to see if they will be capable of becoming chondrocytes and therefore cartilage, they are then injected back into the knee. Several studies have shown this to be a relatively simple and effective method of addressing the pain and cartilage loss in knee osteoarthritis (5) , however there is not enough reliable data from the combined studies to make it a recommended treatment (9). Also at present the lack of a reliable method in applying this technique and the cost of such a treatment may make it unlikely as a treatment option in the near future (10).
As you can see there are several new avenues of research that are leading to treatments designed not only to help people cope with knee pain but ways to stop or even reverse the structural changes that we see in our knees as we get older. However, as they are not readily available at this time the best thing is to follow the best current evidence we have to cope with knee pain from osteoarthritis.
If you think you may have some knee problems he best thing to do is to get an assessment and a diagnosis from a health professional such as your doctor or an osteopath. Most of the time the diagnosis can be made in the clinic room but if the symptoms are severe or debilitating then you may require an x-ray.
If you have been diagnosed with osteoarthritis of the knee there are several ways that you can help relieve the pain and slow the progression of the disease. It is best to take action early and to maintain good habits (11).
The most important action you can take is to start exercising the knee as this has been shown to be very beneficial in the short and medium term (12). The most important aspects to develop are;
- Maintain knee range of movement – using stretching, exercises, or joint mobilisation, either at home or by your osteopath
- Maintain or maximise strength – using strengthening exercises to strengthen the muscles around the knee and hip
- Maintain or improve aerobic capacity – e.g walking, exercise bike, swimming, aqua-aerobics.
- Reduce weight or maintain a healthy weight – health diet and exercise to reduce the load on weight bearing joints.
Treatments such as ultrasound (13), and manual therapies such as osteopathy (14) are also beneficial to osteoarthritis in the knee.
Do you struggle with knee pain?
At Align Body Clinic we have helped hundreds of people who have suffered with knee pain get rid of their pain and return to normal activity. We are experts in the diagnosis and treatment planning for people who have been suffering from pain for anything from a few days up to several decades. We primarily use osteopathy, medical acupuncture and carefully prescribed exercises to help people, although we also refer people on to other health providers if we think that they will be more suitable to provide care for that person.
Do you want to know what is causing your pain and if we can help? Why not take advantage of our new patient assessment introductory offer to get you started towards a tailor made recovery plan for only £19.
Are you in a lot of pain and want to get better as soon as possible? If so then why not book in for a new patient consultation, with treatment on the day, for £60.
We are also there to help you from home. Take a look at our suite of exercise resources and advice sheets which you can easily download and use from home.
1 – Joshua D. Harris, J. D. et al (2013). Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Sports Health. 2013 Nov; 5(6): 562–568
3 – Hawker, G. et al (2008). Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am, 90:2337-45.
4 – Thorlund, J. B., et al (2015). Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms BMJ ; 350, p2747.
5 – Wei Zhang et al (2016). Current research on pharmacologic and regenerative therapies for osteoarthritis. Bone Research 4, Article number: 15040.
6 – Lohmander L., S. et al (2014). Intraarticular sprifermin (recombinant human fibroblast growth factor 18) in knee osteoarthritis: a randomized, double-blind, placebo-controlled trial. Arthritis Rheumatol ; 66: 1820–1831.
7 – Sánchez, M., et al (2008). Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee oa: a retrospective cohort study. Clin Exp Rheumatol ; 26: 910–913.
8 – Daher, R. J., et al (2009). New methods to diagnose and treat cartilage degeneration. Nat Rev Rheumatol ; 5: 599–607.
9 – Singh J., A. (2012) . Stem cells and other innovative intra-articular therapies for osteoarthritis: what does the future hold? BMC Med; 10:44
10 – Uth, K., & Trifonov, D. (2014). Stem cell application for osteoarthritis in the knee joint: A mini-review. World Journal of Stem Cells, 6(5), 629–636.
11 – Magee, D. Zachazewski, J. and Quillen, W., 2009. Pathology and Intervention in Musculoskeletal Rehabilitation, Missouri, Elselvier.
12 – Fransen et al (2015). Exercise for osteoarthritis of the knee. Available at, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004376.pub3/abstract.