Beyond the Cortisone Shot
A New Era of Options for Knee Pain
Knee pain has a frustrating way of changing how you live.
Maybe it starts as stiffness when you get out of bed. Then stairs become uncomfortable. Hiking gets harder. Your knee begins swelling after activity. Or an MRI comes back with words like osteoarthritis, cartilage loss, meniscus degeneration, or tendinopathy.
For decades, the conventional pathway for chronic knee problems has often looked something like this:
Physical therapy
Anti-inflammatory medications
Steroid injections
Eventually, surgery or joint replacement.
Those treatments absolutely have a place. But they are no longer the only conversation worth having.
A rapidly evolving field of orthopedics and regenerative medicine is exploring ways to reduce inflammation, improve the environment inside the joint, support injured soft tissue and potentially delay more invasive procedures.
Over the next several weeks, we're going to take a deeper look at these therapies individually. For now, consider this your introduction to the growing world of non-surgical and regenerative knee care.
First: What Is Actually Causing the Pain?
"Knee pain" isn't one diagnosis.
Pain may come from osteoarthritis (OA), deteriorating cartilage, meniscus injuries, ligament injuries, tendon problems, inflammation of the synovial lining, altered kneecap mechanics, muscle weakness, or several of these simultaneously.
That's important because the best treatment for an arthritic joint may be very different from the best treatment for an injured tendon.
Before choosing a regenerative treatment, understanding the structure involved and the degree of degeneration matters. Therefore, as always, we encourage consulting with multiple providers to determine the best option for your specific injury.
1. Platelet-Rich Plasma (PRP)
PRP has become one of the most established options within the orthobiologic space.
A patient's own blood is drawn and processed to concentrate platelets and other components involved in the body's healing response. The resulting platelet-rich plasma is then injected into the targeted joint or injured tissue.
PRP is being used for conditions including knee osteoarthritis and certain tendon and soft-tissue injuries.
For knee OA specifically, the American Academy of Orthopaedic Surgeons states that PRP may reduce pain and improve function, although its recommendation remains limited because PRP preparation methods and study results vary considerably.
One important distinction is not all PRP is the same. Platelet concentration, leukocyte content, preparation technique, injection location and the underlying injury can all matter. Additionally, the overall health of the patient can also influence how optimal the fluid is.
2. "Stem Cell" and Cell-Based Therapies
Few areas of regenerative medicine generate more excitement than stem cells.
Bone-marrow-derived preparations and other cellular products are being investigated for their potential effects on inflammation, tissue signaling and joint health.
But this is also an area where marketing has moved considerably faster than regulatory approval.
In the United States, the FDA specifically notes that regenerative medicine products marketed as stem cells, Wharton's jelly, amniotic products and similar products are not FDA-approved to treat orthopedic conditions such as knee osteoarthritis or knee pain.
That doesn't mean research in cellular medicine isn't exciting. It means patients need to understand exactly what product is being offered, where it came from, what evidence supports it and how it is regulated.
We'll dedicate an entire article to separating legitimate orthobiologic research from regenerative-medicine marketing on our substack in the future.
3. Red & Near-Infrared Light Therapy
One of the least invasive options may also be one of the easiest to incorporate alongside other treatments.
Photobiomodulation, commonly called red-light or near-infrared light therapy, uses specific wavelengths of light to influence cellular processes.
Research is investigating its ability to reduce pain and inflammation and improve function in people with knee osteoarthritis.
A 2024 systematic review and meta-analysis of randomized placebo-controlled trials found encouraging results, although study quality and treatment protocols vary and more research is needed.
Unlike an injection, photobiomodulation can also be used repeatedly, which makes it particularly interesting as an adjunct to rehabilitation and other therapies rather than necessarily a replacement for them.
And here's where details matter: wavelength, power, treatment time and total dose can determine whether you're getting meaningful photobiomodulation or simply wearing a device that glows red. It is important to know and understand the quality of light you are using.
4. Arthrosamid and Injectable Hydrogels
One of the newer technologies gaining attention internationally is Arthrosamid, an injectable polyacrylamide hydrogel used for knee osteoarthritis.
This isn't PRP or a stem-cell treatment.
The hydrogel is injected into the knee joint and is designed to integrate with the synovial tissue and modify the joint environment. Emerging clinical research has reported improvements in pain and function, including follow-up extending several years in some patients.
It's an intriguing development, but one that deserves some perspective. A 2026 review concluded that results are promising while also emphasizing limitations in study quality and the need for better controlled trials before routine use can be firmly recommended.
5. Hyaluronic Acid
Hyaluronic acid injections, sometimes called "gel injections", have been around for a long time.
Hyaluronic acid is naturally present within joint fluid and contributes to lubrication and shock absorption. Injections attempt to supplement the joint environment and reduce symptoms.
Results vary substantially from person to person, and recommendations surrounding its routine use have been mixed.
Still, HA remains an important part of the conversation because newer injectable hydrogels are frequently compared with it.
6. Shockwave Therapy
For certain knee problems, the joint itself isn't necessarily the primary target.
Extracorporeal shockwave therapy uses acoustic energy delivered into tissue and has become increasingly interesting for stubborn tendon and soft-tissue injuries.
That makes it potentially relevant for problems such as patellar tendinopathy and other chronic tendon disorders around the knee.
It's another reminder that treating "knee pain" doesn't always mean injecting the knee joint.
7. Rehabilitation Is Still Regenerative Medicine
This may be the least exciting answer, but potentially one of the most important.
Muscle is medicine for an arthritic joint.
Progressive strengthening of the quadriceps, hamstrings, glutes and calves can change how forces move through the knee. Improving hip stability, gait mechanics, mobility and proprioception can further alter the load placed on painful structures.
Exercise remains a core evidence-based treatment for knee osteoarthritis.
The future of knee care probably isn't PRP versus physical therapy.
It's much more likely to be intelligently combining therapies.
Imagine an approach involving appropriate imaging and diagnosis, progressive strength training, metabolic and nutritional optimization, photobiomodulation and, when appropriate, a targeted orthobiologic or injectable treatment.
That is a very different philosophy than simply waiting until the knee becomes "bad enough" to replace it.
What About Cartilage Regeneration?
This is where we need to be careful with language.
Reducing pain is not necessarily the same thing as rebuilding cartilage.
Improving joint function is not necessarily evidence that cartilage has regrown.
And a treatment stimulating biological activity doesn't automatically mean it can restore a severely deteriorated joint.
There is tremendous research interest in cartilage restoration, scaffolds, biologics, cell therapies and tissue engineering.
The Bigger Question: Can We Intervene Earlier?
Perhaps the most interesting shift happening in orthopedic medicine isn't one particular injection or device. It's the idea that we don't necessarily have to wait for a joint to completely deteriorate before becoming proactive.
If we can identify mechanical dysfunction, muscle weakness, tendon injury, inflammation or early osteoarthritis sooner, there may be opportunities to improve the environment surrounding that joint long before replacement becomes the only meaningful option.
Because when it comes to keeping your knees working for the next 20, 30 or 40 years, the conversation should be bigger than simply asking:
"What can I do now to preserve the knee I have?"
And working with a team of providers who wants to optimize your joint to operate at its best.
References
American Academy of Orthopaedic Surgeons (AAOS). Management of Osteoarthritis of the Knee (Non-Arthroplasty), Third Edition: Clinical Practice Guideline.
U.S. Food & Drug Administration (FDA). Important Patient and Consumer Information About Regenerative Medicine Therapies.
Stausholm MB, et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomized placebo-controlled trials. BMJ Open. 2019;9.
Henrotin Y, et al. Polyacrylamide hydrogel injection for knee osteoarthritis.
American College of Rheumatology/Arthritis Foundation. Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research.
This article is for educational purposes and is not intended to diagnose or treat any medical condition. Treatment decisions should be made with an appropriately licensed healthcare professional after evaluation of the individual injury or condition.