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Older man expressing knee pain while on a walk outside in Maryland

If you experience daily pain from the osteoarthritis in your knees, you may be contemplating knee replacement surgery. Maybe you’ve already tried joint injections, but they didn’t work well for you, so now you’re exploring other treatment options. Learn more about the cartilage between your joints, the connection to osteoarthritis, and how joint injections can provide pain relief if you have lost cartilage in your knees.

What is Cartilage?

Cartilage is smooth, rubber-like tissue found throughout the body. Joint cartilage, also called hyaline or articular cartilage, is designed to cushion your bones, help them glide smoothly, and prevent them from rubbing together.

Your body also produces a thick, gel-like substance called synovial fluid that works in tandem with cartilage. This fluid contains hyaluronic acid, which increases its viscosity and lubricating properties. Synovial fluid seeps into the microcavities of your cartilage, enhancing the ability to prevent painful friction and grinding in your joints.

What Does Cartilage Have to Do with Osteoarthritis?

When cartilage and synovial fluid break down, you experience pain, swelling, and reduced range of motion in your joints. Factors such as age, genetics, weight, disease, injury, and overuse contribute to the breakdown of cartilage and the eventual onset of osteoarthritis.

Can the Body Repair Lost Cartilage?

Cartilage doesn’t contain nerves or blood vessels, so your body can’t heal it the way it can heal a cut or a broken bone. This means medical intervention is the only way to replace, regenerate, or stimulate the regrowth of lost or damaged cartilage. The surgical options available for accomplishing this include:

  • Microfracturing: Surgeons pierce holes in the bone below the degraded cartilage, forming a blood clot. This promotes healing and produces fibrocartilage, a different type of cartilage than what is usually found in the knee. Fibrocartilage is less durable than joint cartilage, but it’s better than bone-on-bone contact.
  • Autologous Chondrite Implantation (ACI): Also known as scaffolding, ACI first involves removing a small piece of cartilage from your joint. Then, surgeons “scaffold” or layer the cartilage-producing cells and incubate them outside of the body. Finally, the cells are implanted back into the damaged joint. Physical therapy helps these cells stimulate new cartilage growth.
  • Arthroscopy: Surgeons insert surgical instruments into three or four small incisions around the knee joint. They use these tools to grind and drill the bone, creating small areas of intentional injury that stimulate the body’s natural healing process.
  • Osteochondral Autograft Transplantation Surgery (OATS): This surgery replaces lost cartilage and the bone it attaches to by transplanting bone and attached cartilage from another part of your body. A donor graft can also be used in some cases.

It’s important to note that these treatments are only recommended for patients with fundamentally healthy joints and only a small area of damaged cartilage in need of repair. There is currently no cure for osteoarthritis and no FDA-approved injection, treatment, or surgery to replace highly degraded cartilage in arthritis patients’ joints.

Knee Injections Can Treat Osteoarthritis Pain

Most doctors recommend knee injections before suggesting any of the surgical procedures outlined above or full-blown knee replacement surgery. Several different types of injections are available, all of which are designed to alleviate knee pain and inflammation caused by cartilage loss. Here’s a look at the most common knee injections for treating osteoarthritis and why, based on our medical training and experience, we believe gel knee injections are the most effective option.

Gel Knee Injections

As previously mentioned, when cartilage deteriorates, so does synovial fluid. Gel knee injections, also known as viscosupplementation, aim to renew the synovial fluid around your joints. The injections contain hyaluronic acid, the naturally occurring substance found in synovial fluid, so the treatment is also sometimes called hyaluronic acid injections.

Viscosupplementation creates a gel-like cushion in your knee, alleviating the pain and grinding from bone-on-bone contact. Treatment is also shown to reduce inflammation and protect joint cartilage from further wear and tear, slowing the progression of osteoarthritis in the process.

Gel knee therapy has been in use for 20 years, offering high success rates and low instances of side effects. You are most likely to benefit from viscosupplementation if you have mild to moderate osteoarthritis. To maintain consistent pain relief, you may need to receive a series of injections administered over several weeks. Each office visit is quick and easy, with minimal discomfort and noticeable, lasting results.

Cortisone Injections

Cortisone or corticosteroid injections were once the treatment of choice for knee arthritis, but much debate surrounds them these days. Because of safety concerns, potential side effects that could worsen your condition, and limited evidence for their effectiveness over gel knee injections, many doctors recommend cortisone injections sparingly, if at all. The debate rages on, so ask your doctor to assess your situation closely before agreeing to receive cortisone injections.

Cortisone Injections with Electrical Dry Needling

If your doctor recommends corticosteroids, you may experience enhanced results if you add electric stimulation in the form of electrical dry needling to your treatment plan. By electrically stimulating myofascial trigger points, you can expect more effective pain relief and increased mobility than receiving cortisone injections alone.

Platelet-Rich Plasma (PRP) Therapy

PRP treatment begins with having your blood drawn. Then, a technician places your blood in a centrifuge to concentrate your blood platelets. The separated platelet-rich plasma is then injected directly into and around your knee joint. PRP contains valuable growth and healing factors, but this therapy is not a single-shot miracle cure. It requires three to six visits spaced every four to six weeks. It also may not work for you if your osteoarthritis is too advanced.


The exact mechanisms behind hypertonic dextrose prolotherapy are not well understood. Still, the injections are thought to induce controlled inflammation to mimic an injury response. This tricks the cells into thinking a new wound has occurred, calling for the release of growth and repair factors to initiate the healing process. Simply put, prolotherapy rebuilds damaged soft tissue.

This relatively simple and inexpensive therapy offers a high safety profile and significant improvement in pain, function, and range of motion for most patients. The results are comparable to viscosupplementation, but the limited quality and quantity of clinical trials make some doctors hesitate to recommend prolotherapy over well-established gel knee injections.

Stem Cell Therapy

Considered equally promising and controversial, stem cell therapy is available in various forms. The least controversial therapies take stem cells from the patient’s own body. Options include bone marrow-derived stem cells and fat-derived stem cells.

Be aware that stem cell therapy is most effective when administered as part of a comprehensive treatment plan. You should also know that stem cell therapy can patch damaged cartilage, but it can’t make a highly degenerated knee “as good as new.”

Some people benefit from a one-time shot, but most of the time, a single injection isn’t comprehensive enough to reverse years of knee joint damage. In the end, gel knee injections may be the superior choice, offering similar results with much less invasive treatment methods.

Amniotic, Cord Blood & Placenta Tissue Injections

There is a great deal of misinformation surrounding “stem cell therapy” sourced from amniotic fluid, umbilical cords, and placentas. The remnant growth factors contained within these afterbirth materials are considered the healing elements. Any stem cells present are killed when the afterbirth materials are processed.

Do you feel unsure about amniotic, cord blood, and placenta tissue injections? Then don’t pursue them. The heightened controversy, cost, and lack of increased effectiveness compared to gel knee injections make these treatments an inferior choice.

Botox Knee Injections

Botox is best known for its ability to paralyze muscles, thus treating everything from wrinkles to muscle spasms to excessive underarm sweating. However, in knee pain, Botox works primarily as a nerve blocker. In this way, it suppresses your pain but does nothing to repair damaged cartilage.

Ozone Therapy

A lot of talk surrounds the possibility of using ozone (O3) as a treatment for knee osteoarthritis. It has proven to be better than corticosteroids and roughly equal to prolotherapy and gel knee injections in the short term. However, the efficacy of ozone therapy decreases after three to six months and offers no notable benefits after the six-month mark.

Seek Knee Pain Relief at Effective Integrative Healthcare

Clearly, with so many surgical treatment alternatives to explore, knee replacement surgery should be a last resort. Begin by trying gel knee injections at Effective Integrative Healthcare. We have over a decade of experience treating patients with a broad range of conditions, including osteoarthritis of the knee. Our treatments aim to relieve your pain and address your symptoms at the core. With a custom treatment plan from our experienced team, you can expect long-term comfort, restored mobility, and improved quality of life.

If you’re interested in trying gel knee injections or other minimally invasive treatments for your knee arthritis, please request a free consultation at our Crofton or Millersville, MD office today.