Treating, Preventing, & Curing Knee Arthritis: What Can Be Done Today & Tomorrow?

Arthritis is a disease that affects not just the joint involved but also the entire body and mind. Here are some selected insights into the types of arthritis we see in the knee joints of athletes of all ages.

The bones of the knee joint are covered by a smooth, slick surface called articular cartilage, padded by meniscus cartilages and surrounded by a synovium (capsule) that keeps the lubricating fluid in and filters the surrounding blood. 

Damage to any of these structures changes the mechanics of the joint, leading to destruction of each of the tissues. The damage can arise from preprogrammed genetic causes, infection, and the excess blood of hemophilia, as well as from immune-related diseases such as psoriasis or rheumatoid inflammation, among others. The most common causes we see are sports-related injuries and the more insidious osteoarthritis of aging.

The initial workup often includes a physical exam, a fitness assessment with a rehabilitation specialist, and a high-quality X-ray and MRI. 

Treating arthritis means relieving the symptoms, thus permitting the person to return to activities without pain and start, hopefully, on a path leading to a cure. In the knee joint today, the initial treatments are focused on optimizing the weight of the patient for their body and joint size; designing rehabilitation and fitness programs that build the muscles and improve the gait; and injections of lubricating substances. These may include hyaluronic acid (HA), augmented by anabolic stimulants such as platelet-rich plasma (PRP) and progenitor (stem) cells. 

Though we don’t yet have data on whether or not regularly lubricating and stimulating injured knees will prevent the progression of arthritis, our intuition is that it will—and the science around these injections is rapidly improving. The old advice to “take a nonsteroidal anti-inflammatory and come back to me for your knee replacement when the pain is too much to bear” is far in the rearview mirror. 

In fact, 80% of patients who are told they need a total knee replacement don’t need one. They most often have severe wear in one part of the knee joint and could either have (a) a course of non-operative care as described above; (b) a biologic joint replacement (meniscus transplant, articular cartilage regeneration, and ligament reconstruction); or (c) a partial knee replacement. Saving the total joint for a future date (which may never come) is wise for most people.

Torn tissues like the meniscus, if repaired or replaced effectively, restore knee joint mechanics and return people to sports. Repair and regeneration of the articular cartilage with the paste graft technique, MACI (which uses a patient's own cartilage cells ), or donor allografts reconstruct the damaged surfaces and are proven to relieve pain. When lesions are found early and successfully treated, arthritis may be prevented from forming. When arthritis is being treated by tissue replacement, regular injections of lubrication and stimulation may augment the healing process and reduce the failure rates.

Curing arthritis will mean restoring the articular cartilage surfaces, remodeling the underlying bone, and optimizing the synovial cellular environment. Each of these target areas is undergoing a revolution in scientific exploration and development. 

While we can, to some extent, do all three of these things today, we expect the techniques will improve as our understanding of how to work with the body’s large reservoir of natural stem cells, which direct this healing process, evolves. We are actively involved in this research—because while cancer may kill many people, arthritis ruins their lives