Short answer
Knee arthritis (osteoarthritis) cannot be reversed, but its symptoms can usually be managed. The main U.S. guideline’s strongest recommendations are exercise, weight loss if you are overweight, tai chi and self-management programs, and even a 5% weight loss brings notable improvement in knee pain.
For injections, the picture is mixed: the guideline strongly recommends cortisone injections and strongly recommends against PRP and stem cell injections, and it does not favor hyaluronic acid. The newer options, including shockwave, laser and A2M, have early or uneven evidence.
At Charleston Pain Relief Center in North Charleston, SC, we walk through which options fit your knee, your goals and your health, and what each is likely to do.
This article is general information, not medical advice for your situation. Do not stop or change a prescribed medication on your own — talk with whoever prescribed it first.
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Where the research in this article comes from
We would rather you check our numbers than take our word for them. The basics on osteoarthritis come from the Mayo Clinic patient guide. The treatment recommendations come from the 2019 American College of Rheumatology/Arthritis Foundation guideline, summarized for family doctors in American Family Physician, and from the 2021 American Academy of Orthopaedic Surgeons knee osteoarthritis guideline. On specific treatments, the key studies are a 2021 randomized trial of PRP versus saline published in JAMA, a 75-patient randomized trial of A2M injections, a 2020 meta-analysis of shockwave therapy and a 2022 meta-analysis of laser therapy. Full citations are at the end. From here on we will refer to them as the patient guide, the guidelines, the PRP trial and the reviews.
What is knee arthritis?
Knee arthritis usually means osteoarthritis (OA). It happens when the cartilage that cushions the ends of the bones gradually wears away, and it also affects the bone and the tissues that hold the joint together. It is often called a wear-and-tear disease, but it involves the entire joint. Symptoms often develop slowly and worsen over time, and they can usually be managed even though the joint damage cannot be reversed.
Common symptoms of knee arthritis
- Pain in or around the knee
- Stiffness, often most noticeable on waking or after inactivity
- Swelling and a reduced range of motion
- Pain that makes everyday tasks harder; depression and sleep problems can follow chronic joint pain
Similar symptoms can have other causes, such as a meniscus tear or inflammatory arthritis, which is why an exam matters.
Why knee arthritis can get worse with activity
As cartilage wears and the joint changes, everyday loading becomes more painful. Repeated stress on a joint, from a job or a sport, is one of the recognized causes of OA. Body weight matters too: pain in knee OA is related to weight, and even a 5% weight loss brings notable improvement in knee and hip pain.
That can make exercise feel counterintuitive, but exercise is one of the guidelines’ strongest recommendations, and a supervised program can be paced to your knee.
What the guidelines put first
The rheumatology guideline recommends exercise, tai chi and self-management programs as first-line treatments, with weight loss for people who are overweight. The orthopaedic guideline lists topical and oral NSAIDs, supervised, unsupervised or aquatic exercise, self-management, patient education and sustained weight loss as recommended treatments, with canes and braces among its “allowed” treatments.
Medications: NSAIDs and their trade-offs
Oral NSAIDs provide temporary improvement in pain and function for knee OA, and topical NSAIDs are strongly recommended for the knee. Daily long-term use carries risks, including the heart attack and stroke warning the FDA strengthened in 2015, which we covered in Cortisone Shots and NSAIDs: What the Research Actually Says.
Injections: what to know before you agree to one
Cortisone
The rheumatology guideline strongly recommends cortisone injections into the knee, and they can calm a flare for a while. The research on repeated injections over years is less reassuring, and our article above covers it.
Hyaluronic acid
The rheumatology guideline does not favor hyaluronic acid injections for knee OA. If a provider suggests them, ask why you would be expected to respond when the guideline does not.
PRP and stem cells
The rheumatology guideline strongly recommends against PRP and stem cell injections for knee OA. The PRP trial randomized 288 adults with mild-to-moderate knee OA to three weekly PRP injections or saline and found no significant difference in knee pain or cartilage volume at 12 months. PRP preparations differ, so one formulation’s result does not automatically apply to another. If you choose PRP anyway, agree beforehand on what improvement you are looking for and by when.
A2M
Alpha-2-macroglobulin (A2M) is a plasma protein that blocks cartilage-degrading enzymes in laboratory and animal studies. The only randomized trial in people that we found followed 75 patients with knee OA for 12 weeks after A2M, PRP or cortisone injections. A2M gave modest improvement in pain and function at 6 weeks, inconsistently across measures and similar to PRP and cortisone. That is early, short-term evidence.
Other options: shockwave and laser
Shockwave therapy: the 2020 meta-analysis of randomized trials in knee OA found reduced pain at 4, 8 and 12 weeks and concluded shockwave was efficacious and safe. A larger review of 50 trials found benefit too, with big differences in results between studies, so it is reasonable to try with a clear checkpoint.
Class IV laser therapy: the 2022 meta-analysis found that high-intensity laser plus rehabilitation exercise improved knee pain, stiffness and function compared with control, though a direct comparison with low-level laser is still needed. The orthopaedic guideline lists “FDA-approved laser treatment” under allowed treatments rather than recommended ones.
What influences which treatment fits you
- How advanced the arthritis is, based on your exam and imaging
- How much pain and loss of function you have, and what you want to get back to
- Your weight and overall health, including conditions that affect whether NSAIDs or injections are safe for you
- What you have already tried and how you responded
- Your preferences, time and budget
When knee replacement enters the conversation
For advanced osteoarthritis, joint replacement is a legitimate option, and the decision usually depends on how much pain and loss of function you have and whether non-surgical care is still helping. An orthopedic consultation does not commit you to surgery, and it can help you understand your options.
How we approach knee arthritis at CPRC
- History and exam, including your goals and what you have already tried.
- A review of any imaging you have.
- A plan that starts with the best-supported steps and adds other options only where they fit your knee.
- A reassessment partway through, with a referral if it is not working.
Frequently asked questions
Can knee arthritis be reversed?
Symptoms can usually be managed, but the damage to the joint cannot be reversed. Be cautious about any treatment that promises to regrow cartilage.
What is the best treatment for knee arthritis without surgery?
The strongest recommendations are for exercise, weight loss when you are overweight, tai chi and self-management programs. Other treatments are best seen as add-ons chosen to fit your knee.
Are cortisone shots safe for knee arthritis?
The rheumatology guideline strongly recommends them, and they can give short-term relief. Repeated injections over years are a different question, which our cortisone article covers.
Do hyaluronic acid injections work?
The rheumatology guideline does not favor hyaluronic acid injections for knee OA. Ask your provider why you would be expected to benefit.
Does exercise make knee arthritis worse?
The guidelines strongly recommend exercise for knee OA. A supervised program can be paced to your knee. Stop and call your provider if you have sharp new pain or swelling.
Where can I get knee arthritis treatment near North Charleston?
Charleston Pain Relief Center is at 2294 Otranto Rd, North Charleston, SC 29406, serving North Charleston, Hanahan, Goose Creek, Ladson, Summerville, Park Circle and the wider Lowcountry. Call or text 843-604-2276.
Knee arthritis limiting your life? Let us look at your options.
Tell us what hurts and what you have already tried. Our North Charleston team will text you back with a straight answer about whether we can help — and what it would involve.
Sources
- Mayo Clinic Staff. Osteoarthritis: Symptoms and causes. Mayo Clinic. mayoclinic.org
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72(2):149–162.
- Buelt A, Narducci DM. Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation. Am Fam Physician. 2021;103(2):120–121. aafp.org
- American Academy of Orthopaedic Surgeons. Non-Arthroplasty Treatment of Osteoarthritis of the Knee: Patient Guideline Summary (Guideline Central, published September 1, 2021). guidelinecentral.com
- Bennell KL, Paterson KL, Metcalf BR, et al. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA. 2021;326(20):2021–2030. doi:10.1001/jama.2021.19415. PMC
- The Effectiveness of Alpha-2-Macroglobulin Injections for Osteoarthritis of the Knee (single-center randomized trial, 75 patients, 12-week follow-up). Icahn School of Medicine record
- The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: a systematic review and meta-analysis. Int J Surg. 2020;75:24–34. PubMed
- Ahmad MA, Hamid MSA, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy. 2022;114:85–95. PEDro record
Charleston Pain Relief Center · 2294 Otranto Rd, North Charleston, SC 29406 · 843-604-2276 · Last updated 3 October 2026. This article is educational and is not a substitute for individual medical advice. Do not start or stop any medication without speaking to your prescriber.