Which knee care choice fits your needs now?

What usually comes before a procedure?

Regular movement helps keep the leg strong, but the amount must suit the knee. A physical therapist can change an exercise if soreness, balance, or an old injury gets in the way. If it applies to you, losing weight can place less strain on the joint. A cane or brace can make walking feel safer.

There's no need to start everything together.

Medicine may ease soreness, yet heart, kidney, stomach, or bleeding trouble can change what is safe. Your doctor can review those risks. Basic care may need another try if no one checked your exercise form, adjusted the amount, or asked whether the brace felt comfortable. Strength will still matter if a procedure comes later.

How do cortisone, PRP, and surgery differ?

Cortisone may ease soreness sooner, though repeated use isn't a simple long-term answer. PRP often takes longer to judge, and its results are mixed. When the joint is badly worn and daily tasks are hard, surgery deserves a calm discussion. Asking about surgery doesn't commit you to it.

Your timing matters.

Tell the person examining you whether sleep, a coming trip, or everyday walking matters most. Ask when relief may begin and how long it often lasts. Recovery may affect driving, exercise, and help at home. A choice that doesn't fit your health or schedule probably won't serve you well.

What will PRP cost me in full?

Most people pay the clinic directly for PRP. We won't guess at an average price. Ask for a written total showing the exam, blood preparation, procedure, and later checks. You can also ask whether another visit would add a charge.

Insurance may not pay.

Call your plan before choosing a date, because your own benefits decide what is covered. Don't expect the plan to repay you unless it confirms that in advance. Compare the full price with the uncertain amount of relief and the recovery time. If the bill strains your budget, simpler care can continue while you think.

Sources

1. The 2019 ACR/Arthritis Foundation osteoarthritis guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-management programmes, tai chi, cane use, tibiofemoral bracing, topical and oral NSAIDs and intra-articular glucocorticoid injections for knee OA. Its conditional recommendations cover balance exercises, yoga, CBT, acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol. Anything offered before a course of the strongly recommended options is being offered out of order.

   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 & Rheumatology, 2020. DOI: 10.1002/art.41142.

2. The OARSI non-surgical management guideline places intra-articular corticosteroids, intra-articular hyaluronic acid and aquatic exercise at Level 1B/Level 2 for KNEE osteoarthritis depending on comorbidity status, and specifically does NOT recommend them for hip or polyarticular osteoarthritis. Oral and transdermal opioids are strongly not recommended and acetaminophen is conditionally not recommended.

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

3. In a 2-year double-blind randomized trial, intra-articular triamcinolone every 12 weeks produced significantly greater cartilage volume loss than saline (mean change in index compartment cartilage thickness -0.21 mm versus -0.10 mm; between-group difference -0.11 mm; 95% CI -0.20 to -0.03) and no significant difference in knee pain (-1.2 versus -1.9). The authors concluded the findings do not support this treatment for symptomatic knee osteoarthritis - which is the honest reason a patient may want an alternative to repeat steroid shots.

   McAlindon TE, LaValley MP, Harvey WF, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

4. A network meta-analysis of 79 randomized trials with 8761 patients compared 11 injectable options for knee osteoarthritis. At 4-6 weeks and 3 months the highest-ranked treatment for WOMAC was high-molecular-weight hyaluronic acid plus corticosteroid; at 6 months the highest-ranked treatment for WOMAC was PRP. Stromal vascular fraction ranked highest for VAS at all time points, on a much thinner evidence base.

   Anil U, Markus DH, Hurley ET, et al. — The efficacy of intra-articular injections in the treatment of knee osteoarthritis: A network meta-analysis of randomized controlled trials. The Knee, 2021. DOI: 10.1016/j.knee.2021.08.008.

5. A Bayesian network meta-analysis restricted to LARGE randomized trials (at least 100 patients per group; 57 trials, 22,795 participants, 18 intra-articular interventions) found treatment effects were larger in the 35 high-risk-of-bias trials than in the 22 low/unclear-risk trials. Excluding high-risk trials, the effects of 16 of the 18 intra-articular interventions in knee or hip OA were smaller than the minimal clinically important difference and most were consistent with placebo effects; triamcinolone had the highest probability of exceeding the MID at weeks 2-6.

   Pereira TV, Saadat P, Bobos P, et al. — Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: A systematic review and network meta-analysis. Osteoarthritis and Cartilage, 2025. DOI: 10.1016/j.joca.2024.08.014.

6. Medicare's national coverage policy covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only within an approved coverage-with-evidence-development clinical study. There is no Medicare national coverage for PRP in osteoarthritis or tendinopathy, which is why these injections are billed to the patient as cash-pay.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.

7. In the RESTORE trial - the largest placebo-controlled PRP trial in knee osteoarthritis - 288 adults aged 50+ with symptomatic Kellgren-Lawrence grade 2-3 medial knee OA received three weekly intra-articular injections of leukocyte-poor PRP from a commercial system or saline placebo. At 12 months the mean change in knee pain was -2.1 points with PRP versus -1.8 with saline (difference -0.4; 95% CI -0.9 to 0.2; P=.17) against a minimum clinically important difference of 1.8, and the change in medial tibial cartilage volume was -1.4% versus -1.2% (difference -0.2%; 95% CI -1.9% to 1.5%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings do not support use of PRP for knee OA.

   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. DOI: 10.1001/jama.2021.19415.

8. A meta-analysis of 18 Level I randomized trials (811 patients receiving PRP, 797 receiving hyaluronic acid, mean follow-up 11.1 months) found mean improvement in total WOMAC scores was significantly higher with PRP (44.7%) than with hyaluronic acid (12.6%) (P<.01), and 6 of 11 VAS-reporting studies found significantly less pain with PRP at latest follow-up.

   Belk JW, Kraeutler MJ, Houck DA, et al. — Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, 2021. DOI: 10.1177/0363546520909397.

9. The ESSKA-ICRS consensus applied the RAND/UCLA appropriateness method to 216 clinical scenarios for intra-articular PRP in knee OA. Only 84 scenarios (38.9%) were rated appropriate, 9 (4.2%) inappropriate and 123 (56.9%) uncertain. PRP was judged appropriate in patients aged 80 or under with KL grade 0-III osteoarthritis AFTER failed conservative non-injective or injective treatment; it was NOT considered appropriate as a first treatment, nor in KL grade IV (bone-on-bone) osteoarthritis, where 91.7% and 87.5% of scenarios respectively were uncertain.

   Kon E, de Girolamo L, Laver L, et al. — Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12320.