LAST year Leslie Magno tore the meniscus cartilage in her left knee while dancing in a Zumba class near her Roy, Washington, home. Already damaged a bit by osteoarthritis, her knee began throbbing, and at times she could barely hobble around. “My doctor told me I’d need arthroscopic surgery. But I wasn’t crazy about the idea and did research on alternatives,” Magno says.

And she found them. Magno preserved her knee by opting for a -platelet-rich plasma (PRP) and stem cell procedure, in which a surgeon injects a joint with a patient’s own healing cells. PRP has generated a lot of buzz in sports medicine circles and has been used by some major athletes: In 2008, Tiger Woods underwent a PRP procedure to speed up healing in a knee ligament; in 2009, a few weeks before playing in the Super Bowl, Pittsburgh Steeler Hines Ward, winner of last season’s Dancing with the Stars, had a PRP injection to boost his recovery from a sprained knee ligament. Magno is happy about her choice. “I started to feel improvement after about a week,” she recalls. “Now, a few months later, I’m back to around 95 percent of where I was several years ago.”

Magno was fortunate to find a procedure that gave her so much relief. Knee pain afflicts one in four women daily, according to the third National Health and Nutrition Examination Survey; one reason the number is so high is that osteoarthritis of the knee—the wearing down of its cartilage—is much more common in women than in men. Women who play sports that involve jumping and pivoting are at especially high risk: University of Michigan researchers found that these women are up to eight times as likely to injure the anterior cruciate ligament (ACL)—one of the four major ligaments in the knee—as men who play the same sports.

Why are women more susceptible to knee trouble? “Women’s hips are wider, which places greater pressure on the inside of the knee,” answers Christopher J. Centeno, MD, founder of the Centeno-Schultz Clinic in Broomfield, Colorado. Also, estrogen may make women’s joints looser, and hence less stable, which leads to more wear and tear on the knee. Walking around in high heels is another factor: They usually tilt you forward, which places pressure on the underside of the kneecap, a common site of osteoarthritis. No wonder, then, that women undergo six out of 10 total-knee-replacement operations, according to the American Academy of Orthopaedic Surgeons.

If you have stiff or achy knees, there are a lot of traditional treatments you can try, such as icing, physical therapy and NSAIDs like ibuprofen. But if those don’t work and you’d like to avoid major surgery, check out these newer, less invasive procedures, which are designed to help extend the life of your knees.

PLATELET-RICH PLASMA
USED FOR Maximizing muscle and connective-tissue healing and reducing the pain of osteoarthritis and joint damage.
WHAT IT IS A medical professional draws a small amount of blood from the patient and spins it in a centrifuge to separate out the platelets—cells packed with growth and repair factors that initiate mending. The platelets are then injected into the arthritic knee joint, strained muscle or torn tendon, ligament or cartilage.
HOW IT WORKS “PRP intensifies the body’s own efforts at repair by delivering a high concentration of platelets to the injured area,” explains David C. Wang, DO, a physiatrist (a doctor who specializes in nonsurgical physical medicine and rehabilitation) at the Kaplan Center for Integrative Medicine in McLean, Virginia. Wang says that after two to four injections, more than 90 percent of his patients experience a 50 percent or greater reduction in knee pain. Wang’s clinical experience is backed up by a research review done earlier this year at Mount Sinai Hospital in Toronto. It concluded that PRP has potential advantages including faster recovery and lower rates of injury reoccurrence. Another big advantage: The procedure can be done in about an hour at a doctor’s office under local anesthesia, so most people are back on their feet immediately with a few days of moderate soreness. In contrast, total knee replacements typically involve general anesthesia and a hospital stay of one or two days. If you decide to give PRP a try, get a referral from a doctor you trust; a physician should always perform the procedure.
STATUS New but used in a growing number of sports medicine practices and physical rehab centers; insurance may not cover the price tag of $600 to $2,500 per injection. If you need a second shot, it will be scheduled for a few months to a couple of years later, depending on factors such as the severity of the condition.

STEM CELL THERAPY
USED FOR Rebuilding cartilage that has deteriorated because of arthritis.
WHAT IT IS Doctors extract stem cells from the hip bone or a fatty area, spin them in a centrifuge and then inject the concentrated mixture back into the knee, helping it regenerate cartilage.
HOW IT WORKS Stem cells are the only parts of the body that can be transformed into other types of specialized cells, such as those found in cartilage, making them even more potent than platelets for repairing damage. “Although stem cells are always present in the body to help out, we have less as we get older, and their message isn’t always loud enough to be heard,” says Bal Rajagopalan, MD, an orthopedic surgeon in Beverly Hills. “Concentrating the stem cells is like having them shout through a megaphone, setting off a cascade of healing factors.” Like Rajagopalan, most practitioners believe that stem cell treatment might buy you three to five years of pain relief, but they expect you may ultimately end up needing knee-replacement surgery.
STATUS Very experimental. Little research has been done on humans to prove the effectiveness. However, some racehorses that received stem cells after an injury cut their reoccurrence rate in half, according to a May Equine Veterinary Journal article. The injections have yet to receive FDA approval as an arthritis therapy for humans (though your dog can get them), which means they aren’t covered by insurance. Expect to pay $2,500 to $4,000 a pop; you may need two or three. Get a referral to a board-certified orthopedic surgeon with specific stem cell–therapy training.

PARTIAL KNEE REPLACEMENT
USED FOR Reconstructing an isolated area of damage in an arthritic knee. This procedure is not an option for widespread damage.
WHAT IT IS In a partial (or unicompartmental) knee replacement, a surgeon scrapes out the worn part of the knee and rebuilds it with an implant while leaving the healthy areas intact.
HOW IT WORKS Partial knee replacements have been performed for more than a decade, but recent tinkering with the technology has brought big improvements. For example, while surgeons have long been able to swap out the two side sections of the knee joint, they’ve only lately been able to restore the third compartment, behind the kneecap. Another leap forward: the just-released Conformis implant, which uses 3-D technology to achieve a completely customized fit before surgery takes place. Currently a surgeon is limited to about half a dozen standard models that may not precisely fit a specific knee. Partial knee replacements in general require much less recovery time than total knee replacements: two weeks until a patient can walk unassisted versus six. “And if the partial procedure fails to reduce pain or enhance mobility to a satisfactory degree, there’s usually enough bone preserved so that the door stays open to having a full reconstruction,” says Gregory M. Martin, MD, medical director of the Orthopedic Institute at the JFK Medical Center in Atlantis, Florida. The life span of unicompartmental implants depends on the patient, but most will last at least eight to ten years. Among those who are obese or highly active, the failure rate for surgery is higher than normal, and they are not considered ideal candidates.
STATUS Widely available and usually covered by insurance.

TRIGGER POINT DRY NEEDLING
USED FOR Breaking up myofascial trigger points—tight, knotty areas in the leg muscles that can cause pain and disturb the muscle balance needed to make a knee operate efficiently.
WHAT IT IS After locating trigger points during a physical exam, a physician inserts a small hair-thin needle into a point, manipulates it until he feels the muscle twitch, then removes it. Orthopedic surgeons and rehab specialists often use this technique as an adjunct to other treatments to calm muscle spasms and tightness that occur with injury. (In some states, the most common practitioners of dry needling are physical therapists, but in other states, laws don’t allow PTs to use techniques that break patients’ skin.)
HOW IT WORKS When a needle is accurately inserted into a trigger point, it sets off a local therapeutic twitch response, which helps return the electrical and chemical environment within the muscle to its normal state, alleviating pain and discomfort.
Although it uses acupuncture needles, this is a Western-based technique; trigger points are not the same as acupuncture points. And according to a 2008 Acupuncture in Medicine report, dry needling appears to be more effective for treating knee pain than other needle-based therapies. But think twice before going to a physical therapist, says Wang. PTs are great with anatomy, but not all have training in inserting needles or managing complications, he says.
STATUS Promising. Many orthopedic surgeons and rehab medical practitioners offer needling, and it may be covered by insurance.

Originally published in the September 2011 issue of More.

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