What do people ask about a sore knee?

Sources

1. In a randomized trial of 100 patients with moderate-to-severe knee OA eligible for total knee replacement, TKR followed by 12 weeks of non-surgical care improved the KOOS4 score more than the same non-surgical programme alone (32.5 vs 16.0 points; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) — but produced four times as many serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group had chosen surgery within 12 months, meaning roughly three-quarters had not.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

2. A cross-sectional study of 1,703 primary total knee arthroplasties in Ontario found approximately one in five patients (19%) were NOT satisfied with the outcome. Satisfaction with pain relief ranged 72-86% and with function 70-84% by activity. The strongest predictor of dissatisfaction was expectations not being met (10.7x greater risk).

   Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. — Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clinical Orthopaedics and Related Research, 2010. DOI: 10.1007/s11999-009-1119-9.

3. A population-based cohort of 54,276 total knee replacements followed up to 20 years found a 10-year implant survival of 96.1% and 20-year survival of 89.7%. Lifetime risk of revision surgery was about 5% for patients operated after age 70, but rose sharply for younger patients — the central argument for not operating earlier than necessary.

   Bayliss LE, Culliford D, Monk AP, et al. — The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.. The Lancet, 2017. DOI: 10.1016/S0140-6736(17)30059-4.

4. The METEOR trial randomized 351 symptomatic patients aged 45+ with a meniscal tear AND mild-to-moderate knee OA to arthroscopic partial meniscectomy plus physical therapy or to standardized physical therapy alone. At 6 months the WOMAC physical-function improvement was 20.9 vs 18.5 points — a non-significant 2.4-point difference (95% CI -1.8 to 6.5) — and results at 12 months were similar. 30% of the physical-therapy group crossed over to surgery, meaning 70% did not.

   Katz JN, Brophy RH, Chaisson CE, et al. — Surgery versus physical therapy for a meniscal tear and osteoarthritis.. New England Journal of Medicine, 2013. DOI: 10.1056/NEJMoa1301408.

5. A prospective longitudinal study of 64 patients with acute medial meniscus posterior root tear managed non-operatively found 76.6% continued non-operative care and only 23.4% converted to surgery (median 6 months). Pain fell from 7.6 to 1.3 on an 11-point scale within 6 months and stayed there — even though structural degeneration on MRI progressed. Symptoms and structure moved in opposite directions.

   Knee Surgery, Sports Traumatology, Arthroscopy authors — Clinical improvement despite structural degeneration after nonoperative treatment of medial meniscus posterior root tear: A prospective longitudinal study.. Knee Surgery, Sports Traumatology, Arthroscopy, 2026. DOI: 10.1002/ksa.70570.

6. FDA states verbatim: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production. There are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.