You are experiencing mechanical knee pain that builds over months, morning stiffness lasting only a few minutes, or audible crepitus under the joint? This page describes, in a strictly informational way, what knee osteoarthritis (gonarthrosis) is, how it is diagnosed, and what non-surgical medical treatment options are offered in sports medicine. Cost questions are covered on the pricing page, and details on the PRP service are presented on the services page.
What is knee osteoarthritis?
Knee osteoarthritis (gonarthrosis) is a progressive degradation of the articular cartilage accompanied by changes in the subchondral bone, synovial fluid, and peri-articular structures. It affects roughly one in three adults after 60, but it frequently appears in younger patients — athletes, post-trauma cases, or those with excess mechanical load on the medial compartment.
The typical clinical picture combines mechanical pain (with effort, relieved by rest), morning stiffness under 30 minutes, audible crepitus, recurrent effusions, and progressively reduced mobility. Recognized risk factors are age, excess weight, prior meniscal or ligament injury, and repetitive load-bearing activity (running, alpine skiing, hockey, physically demanding work).
How is knee osteoarthritis diagnosed?
The diagnosis rests first on the clinical evaluation — a targeted history combined with a focused physical exam strongly orient the diagnosis even before imaging. The key elements:
- Clinical history — pain location (medial, lateral, patellofemoral), mechanical pattern (stairs, squatting, long walking), duration, triggers, activity level, and goals.
- Focused physical exam — palpation of the joint lines, patellar grind assessment, range-of-motion measurement, quadriceps and hamstring strength, gait and transfer analysis.
- In-office musculoskeletal ultrasound — real-time visualization of surface cartilage, quadriceps and patellar tendons, effusions, and popliteal cysts; useful to guide any subsequent injection with precision.
- Standard X-ray — the reference tool for radiological classification (Kellgren-Lawrence scale, grade 0 to 4); used selectively, without unnecessary repeated exposure.
- MRI — reserved for situations where ultrasound and X-ray are insufficient: complex meniscal lesion suspicion, deep cartilage involvement, or persistent diagnostic uncertainty.
Imaging does not replace the clinical exam: an X-ray showing grade 2 is not in itself an indication for treatment — the combination {symptoms + exam + imaging + patient goals} guides the medical decision.
When should you see a sports medicine doctor?
Certain signals justify a specialized sports medicine consultation rather than waiting for spontaneous evolution:
- Persistent pain for more than 4 to 6 weeks despite relative rest and conservative baseline measures.
- Joint locking — an episode of the knee "locking up" or giving way on weight-bearing.
- Acute effusion — knee swelling rapidly after effort or trauma.
- Post-traumatic pain that does not improve with progressive return to activity.
- Functional loss — inability to climb stairs normally, squat, practice one's sport, or sleep because of nocturnal pain.
Early consultation is especially useful for active patients who want to maintain their sport level, and for younger patients in whom a secondary cause (meniscal tear, malalignment) can be identified and treated before radiological progression.
Non-Surgical Medical Treatment Options
Conservative treatment typically combines several complementary modalities. No single option is sufficient in the majority of cases — it is the individualized assembly that produces the best result.
Supervised Exercise and Integrated Physiotherapy
The structured exercise program is the cornerstone of gonarthrosis management. It targets functional quadriceps strength, anterior-posterior balance with the hamstrings, hip stabilization, proprioception, and joint mobility without overload. Medical-physio coordination is described on the sports medicine services page.
Weight Management and Lifestyle
Weight modulation is the most influential non-surgical intervention for gonarthrosis, due to the mechanical amplification of load on the medial compartment per step. The clinical goal is a clinically significant loss, adopted according to each patient's profile.
Symptomatic Medication
Non-steroidal anti-inflammatory drugs (NSAIDs — ibuprofen, naproxen), topical NSAIDs (diclofenac gel), and acetaminophen form the first pharmacologic line for acute painful episodes, at the lowest effective dose and for the shortest possible duration. These medications relieve symptoms but do not act on cartilage degradation, and chronic use carries gastric, renal, and cardiovascular risks.
Viscosupplementation (Hyaluronic Acid)
Viscosupplementation involves injecting hyaluronic acid into the joint to restore the viscoelastic properties of the synovial fluid and improve joint lubrication. Indicated mainly in early-to-moderate gonarthrosis (grades 2 to 3), it targets lubrication rather than regeneration.
Intra-Articular Cortisone
Intra-articular cortisone is useful to break an acute inflammatory flare, particularly while waiting for a regenerative treatment or during a crisis on known osteoarthritis. The recognized limit is 2 to 3 infiltrations per year — beyond that, there is a risk of cartilage and soft-tissue weakening.
PRP (Platelet-Rich Plasma)
PRP is a regenerative option: the patient's blood is drawn, centrifuged to concentrate the platelets, then re-injected under ultrasound guidance. The platelet growth factors stimulate the local biological response. PRP acts slowly (maximum effect between 6 and 12 weeks), and the benefit may persist 6 to 12 months, sometimes longer. Details of the service are presented on the PRP service page, and the full procedure is described in the article PRP knee injection: what you should know.
The Specific Role of PRP in Knee Osteoarthritis
PRP distinguishes itself from other infiltrations by its regenerative mechanism of action. Practical details of the procedure appear in the article PRP knee injection: what you should know; the key comparison points are summarized here:
- Cortisone — fast-acting anti-inflammatory, relief within 1 to 2 weeks, limited duration of effect, maximum 2 to 3 infiltrations per year.
- Viscosupplementation — joint lubrication, intermediate effect, favorable safety profile.
- PRP — regenerative, maximum effect between 6 and 12 weeks, benefit may persist 6 to 12 months, sometimes longer.
Ultrasound-guided infiltration is the standard for these procedures: visualizing the target in real time maximizes the precision and clinical relevance of the deposit.
The Place of Exercise and Physiotherapy
Supervised exercise is not an "optional add-on" — it is the cornerstone of conservative treatment. A structured program is built around:
- Quadriceps strengthening in closed kinetic chains (squat, leg press), progression over 8 to 12 weeks.
- Hamstring strengthening — balance with the anterior chain.
- Hip stabilizers — abduction, external rotation, neuromuscular control.
- Proprioception and motor control — balance board, unstable surfaces.
- Joint mobility without overload — flexion and extension via passive and active-assistive mobilizations.
Medical-physio coordination is described on the sports medicine services page.
Common Medications — Key Elements
Oral NSAIDs (ibuprofen, naproxen) are the most commonly used anti-inflammatories for acute painful episodes. Topical NSAIDs (diclofenac gel) offer a favorable efficacy/side-effect profile for localized pain. Acetaminophen can complement for patients who do not tolerate oral NSAIDs.
None of these medications act on cartilage degradation — they only relieve symptoms. Their chronic use carries risks (gastric, renal, cardiovascular) that justify the lowest effective dose and shortest possible duration. The physician evaluates comorbidities (digestive history, renal function, cardiovascular profile) on a case-by-case basis before prescribing or renewing an NSAID.
When Is the Patient Referred to Orthopedics?
Surgical treatment (total knee replacement) is considered when a properly conducted conservative plan over several months no longer maintains quality of life. Referral to orthopedics is typically discussed when:
- Pain becomes refractory to a properly conducted conservative plan.
- Pain disrupts sleep or activities of daily living (walking a few hundred metres, climbing stairs).
- The radiological grade is severe with significant functional impairment.
- The patient wishes to evaluate the surgical option after trying regenerative options.
This referral does not mean conservative treatment has failed: a patient referred to orthopedics may have benefited from several years of non-surgical plan before the surgical consultation. The sports medicine doctor remains available for subsequent musculoskeletal follow-up.
FAQ — Knee Osteoarthritis: Diagnosis and Medical Treatment
How is knee osteoarthritis diagnosed?
The diagnosis rests primarily on the clinical evaluation: targeted history (pain location, mechanical pattern, duration) and physical exam (joint-line palpation, patellar grind, range of motion, quadriceps strength). Imaging is used selectively: standard X-ray for Kellgren-Lawrence classification, in-office musculoskeletal ultrasound to visualize surface cartilage and guide procedures, MRI for complex cases. Imaging does not replace the clinical exam — the combination {symptoms + exam + imaging + goals} guides the medical decision.
When should I see a sports medicine doctor for my knee?
A consultation is warranted in the presence of one or more of these signals: persistent pain for more than 4 to 6 weeks despite conservative measures, joint locking or giving way, acute effusion, post-traumatic pain that does not improve, or functional incapacity affecting sleep, stairs, or sport practice. Early consultation is especially useful for active patients or when a secondary cause is suspected (meniscal tear, malalignment).
What are the non-surgical medical treatment options?
Conservative treatment typically combines several modalities: a supervised exercise program and physiotherapy, weight management, symptomatic medication (NSAIDs, topicals, acetaminophen), viscosupplementation, intra-articular cortisone to break a flare, and PRP as a regenerative option. The plan is individualized according to the radiological grade, pain profile, age, and patient goals — the assembly, rather than a single option, produces the best result.
Where can I find information on the costs of these treatments?
This page is strictly informational and does not reproduce figures. The exact breakdown of fees (specialized consultation, imaging, ultrasound-guided infiltrations, follow-up visits) is presented on the pricing page. For coverage, check your supplemental insurance plan and the applicable reimbursement categories (paramedical care, specialty medicine).
Disclaimer: This article is for informational purposes only and does not constitute medical advice. The information on diagnosis, diagnostic criteria, and non-surgical treatment options reflects current practice in sports medicine; it does not replace an individual evaluation. The indication for a treatment, the choice of modality, and the care timeline must be discussed with a qualified physician during a specialized consultation. In case of doubt, red flags (acute pain, joint lock, signs of infection), or unfavorable evolution, consult a qualified physician promptly or present to the emergency department.
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