Nonsurgical management can be effective for many patients with chronic knee pain.

Physical therapy combined with oral analgesics can be used to treat typical causes of chronic knee pain in adults, including knee osteoarthritis, patellofemoral pain syndrome, and meniscal, tendon and ligament injuries, according to the American Academy of Family Physicians (AAFP).

The AAFP also recommends weight loss for patients with a body mass index (BMI) greater than 25.

Effective treatment options depend on the etiology of the knee pain, according to Scotty R. Newcomer, D.O., nonsurgical orthopedic specialist with Norton Orthopedic Institute.

Studies have found active rehabilitation to be as effective as arthroscopy for reducing pain and improving function in patients with nontraumatic degenerative medial meniscal tears (without mechanical symptoms). Active rehabilitation is also as good as meniscectomy for improving function in patients with meniscal tears and osteoarthritis.

For patients with osteoarthritis, recommended treatment options include a combination of aerobic and strength training. Extended-release acetaminophen, 1,300 milligrams, three times daily, also may help. Ice can improve range of motion but not pain. Corticosteroid injections offer short-term pain management and improved mobility.

The American Academy of Orthopaedic Surgeons (AAOS) recommends against glucosamine/chondroitin supplements for osteoarthritis in nonsurgical patients.

For patients with patellofemoral pain syndrome, quadriceps and hip strengthening, along with stretching three times weekly for six to eight weeks, has been shown to be effective. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for short-term pain knee pain relief. Patellar taping and ultrasonography have shown mixed results but may be helpful.

The most common oral analgesics used for chronic knee joint pain are NSAIDs and acetaminophen. If NSAIDs and acetaminophen are ineffective, one of the following can be considered: regenerative injections, tramadol, a valgus brace or a corticosteroid injection for short-term relief.

A Cochrane Review found intra-articular injections of corticosteroids typically offer one to two weeks of pain relief.

Opioid analgesics should be avoided in nonsurgical patients unless conservative pharmacotherapy is ineffective, according to the AAFP.

There is little evidence knee braces are effective for chronic knee pain, aside from stabilizing traumatic knee ligament and tendon tears. A knee brace should not replace physical therapy.

According to the AAOS, orthotics can help with anterior knee pain, but lateral wedges should not be used to treat patients with medial compartment osteoarthritis of the knee.

Intra-articular hyaluronic acid injections (viscosupplementation) for knee osteoarthritis have been controversial, but they have been shown to be helpful at least for some patients. One review of meta-analyses that involved more than 20,000 patients concluded that hyaluronic acid injections were a viable option for patients with osteoarthritis, with a good safety profile and improvement in pain and function that persisted up to 26 weeks.

A prospective, observational study found only 57% of 102 patients with osteoarthritis overall had a positive response to hyaluronic acid injections, but patients with mild-to-moderate osteoarthritis and patients 60 or older were twice as likely to respond positively.

A separate long-term study found hyaluronic acid injections provided significant benefits at two years and were as effective at improving knee function and symptoms as platelet-rich plasma.