Knee surgery and non-surgical options

Written by Dr Sean Leo, a consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.

Last updated: 9 October 2026.

For people with osteoarthritis, NICE (the UK’s National Institute for Health and Care Excellence) says the core treatments are therapeutic exercise and weight management (if appropriate), along with information and support ^[1]. NICE advises offering therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness) to all people with osteoarthritis ^[1].

For people with osteoarthritis, NICE (the UK’s National Institute for Health and Care Excellence) says the core treatments are therapeutic exercise and weight management (if appropriate), along with information and support ^[1]. This page sets out what the guidance says about non-surgical options and about when surgery is considered. It is general information, not advice for one person.

• What non-surgical treatments does NICE list for knee osteoarthritis?
• What does NICE say about injections?
• When is surgery considered?
• What do the sources say about meniscus, ACL and kneecap problems?
• When is urgent help needed?
• What should I do next?

What non-surgical treatments does NICE list for knee osteoarthritis?

NICE advises offering therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness) to all people with osteoarthritis ^[1]. For people with osteoarthritis who are living with overweight or obesity, NICE says to advise them that weight loss will improve their quality of life and physical function, and reduce pain ^[1]. This guidance is for people who have been diagnosed with osteoarthritis. If you have new knee pain or swelling, ask a doctor to check it.

More on exercise

NICE says to advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise, and to explain that doing regular and consistent exercise, even though this may initially cause pain or discomfort, will be beneficial for their joints ^[1]. If you have new knee pain or swelling, ask a doctor to check it.

More on braces and supports

NICE says insoles, braces, tape, splints or supports should not routinely be offered for osteoarthritis unless there is joint instability or abnormal loading, exercise is not working or not suitable without them, and they are likely to improve movement and function ^[1].

More on medicines

NICE advises offering a topical non-steroidal anti-inflammatory drug (NSAID) to people with knee osteoarthritis ^[1]. Talk to your doctor before you start any medicine.

What does NICE say about injections?

NICE’s recommendation on corticosteroid injections into the joint reads: “Consider intra-articular corticosteroid injections when other pharmacological treatments are ineffective or unsuitable, or to support therapeutic exercise” ^[1]. NICE also says to explain to the person that “these only provide short-term relief (2 to 10 weeks)” ^[1]. On hyaluronan injections, the NICE recommendation reads: “Do not offer intra-articular hyaluronan injections to manage osteoarthritis” ^[1].

When is surgery considered?

NICE advises considering referral for joint replacement for people with hip, knee or shoulder osteoarthritis when joint symptoms are substantially affecting quality of life and non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable ^[1]. NICE advises using clinical assessment when deciding to refer someone for joint replacement, instead of systems that numerically score severity of disease ^[1].

More on keyhole surgery

NICE says not to offer arthroscopic lavage or debridement to people with osteoarthritis ^[1].

What do the sources say about meniscus, ACL and kneecap problems?

• AAOS (the American Academy of Orthopaedic Surgeons) says many meniscus tears will not need immediate surgery ^[2]. If symptoms persist with non-surgical treatment, a doctor may suggest arthroscopic surgery, a procedure in which the surgeon inserts a miniature camera through a small incision (portal) in the knee ^[2]. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time ^[2].
• For an ACL (anterior cruciate ligament) tear, AAOS says treatment will depend on the patient’s individual needs and desired goals for recovery ^[3]. Non-operative management is always an option after an ACL tear ^[3]. It includes reducing inflammation with medications and working with physical therapy to gradually rebuild quadriceps strength and confidence in your knee ^[3]. Most ACL tears form a gap between the torn edges and do not heal on their own ^[4].
• A dislocated kneecap often moves back into place by itself. Even if it does, you will still need to get it checked by a doctor ^[5]. Get medical advice as soon as possible if you think you have a dislocated kneecap ^[5].

When is urgent help needed?

The list below covers the signs that should not wait for a routine appointment.

What should I do next?

If knee pain is not settling, or you are unsure what is causing it, an assessment is a sensible next step. The assessment brings together the patient’s story, an examination and any tests that help, so that the patient and the surgeon can decide together. It looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to surgery.

• Read about the Knee Hub.
• Read about the ACL reconstruction surgery.
• Read about the meniscus repair surgery.
• Read about the MPFL reconstruction surgery.
• Read about the total knee replacement surgery.
• Read about choosing an orthopaedic treatment.

References

1. NICE. Osteoarthritis in over 16s: diagnosis and management (NG226), published 19 October 2022. https://www.nice.org.uk/guidance/ng226/resources/osteoarthritis-in-over-16s-diagnosis-andmanagement-pdf-66143839026373 (accessed 5 October 2026).
2. AAOS OrthoInfo. Meniscus Tears. https://www.orthoinfo.org/diseases–conditions/meniscus-tears (accessed 5 October 2026).
3. AAOS OrthoInfo. Anterior Cruciate Ligament (ACL) Injuries. https://www.orthoinfo.org/diseases–conditions/anterior-cruciate-ligament-acl-injuries (accessed 5 October 2026).
4. MedlinePlus. Anterior cruciate ligament (ACL) injury. https://medlineplus.gov/ency/article/001074.htm (review date 17 June 2024).
5. NHS. Dislocated kneecap. https://www.nhs.uk/conditions/dislocated-kneecap/ (page last reviewed 10 March 2026).