What are the options for knee pain without surgery? A complete medical guide from rehabilitation and prolotherapy to C-TAME

Chronic knee pain does not always require surgery.
Most knee pain can first be assessed thoroughly to locate the source, and then managed step-by-step based on the condition through rehabilitation, medication, ultrasound-guided injections, and prolotherapy or regenerative therapy. If your symptoms consist of recurrent, degenerative knee joint pain that has derived limited relief from injections, you may further evaluate Catheter-based Microarterial Embolization (C-TAME). Which stage is suitable for you requires a doctor's consultation, physical examination, and imaging evaluation to determine.

What are the common causes of knee pain?

The knee is one of the weight-bearing joints under the greatest strain in the entire body, and the sources of pain are not limited to one: after middle age, the most common is osteoarthritis, characterized by cartilage wear accompanied by recurrent inflammation. Among active individuals, ligament or meniscus injuries and patellar tendinitis (jumper's knee) are common. Occupations involving prolonged kneeling or squatting easily accumulate bursitis, while soreness on the lower inner side of the knee is often goosefoot (pes anserinus) tendinitis.

Pain from different sources also presents differently - difficulty going up and down stairs, trouble standing up after squatting, stiffness when first starting to walk after sitting for a long time, and a dull ache at night; these details are all clues for a doctor to determine the source. If knee pain lasts for more than a few weeks, has not improved after a consultation, recurs repeatedly, or has already affected walking and sleep, it is worth arranging a thorough evaluation rather than relying on pain relievers to endure the persistent pain.

Which specialist should I see for knee pain?

Orthopedics and rehabilitation medicine are common starting points after an injury, focusing on structural damage management and rehabilitation training. The specialized pain clinic at Sian Medical Clinic approaches the problem by "identifying the source of the pain": doctors use high-resolution ultrasound imaging to examine tissues from tendon structures to blood vessel status, combined with X-rays to confirm the cause of knee pain, and then arrange rehabilitation, injections, prolotherapy, or catheter-based C-TAME according to the condition.

If you have already been examined at another clinic or hospital and have your X-ray, MRI, or CT reports, please bring them with you. After evaluation, we can directly continue treatment based on your existing data without starting over from scratch.

Does knee degeneration always mean joint replacement surgery?

Not necessarily. Artificial joint replacement is suitable for patients with severe cartilage wear, obvious joint deformities, and for whom conservative and minimally invasive treatments have failed - it is the last step on the ladder, not the only option. Before reaching that point, we still have several stages of options we can pursue:

The first stage is a thorough evaluation: utilizing high-resolution ultrasound imaging, X-rays, and physical examinations to first confirm the source of pain before discussing treatment.

The second stage is conservative treatment: medication, magnetic therapy, rehabilitation exercise prescriptions, and lifestyle adjustments, suitable for first-time flare-ups or those with milder symptoms.

The third stage is injection and prolotherapy: ultrasound-guided injections of hyaluronic acid, PRP (platelet-rich plasma), amniotic fluid extract, or bone marrow aspirate concentrate (BMAC) to promote tissue regeneration and repair.

The fourth stage is s-TAME or Catheter-based Microarterial Embolization (C-TAME): targeting chronic pain that recurs and where prolotherapy has produced limited results, utilizing a catheter to manage abnormal neovascularization (abnormal microvessels). This is performed in our in-house angiography suite.

Which stage you should stop at will be decided by the doctor's subsequent treatment plan after checking and evaluating your condition. Every stage at Sian is executed by the same medical team within the clinic. If the previous stage yields limited results, you can transition directly into the next phase of evaluation or an in-clinic referral; here, treatment is continuous without interruption.

Why does knee pain return after being treated? Understanding abnormal neovascularization

Many people are puzzled by this: they have taken medications, done rehabilitation, and received injections, yet the knee pain still comes back. In fact, sites of chronic pain are often accompanied by abnormal neovascularization and accompanying nerves. In areas where inflammation persists, the body attempts to repair damaged tissues by growing extra tiny blood vessels to supply nutrients. Along with these new blood vessels, new pain receptors and nerves develop, which ultimately become a source of pain that is difficult to address with plain pain relievers and rehabilitation.

This is precisely the target of C-TAME: it is not about masking the sensation of pain, but about addressing the very source that keeps the pain coming back.

What is C-TAME (Catheter-based Microarterial Embolization)?

C-TAME is a catheter-based microarterial embolization therapy developed by Dr. Yuji Okuno of the Okuno Clinic in Japan, and Sian Medical Clinic is authorized to perform it under license in Taiwan. The doctor introduces a microcatheter through the wrist artery. Guided by the GE OEC 3D mobile C-arm with cone-beam CT functionality, contrast agent is injected to confirm the position, and then selective embolization is performed on the abnormal microvessels that have proliferated in the painful area of the knee, reducing chronic inflammation and the source of pain.

The wound is approximately the size of a pinhole at the wrist. In most cases, local anesthesia is used, no hospitalization is required, and follow-ups are conducted in the outpatient clinic. For the knee, which is a deeper structure, catheter-based C-TAME is primarily used; for more superficial pain, the doctor will evaluate whether the ultrasound-guided, simplified s-TAME is suitable.

Who is suitable for a C-TAME evaluation for knee pain?

Those with recurrent degenerative osteoarthritis knee pain; chronic knee pain with limited relief from medication, rehabilitation, or injection treatments; those who have received PRP or hyaluronic acid injections with limited improvement; those who do not wish to undergo surgery, or are not suitable for joint replacement due to age and comorbidities; and those who wish for a short recovery period without affecting daily activities.

Whether to undergo treatment must be determined by a doctor after a consultation, physical examination, and imaging evaluation—C-TAME is not suitable for everyone, so confirmation must come before treatment.

Still in pain after receiving PRP or hyaluronic acid injections, what is the next step?

Limited results from injections do not mean your knee is beyond help. It may simply mean that there is more than one source of pain: hyaluronic acid lubricates the joints, PRP and amniotic extract promote tissue repair, but if the pain primarily stems from abnormally proliferated inflammatory blood vessels, these two types of injections cannot reach that source.

Sian's approach is to return to evaluation: confirm the primary source of the current pain, and then decide whether to enhance prolotherapy or proceed to evaluate for C-TAME. Because every step of the therapeutic ladder is performed in-house by the same team, you do not need to look for a new clinic out of frustration - the injections you had and examinations you went through in the previous stage serve as the basis for decisions in the next stage.

Treatment Process and Recovery Period

Evaluation: High-resolution ultrasound imaging, X-rays, and physical examinations to confirm the source of pain and determine suitability for C-TAME.

Day of Treatment: Performed under local anesthesia, with the patient remaining awake throughout. After a brief period of post-procedure observation, patients can return home without needing hospitalization.

Recovery: The wound is the size of a pinhole on the wrist, and recovery time for daily activities is short. Relief from pain appears progressively as the abnormal blood vessels are addressed; actual outcomes depend on the site and individual status, and the doctor will explain the expected timeline before the procedure.

How are fees calculated?

The first specialized pain consultation is NT$3,000, which includes high-resolution ultrasound imaging, X-ray imaging, physical examination, and a detailed consultation. Follow-up consultations are NT$1,500. Subsequent treatment costs depend on the treatment plan evaluated by the doctor and will be fully explained before treatment; there are no post-treatment hidden fees.

Who performs Sian's C-TAME?

Dr. Lu Ping-Sheng - Specialist in Neuroradiology of the Republic of China, Specialist of the Taiwan Pain Academy, and Director of the Taiwan Society of Interventional Radiology, formerly the Director of the Functional and Regenerative Medicine Center at Landseed International Hospital. Adopting the mindset of a "pain detective" to unravel and identify the causes of chronic pain, he is Sian Medical Clinic's performing physician for C-TAME. Treatments are completed in our in-house angiography suite, requiring no referral to large hospitals.

Frequently Asked Questions

Does knee pain always require surgery? Not necessarily. Most knee pain can first be assessed to identify the source and then managed step-by-step with rehabilitation, medication, injections, and prolotherapy based on the condition. Joint replacement is the last step of the ladder, suitable for patients with severe wear and tear where other treatments have failed.

Hyaluronic acid and PRP have both failed for knee degeneration, what other options are there? You can evaluate Catheter-based Microarterial Embolization (C-TAME). Limited efficacy from injections may be because the source of pain includes abnormally proliferated inflammatory microvessels, which is a component that injections cannot address and needs to be evaluated and confirmed by a doctor.

Does C-TAME treatment for knee pain require hospitalization? In most cases, local anesthesia is used and no hospitalization is required; follow-ups are conducted in the outpatient clinic. The wound is only the size of a pinhole at the wrist, and recovery time for daily activities is short.

What kind of knee pain is suitable for C-TAME evaluation? Recurrent degenerative osteoarthritis, as well as chronic knee pain that has shown limited improvement with medication, rehabilitation, or injection treatments, can be evaluated by a doctor for suitability. Whether the treatment can be performed must be judged after consultation, physical examination, and imaging evaluation.

What is the difference between C-TAME and PRP? Their targets of action are different: PRP aims to promote tissue repair, while C-TAME addresses abnormally proliferated microvessels in the painful area. They do not replace each other; which one is suitable, or whether they should be used in combination, is evaluated by the doctor based on the source of the pain.

Where in Taipei can I get evaluated for knee pain C-TAME? Sian Medical Clinic is located at 2F-1, No. 40, Section 2, Heping East Road, Daan District, Taipei City. It is performed by Dr. Lu Ping-Sheng in our in-house angiography suite. It is by appointment only; you can request a pre-evaluation via LINE or call (02) 2366-0186.

Unsure which stage of treatment is suitable for your knee?

Bring your X-ray, MRI, or CT reports and start with our LINE pre-evaluation first—confirm your source of pain and the appropriate treatment stage before deciding whether to visit the clinic.