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

Long-term knee pain does not necessarily require surgery.
Most knee pain can first be assessed to identify the source of the pain, and treated step-by-step according to the condition—ranging from rehabilitation, medication, ultrasound-guided injections, and prolotherapy/regenerative therapies. If your symptoms are recurrent, degenerative joint pain with limited relief from injections, you may further evaluate catheter-based C-TAME (Catheter-based Transarterial Microembolization). Which step is suitable for you requires an evaluation by a physician through medical history, physical examination, and imaging.

What are the common causes of knee pain?

The knee is one of the joints bearing the greatest weight in the body, and the sources of pain are more than one: after middle age, the most common is osteoarthritis, characterized by cartilage wear and tear accompanied by chronic inflammation. For athletic populations, ligament or meniscus injuries and patellar tendinitis (jumper's knee) are common. Occupations involving prolonged kneeling or squatting easily accumulate bursitis, while pain on the lower inner side of the knee is often pes anserine tendinitis.

Different sources of pain present differently—pain going up and down stairs, difficulty standing up from a squat, stiffness when taking the first steps after sitting for a long time, and a dull ache at night. These details are all clues for physicians to determine the source. If knee pain lasts for more than a few weeks, does not improve after a consultation, recurs repeatedly, or has already affected walking and sleep, it is worth arranging a complete evaluation rather than relying on painkillers to endure the recurring pain.

Which department should I visit for knee pain?

Orthopedics and physical medicine & rehabilitation are common starting points after an injury to address structural damage and rehab training. The specialized pain clinic at Shyi Clinic approaches this by "finding the source of pain": physicians use high-resolution ultrasound to examine tendon tissues and vascular conditions, while combining X-rays to confirm the cause of knee pain. Based on the condition, they then arrange rehabilitation, injections, prolotherapy, or catheter-based C-TAME.

If you have already been evaluated at another medical institution and have X-ray, MRI, or CT reports on hand, please bring them with you. After evaluation, we can continue treatment directly from your existing data without having to start over.

Does knee degeneration always require artificial joint replacement?

Not necessarily. Joint replacement surgery is suitable for patients with severe cartilage wear, significant joint deformity, and for whom conservative and minimally invasive treatments have failed—it is the last step on the ladder, not the only option. Before that, we still have several steps we can work through:

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

The second stage is conservative treatment: medications, electromagnetic therapy, rehabilitation exercise prescriptions, and lifestyle adjustments, which are suitable for first-time episodes 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 C-TAME (Catheter-based Transarterial Microembolization): targeting chronic pain that recurs and has limited results from prolotherapy. This procedure addresses abnormally proliferating microvessels using a catheter and is performed in our in-clinic angiography suite.

Which stage you should stop at will be decided by the physician's evaluation after an examination. At Shyi Clinic, every stage is performed by the same medical team in-house. If the previous stage has limited effectiveness, you can transition directly to the next stage of evaluation or receive an internal referral. Here, there are no gaps in your treatment.

Why does my knee pain keep coming back after treatment? Understanding abnormal microvascular proliferation

Many people are puzzled: they have taken medications, done physical therapy, and received injections, yet the knee pain still recurs. In fact, areas with long-term pain are often accompanied by abnormally proliferating microvessels and nerves. Where inflammation persists, the body—in an effort to repair the damaged area—grows extra tiny blood vessels to supply nutrients to the injured site. New pain-sensing nerves grow alongside these blood vessels, ultimately becoming a source of pain that is difficult to address with painkillers and physical therapy.

This is precisely the target of C-TAME: not to mask the sensation of pain, but to treat the very source that makes the pain keep returning.

What is C-TAME (Catheter-based Transarterial Microembolization)?

C-TAME is a catheter-based microvascular embolization therapy developed by Dr. Yuji Okuno of Okuno Clinic in Japan. Shyi Clinic is authorized to perform this under its trademark in Taiwan. The physician inserts a microcatheter through the wrist artery. Guided by the GE OEC 3D mobile C-arm with cone-beam CT capability, contrast agent is injected to confirm the position, and then selective embolization is performed on the abnormal microvessels that have proliferated at the painful site of the knee, reducing chronic inflammation and the source of pain.

The wound is about the size of a pinhole at the wrist. In most cases, it is performed under local anesthesia without hospitalization, and follow-ups are conducted in the outpatient clinic. Because the knee is a deeper structure, catheter-based C-TAME is primary; for superficial pain, the physician will evaluate whether a simplified ultrasound-guided s-TAME is applicable.

What kind of knee pain is suitable for C-TAME evaluation?

Recurrent pain from degenerative osteoarthritis of the knee; long-term knee pain with limited relief from medications, rehabilitation, or injection therapies; those who have received PRP or hyaluronic acid injections with limited improvement; those who do not want surgery or are not suitable for joint replacement due to age and comorbidities; and those who desire a short recovery time without affecting daily life.

Whether to undergo treatment must be determined by a physician after a medical consultation, physical examination, and imaging evaluation—C-TAME is not suitable for everyone, confirm before treating.

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

Limited effectiveness of injections does not mean your knee is beyond help. It may just mean that there is more than one source of pain: hyaluronic acid lubricates the joint, while PRP and amniotic fluid promote tissue repair. However, if the pain mainly stems from abnormally proliferating inflammatory blood vessels, these two types of injections cannot address that source.

At Shyi Clinic, our approach is to return to evaluation: confirm the main source of the current pain, and then decide whether to enhance prolotherapy or proceed to C-TAME evaluation. Because every step of the ladder is executed in-house by the same team, you do not need to look for a new clinic with a sense of frustration—the injections you received and the examinations you underwent in the previous stage serve as the basis for decisions in the next stage.

Treatment Process and Recovery Period

Evaluation: High-resolution ultrasound, X-rays, and physical examinations to confirm the source of pain and determine if C-TAME is suitable.

Day of Treatment: Performed under local anesthesia; you remain conscious throughout the procedure. After a short observation period, you can return home without hospitalization.

Recovery: The wound is a pinhole-sized puncture at the wrist, and the recovery time for daily activities is short. Pain relief gradually appears as the abnormal blood vessels are treated. The actual outcome depends on the location and individual condition, and the physician will explain the expected timeline before the procedure.

How are the fees calculated?

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

Who performs C-TAME at Shyi Clinic?

Dr. Ping-Hsing Lu - Specialist in Neuroradiology of the Republic of China, Specialist of the Taiwan Pain Society, Director of the Taiwan Society of Interventional Radiology, and former Director of the Functional and Regenerative Medicine Center at Landseed International Hospital. Adopting the mindset of a "pain detective" to unravel and find the cause of chronic pain, Dr. Lu is the operating physician for C-TAME microvascular embolization at Shyi Clinic. The treatment is completed in our in-clinic angiography suite, requiring no referral to a large hospital.

Frequently Asked Questions

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

Hyaluronic acid and PRP injections didn't work for my knee degeneration, what other options are there? You can evaluate catheter-based C-TAME microvascular embolization. Limited injection effectiveness may be because the source of pain includes abnormally proliferating inflammatory microvessels, which injections cannot address. This requires evaluation and confirmation by a physician.

Does C-TAME treatment for knee pain require hospitalization? In most cases, it is performed under local anesthesia without the need for hospitalization, and follow-ups are done in the outpatient clinic. The wound is about the size of a pinhole at the wrist, and the recovery period for daily activities is short.

What kind of knee pain is suitable for C-TAME evaluation? Recurrent osteoarthritis and chronic knee pain with limited results from medications, physical therapy, or injections can be evaluated by a physician for suitability. Whether to undergo treatment requires medical history, physical examination, and imaging evaluation.

What is the difference between C-TAME and PRP? They have different target mechanisms: PRP aims to promote tissue repair, while C-TAME addresses the abnormally proliferating microvessels at the site of pain. They do not replace each other; which one is suitable, or whether they should be used in combination, is evaluated by the physician based on the source of pain.

Where in Taipei can I get evaluated for knee pain C-TAME? Shyi Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da’an Dist., Taipei City. It is performed by Director Ping-Hsing Lu in our in-clinic angiography suite. By appointment only, you can conduct a pre-evaluation via LINE or call (02) 2366-0186.

Unsure which step is suitable for your knee?

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

Author: Dr. Ping-Hsing Lu

Last Updated: August 6, 2026

Disclaimer: This article is for health education purposes only and cannot replace professional medical diagnosis and treatment advice. The suitability of any treatment must be evaluated and decided by a physician.

References for Dr. Yuji Okuno's Microvascular Embolization Papers:
Okuno Y, Korchi AM, Shinjo T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995-1002. doi:10.1016/j.jvir.2017.02.033

Okuno Y, Korchi AM, Shinjo T, et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol. 2015;38(2):336-343. doi:10.1007/s00270-014-0944-8