advice the expert Simon Moyes, consultant orthopaedic surgeon at The Wellington Hospital, answers your questions QI am in my early forties and, over the years, have enjoyed a range of sports. I am now finding my ability to continue with these sports is compromised by my knee, as I have been told I have arthritis. This is causing me daily pain, swelling and weakness, and Id like to know what the best kind of treatment would be. John Walker, Wakefield Simon Moyes replies: A new range of treatments is developing for tackling arthritis at your age and activity level. While most patients can be treated non-operatively with the use of analgesics, antiinflammatories, physiotherapy and activity modification, 10-20 per cent may require imaging and potentially reconstructive surgery to the knee. Normally a specialist would review you, look at a high-resolution MRI scan of your knee and may try to restore and repair cartilage damage. New treatments available include meniscal repair techniques. This is when the shock-absorbing, specialised meniscus in your knee becomes torn and, instead of simply cutting it back or removing it, it is stitched and repaired. The other type of cartilage in the knee that can be treated reconstructively is that which covers the joint surfaces, known at hyaline cartilage. This can be stimulated to repair in a number of ways. These include making miniature holes in the bone, where it is exposed, to release stem cells to promote cartilage healing. Cartilage can also be transplanted from an area in the knee where it is not needed to where it is, or a donor graft can be used. Other more complex but similarly successful techniquesinvolve removing a few cells from your knee, growing them in the laboratory and then re-implanting them after six weeks. Companies are working on artificial cartilage substitutes to cover damaged joint surfaces, and new stem cell technologies are being developed to regenerate damaged cartilage. There are also newer injection techniques. These include high molecular weight hyaluronic acid, which is essentially artificial joint fluid that can reduce the symptoms in a knee with arthritis and may have an effect on the underlying cartilage damage.