In orthopedic care, the pathway for knee pain has long followed a predictable arc.
Patients move through conservative therapies, injections, physical therapy, activity modification, until those options are exhausted. At that point, the conversation shifts to joint replacement.
For a growing number of patients, that progression does not fit.
“They’ve been told they need a total joint,” Thomas DeBerardino, MD, division chief of sports medicine at UT Health San Antonio, said. “They’re in no way ready for it, want it or truly need it.”
In between those endpoints is a widening group of patients, often active, often younger and often underserved by the current model.
Redefining the ‘gap’ in knee care
The traditional model leaves little room for nuance, Dr. DeBerardino said.
Nonoperative options can be inconsistent or inaccessible. Surgical options, including osteotomy or partial knee replacement, are more invasive and often difficult for patients to accept, particularly when the goal is to maintain activity rather than restore basic function.
The result is a system that serves the endpoints well but struggles to address the middle, patients who span decades in age and activity level.
“They’re this growing body of tweeners,” he said, adding that “they didn’t have much else to turn to until about two years ago.”
Historically, that has meant a difficult trade-off, continuing therapies that may no longer provide relief or moving toward procedures that can feel disproportionate to their condition.
A new category emerges
That gap is beginning to draw attention not just from clinicians, but from regulators and the industry at large.
“They realized it was the first of many to follow that are going to fall into this new category [of treatments],” Dr. DeBerardino said.
The category centers on implantable shock absorbers designed to offload the medial compartment of the knee without entering the joint.
The concept is straightforward.
“You lost the shock absorber on your car. Can you put one back in?” he said.
Unlike traditional procedures, the approach is extra-articular and does not remove bone, a distinction that preserves future treatment options.
“It’s not in the joint. We’re not taking bone away. It’s not a one-way street,” he said.
Bridging the surgical timeline
For many patients, the goal is not to avoid surgery but to delay it.
“It legitimately kicks the can down the road,” Dr. DeBerardino said.
That delay carries long-term implications. Earlier joint replacement can lead to revision procedures later, operations that are more complex and carry higher risks.
“[But] if you had gotten a medial shock absorber, you’d be getting ready for your primary total knee 10 to 15 years down the road,” he said.
In that sense, the technology functions less as a replacement for surgery and more as a bridge to it.
Reframing recovery
The shift is also visible in how patients recover.
“The concept of the patients walking into your clinic the next day, often without crutches, with no brace,” Dr. DeBerardino said.
For many, the experience more closely resembles a minimally invasive procedure than a traditional orthopedic surgery.
The procedure is performed on an outpatient basis, with a shorter recovery timeline and a faster return to daily activities.
Some of the most meaningful outcomes are not measured in clinical scores, but in daily life.
Dr. DeBerardino said patients often tell him, “I can’t get out of a chair without pushing off with both hands.” That loss of function can define independence.
“When I saw someone do it and how happy they were when they regained that ability, I was like, ‘Wow, that’s actually really impressive,’” he said.
Restoring those movements can have an outsized impact on how patients experience recovery.
A shift in how care is evaluated
As the category of care evolves, its impact may extend beyond clinical outcomes.
With FDA approval in place and coding decisions underway, the technology is positioned for broader adoption. That may influence how treatment pathways are evaluated — particularly for patients who fall between conservative care and joint replacement.
“This is going to be a boom,” Dr. DeBerardino said.
For Dr. DeBerardino, the long-term trajectory is clear.
“This one’s got some legitimate chance of staying in power in the industry of orthopedics and musculoskeletal care” he said.
The broader impact will likely extend beyond a single device, as more companies enter the space.
“There’ll be five or six by 2030 that fill this space,” he said.
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