What is the recommended injection for treating knee plica?

From the Guidelines

Corticosteroid injections are the recommended treatment for symptomatic knee plica syndrome when conservative measures fail. The typical injection consists of a mixture of a corticosteroid (such as methylprednisolone 40mg or triamcinolone acetonide 40mg) combined with a local anesthetic (like lidocaine 1% or bupivacaine 0.25%, 2-3ml) 1. The injection should be delivered directly into the affected plica under sterile conditions, often using anatomical landmarks or ultrasound guidance for accurate placement. A single injection is usually sufficient, though some patients may require a repeat injection after 3-6 months if symptoms recur. The corticosteroid works by reducing inflammation in the plica tissue, which decreases pain and friction against the femoral condyle during knee movement.

Before proceeding with injection, it's essential to confirm the diagnosis of plica syndrome through physical examination and possibly imaging. Patients should be advised to rest the knee for 24-48 hours post-injection and gradually return to activities as symptoms improve. These injections should be limited to 2-3 per year in the same location to avoid potential side effects such as cartilage damage or tendon weakening. The evidence from recent studies, such as the 2022 AAOS clinical practice guideline summary, supports the use of corticosteroid injections for knee osteoarthritis, which can be applied to knee plica syndrome management 1.

Key considerations for the treatment of knee plica syndrome include:

• Confirming the diagnosis through physical examination and imaging
• Using corticosteroid injections as a first-line treatment for symptomatic relief
• Limiting the number of injections per year to minimize potential side effects
• Advising patients on post-injection care and gradual return to activities
• Considering the individual patient's needs and response to treatment when determining the best course of action.

Overall, the use of corticosteroid injections for knee plica syndrome is supported by recent evidence and should be considered a viable treatment option for patients who have failed conservative measures 1.

From the FDA Drug Label

A single local injection of triamcinolone acetonide is frequently sufficient, but several injections may be needed for adequate relief of symptoms. Initial dose: 2. 5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entity being treated. The recommended injection for treating knee plica is triamcinolone acetonide. The initial dose is 2.5 mg to 5 mg for smaller joints and 5 mg to 15 mg for larger joints, such as the knee.

• Key points:
  • A single local injection is often sufficient
  • Several injections may be needed for adequate relief
  • Initial dose depends on the specific disease entity being treated
  • Use strict aseptic technique and careful injection technique to avoid complications 2

From the Research

Treatment Options for Knee Plica

• Intraarticular steroid injections may be indicated for patients with knee plica who do not respond to non-operative treatment programs, such as quadriceps strengthening and hamstring stretching 3.
• The evidence supports the use of intraarticular corticosteroid injections for various types of arthritis, including rheumatoid arthritis, osteoarthritis, and juvenile idiopathic arthritis 4.

Recommended Injections

• Triamcinolone hexacetonide is recommended as the intraarticular steroid of choice due to its advantage over triamcinolone acetonide 4.
• Intraarticular injection of hyaluronic acid may provide longer pain relief than steroid injection in osteoarthritis 4, 5.
• Triamcinolone acetonide extended-release is a formulation that enables prolonged presence in the joint, reducing systemic exposure and lessening corticosteroid-related systemic adverse reactions 6.

Efficacy of Injections

• Intra-articular injection of Triamcinolone acetonide is effective in symptoms control and improving functional outcome in clinically diagnosed osteoarthritis of knees 7.
• Triamcinolone acetonide extended-release significantly improved mean average daily pain intensity in patients with knee OA relative to placebo 6.