What is the recommended protocol for a knee joint injection, specifically the medication and dosage?

From the Guidelines

The recommended protocol for a knee joint injection is corticosteroids combined with a local anesthetic, with a common regimen including 40mg of methylprednisolone acetate or triamcinolone acetonide mixed with 4-5ml of 1% lidocaine without epinephrine, as supported by the most recent and highest quality study 1.

Key Considerations

• The procedure should be performed using sterile technique, with the patient positioned supine and the knee slightly flexed.
• The most common approach is the anterolateral or anteromedial portal, approximately 1cm above the joint line.
• Prior to injection, aspiration of any effusion is recommended to reduce pressure and improve medication distribution.
• The injection should be delivered slowly to minimize discomfort.

Post-Injection Care

• Patients should rest the joint for 24-48 hours post-injection and avoid strenuous activity for at least a week.
• Corticosteroids work by reducing inflammation through inhibition of inflammatory mediators, while the local anesthetic provides immediate pain relief.
• Most patients experience improvement within 24-72 hours, with effects typically lasting 3-4 months.

Limitations and Precautions

• These injections should generally be limited to 3-4 per year in the same joint to minimize potential side effects such as cartilage damage or tendon weakening, as noted in previous studies 1.
• The evidence for the effectiveness of intra-articular injections, including corticosteroids, hyaluronic acid, and platelet-rich plasma, is summarized in the most recent study 1, which provides the basis for this recommendation.

From the FDA Drug Label

Dosage and Administration: The recommended dose of Hyalovet (hyaluronate sodium) is 2 mL (20 mg hyaluronate sodium) in small or medium sized joints (carpus, fetlock) given by intra-articular injection. The recommended protocol for a knee joint injection is not explicitly stated in the provided drug label, as it only mentions small or medium sized joints such as carpus or fetlock.

• Medication: Hyaluronic acid (IN)
• Dosage: The label does not provide a specific dosage for knee joint injections, only for small or medium sized joints. 2

From the Research

Medication for Knee Joint Injection

• The medication used for knee joint injection includes corticosteroids such as triamcinolone acetonide 3, 4 and methylprednisolone acetate 3.
• Hyaluronic acid is also used for intra-articular knee injections, particularly for osteoarthritis 5, 6.
• Triamcinolone hexacetonide is considered to be more efficacious than triamcinolone acetonide and should be the intra-articular steroid of choice 6.

Dosage for Knee Joint Injection

• The dosage of triamcinolone acetonide for intra-articular knee injection is 80 mg, 2 mL 3.
• Triamcinolone acetonide extended-release 32 mg (Zilretta®) is administered as a single, 5 mL intra-articular injection 4.
• The optimal dosing regimen for corticosteroid injection into the osteoarthritic knee has not been established, and the current recommendations appear to have arisen as a consequence of a misinterpretation of previously published works 7.

Treatment Interval

• The treatment interval for knee joint injection varies, but injections can be repeated as needed 4.
• The evidence supports the use of intraarticular corticosteroid injections for rheumatoid arthritis, osteoarthritis, and juvenile idiopathic arthritis, with pain relief and functional improvement significant for months up to 1 year after the injection 6.
• Intra-articular injection of hyaluronate may provide longer pain relief than steroid injection in osteoarthritis 6.