Can steroid injections help with meniscus injuries?

Steroid Injections for Meniscus Injuries: Effectiveness and Recommendations

Corticosteroid injections can provide short-term pain relief for meniscus injuries, particularly when used as part of a comprehensive conservative management approach, but they do not alter long-term outcomes and should be considered after initial conservative measures have failed. 1, 2

Evidence for Steroid Injections in Meniscus Injuries

Effectiveness and Duration

• Intra-articular corticosteroid injections have considerable evidence supporting their use for knee pain, with 19 high-quality and 6 moderate-quality studies demonstrating effectiveness 1
• Benefits typically last up to 3 months, making them suitable for short-term symptom management 1, 2
• Particularly effective for managing synovial effusion and inflammation associated with meniscal tears 2

Specific Application for Meniscus Tears

• Recent research shows that combined intra- and perimeniscal corticosteroid injections with structured physiotherapy can result in:
  • 83% surgery-free survivorship at 5 years
  • 52% second-injection-free survivorship at 5 years 3
• Ultrasound guidance may improve accuracy of injection delivery, especially for targeting specific meniscal areas 4

Treatment Algorithm for Meniscus Injuries

First-Line Approach (0-6 weeks)

1. Conservative management:
   • Physical therapy focused on quadriceps and hamstring strengthening
   • Activity modification to avoid high-impact activities
   • Weight management if patient is overweight
   • Pain control with oral or topical NSAIDs 2

Second-Line Approach (after 6-8 weeks of failed conservative treatment)

1. Consider corticosteroid injection if:
   • Patient continues to have significant pain
   • There is evidence of effusion (presence of effusion is associated with better response) 3
   • Patient has not responded adequately to first-line measures 2

Third-Line Approach

1. Consider surgical options only if:
   • Complete failure of conservative management including injections
   • Symptoms significantly impact quality of life
   • Patient has a true locked knee (complete mechanical block to extension) 2

Important Considerations and Limitations

Factors Affecting Treatment Success

• Presence of knee effusion before steroid injection is an independent risk factor for treatment failure 3
• Advanced osteoarthritis (Kellgren-Lawrence > III) is associated with poorer outcomes 3
• Extrusion of the meniscus, bone marrow edema, duration of clinical symptoms, obesity, and low preoperative functional scores are negative prognostic factors 5

Cautions with Steroid Use

• Injected corticosteroids should be used with caution as they may:
  • Inhibit healing
  • Reduce tensile strength of tissue
  • Potentially predispose to spontaneous rupture 1
• A recent report raised concerns that specific steroid preparations or frequency of injections may contribute to cartilage loss, though the clinical significance remains uncertain 1

Comparative Effectiveness

• When comparing arthroscopic debridement to intra-articular steroid injections for degenerative medial meniscal tears:
  • At one month, arthroscopic group showed better symptom improvement
  • At one year, symptom improvement was maintained in 79% of arthroscopic group vs. 61% in steroid group
  • However, the marginal benefit of arthroscopy over steroid injections in the short term may not justify the risks and costs 5

Conclusion

Corticosteroid injections represent an effective second-line treatment option for meniscal injuries when initial conservative measures fail. They provide meaningful short-term pain relief but should be used judiciously given potential long-term concerns about tissue integrity. For optimal results, injections should be combined with structured physical therapy and other conservative measures.