Are steroid knee injections effective for treating meniscal tears?

Steroid Knee Injections for Meniscal Tears

Corticosteroid injections provide effective short-term pain relief (typically up to 3 months) for patients with degenerative meniscal tears, but should be used as part of a comprehensive conservative management approach before considering surgery. 1, 2

Effectiveness of Steroid Injections for Meniscal Tears

• Corticosteroid injections have substantial evidence supporting their use for knee pain related to meniscal tears, with 19 high-quality and 6 moderate-quality studies demonstrating benefit 1
• The duration of benefit is typically limited to approximately 3 months 1
• Recent research shows that targeted meniscal injections may provide about 5.7 weeks of significant pain relief on average 3
• A 2024 study found that combined intra- and perimeniscal corticosteroid injections with structured physiotherapy resulted in 83% surgery-free survivorship at 5 years 4

Treatment Algorithm for Meniscal Tears

1. First-line treatment: Conservative management

   • Structured exercise program focusing on quadriceps and hamstring strengthening
   • Weight management
   • Activity modification
   • Oral or topical NSAIDs

2. Second-line treatment: Corticosteroid injections

   • Consider when initial conservative measures fail to provide adequate relief
   • Can be administered as intra-articular or meniscus-targeted injections
   • Expect temporary relief (3 months or less in most cases)
   • Continue with physical therapy during this period of pain relief

3. Third-line treatment: Consider surgery only if:

   • Conservative management fails for at least 6-8 weeks 2
   • Patient has true mechanical symptoms that significantly impact quality of life
   • Patient has a mild-to-moderate knee osteoarthritis where meniscal tears are a notable contributor to symptoms 1

Factors Affecting Treatment Outcomes

• Negative prognostic factors:

  • Presence of knee effusion before injection (independent risk factor for treatment failure) 4
  • Advanced osteoarthritis (Kellgren-Lawrence > III) 4
  • Degenerative rather than traumatic tears 5

• Patient selection considerations:

  • Patients with isolated meniscal tears show better response (72% complete resolution) compared to those with concurrent degenerative changes 6
  • Middle-aged and older patients with degenerative meniscal lesions respond better to conservative management 5

Important Caveats

• Avoid overreliance on MRI findings - asymptomatic meniscal tears are common, especially in patients over 35 2
• Diagnostic challenges - all clinical diagnostic tests for meniscal tears have high risk of misclassification 5
• Limited evidence for young patients - no randomized trials comparing non-surgical treatments with surgery in patients younger than 40 years or patients with traumatic meniscal tears 5
• Consider arthroscopic partial meniscectomy only after failing conservative management, including corticosteroid injections 1
• BMJ guidelines strongly recommend against routine arthroscopic surgery for degenerative knee disease, including meniscal tears 1

Injection Technique Considerations

• Ultrasound-guided meniscus-targeted injections may be more effective than standard intra-articular injections 3
• Combined intra- and perimeniscal corticosteroid injections show promising results when paired with structured physiotherapy 4

Steroid injections represent an effective temporary solution for meniscal tear pain, but should be viewed as part of a comprehensive management strategy rather than a definitive treatment. For most patients, especially those with degenerative tears, conservative management including physical therapy and corticosteroid injections should be exhausted before considering surgical intervention.