From the Guidelines
Corticosteroid injections, such as cortisone, are generally safe for short-term use in the knee, but their repeated use can potentially damage articular cartilage. The most recent and highest quality study, 1, suggests that corticosteroid injections have considerable evidence supporting their use, with 19 high-quality and six moderate-quality studies demonstrating improved pain and function in patients with knee osteoarthritis, although the duration of benefits was often only 3 months. However, the study also notes that repeated cortisone exposure can weaken cartilage, potentially accelerating joint degeneration over time. Key points to consider when using corticosteroid injections for knee pain include:
- Limiting injections to 3-4 times per year in the same joint, with at least 3 months between injections, as suggested by 1
- Using common corticosteroids such as methylprednisolone, triamcinolone, and betamethasone, typically at doses of 20-80 mg depending on the specific medication and severity of symptoms
- Discussing alternative treatments with a doctor for long-term management, such as physical therapy, weight management, and other medications that might be more appropriate for ongoing knee problems
- Being aware of the potential risks and benefits of corticosteroid injections, including the risk of transient increased glycaemia in diabetic patients, as noted in 1
- Considering the individualized factors, such as treatment options, compound used, systemic treatment, and comorbidities, when deciding to reinject a joint, as suggested by 1. Overall, the risk-benefit ratio is most favorable when cortisone is used judiciously for flare-ups rather than as a regular treatment, and patients should be informed about the potential risks and benefits of corticosteroid injections.
From the FDA Drug Label
Intra-articularly injected corticosteroids may be systemically absorbed. A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis. Local injection of a steroid into an infected site is to be avoided Corticosteroids decrease bone formation and increase bone resorption
The use of corticosteroids, such as cortisone, in the knee joint may lead to systemic absorption and has been associated with increased risk of septic arthritis and bone resorption. Therefore, corticosteroid injection into the knee joint should be used with caution. Key considerations include:
- Avoiding injection into an infected site
- Monitoring for signs of septic arthritis
- Being aware of the potential for bone resorption and osteoporosis 2
From the Research
Safety of Corticosteroid for Articular Cartilage in the Knee
- The safety of corticosteroid (cortisone) for articular cartilage in the knee is a topic of ongoing research and debate 3, 4, 5.
- A study published in 2020 found that intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty, suggesting that corticosteroid injections may harm the joint and accelerate the progression of osteoarthritis (OA) 3.
- Another study published in 2025 compared the effectiveness of amniotic tissue injections and corticosteroid injections for pain relief and function in patients with severe knee osteoarthritis, and found that amniotic tissue injections may be a safe and effective alternative to corticosteroid injections 4.
- A study published in 2018 found that intra-articular corticosteroid injections may reduce cartilage degradation in the short term, but the long-term effects are unclear 5.
- A survey of the American Association of Hip and Knee Surgeons membership found that nearly all respondents use intra-articular corticosteroid injections in their practice, but there is great variability in the number of injections allowed and the formulation of the corticosteroid used 6.
Key Findings
- Intra-articular corticosteroid injections may increase the risk of requiring knee arthroplasty 3.
- Amniotic tissue injections may be a safe and effective alternative to corticosteroid injections for pain relief and function in patients with severe knee osteoarthritis 4.
- Intra-articular corticosteroid injections may reduce cartilage degradation in the short term, but the long-term effects are unclear 5.
- There is great variability in the use of intra-articular corticosteroid injections among hip and knee surgeons, including the number of injections allowed and the formulation of the corticosteroid used 6.
Biomarkers and Cartilage Turnover
- Biomarkers such as C-telopeptides of type-II collagen (uCTX-II) and cartilage oligomeric matrix protein (COMP) may be helpful in further elucidating the effects of intra-articular corticosteroid injections on cartilage turnover and degradation 5.
- A study found that median uCTX-II, a cartilage degradation marker, was lower at 3 weeks post intra-articular corticosteroid injection compared with baseline, suggesting that intra-articular corticosteroid injections may reduce cartilage degradation in the short term 5.