Is a steroid injection recommended for a patient with a meniscal injury?

Steroid Injection for Meniscal Injury

Corticosteroid injections are recommended as a second-line treatment for patients with meniscal injuries, particularly for those with persistent pain after first-line conservative management. 1, 2

Treatment Algorithm for Meniscal Injuries

First-Line Management

1. Conservative approaches should be tried first:
   • Structured exercise therapy/physical therapy
   • Activity modification (avoiding high-impact activities)
   • Oral or topical NSAIDs
   • Acetaminophen (up to 4g/day with appropriate precautions)
   • Ice therapy for acute pain flares

Second-Line Treatment

1. Corticosteroid injections when first-line treatments fail:
   • Intra-articular corticosteroid injections have been found to reduce joint pain and improve function 1
   • Methylprednisolone improves knee pain and function at 4 and 24 weeks
   • Triamcinolone improves pain and function at 6 weeks but not 12 weeks
   • Meniscus-targeted injections may provide approximately 5-6 weeks of pain relief 3

Special Considerations

• Timing: Corticosteroid injections should be avoided within 3 months preceding joint replacement surgery 1
• Technique: Hip injections require image guidance; knee injections typically do not 1
• Cautions: Consider potential long-term negative effects on bone health, joint structure, and meniscal thickness with repeated injections 1

Evidence for Efficacy

Recent evidence shows promising results for meniscal-targeted steroid injections:

• Ultrasound-guided meniscus-targeted injections for meniscal tears produced an average of 5.68 weeks of pain relief 3
• Combined intra- and perimeniscal corticosteroid injections with structured physiotherapy resulted in 83% surgery-free survivorship at 5 years 4
• Meniscal-wall ultrasound-guided steroid infiltration for degenerative meniscal lesions showed a 95% surgery-free survival rate at approximately 33 months 5

Patient Selection Factors

Steroid injections may be more beneficial for:

• Patients with persistent knee pain despite first-line treatments
• Patients with degenerative meniscal tears without mechanical symptoms (locking/catching)
• Patients without advanced radiological signs of osteoarthritis

Lower BMI appears to be associated with better response to meniscal injections 5.

Limitations and Precautions

• Effects are time-limited without long-term improvement at 2-year follow-up 1
• Patients with diabetes should closely monitor blood glucose for two weeks following injection 6
• Knee effusion and advanced osteoarthritis (Kellgren-Lawrence > III) are associated with poorer outcomes 4
• Patients should be counseled about potential risks, though complications from steroid injections are rare 6

Surgical Considerations

Surgery should only be considered in specific circumstances:

• Failure of conservative management after 6-8 weeks
• Significant impact on quality of life
• True mechanical symptoms like locked knee
• Younger patients with higher activity demands 2

Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 7.