Cortisone Injection for Medial Meniscus Pain
Yes, cortisone injections can provide effective short-term pain relief for medial meniscus tears, particularly when combined with structured physiotherapy, with benefits lasting 1-4 weeks and potentially extending to 16-24 weeks in some patients. 1
Evidence for Efficacy
Intra-articular corticosteroid injections demonstrate clinically significant pain reduction for degenerative meniscal tears, with the strongest evidence supporting their use as part of conservative management before considering surgical intervention. 1
Key clinical outcomes include:
- Surgery-free survivorship of 83% at 5 years when intra- and perimeniscal corticosteroid injections are combined with structured physiotherapy 2
- Pain relief is most pronounced at 1 week post-injection, with some patients experiencing relief extending to 16-24 weeks 1
- Functional improvement parallels pain reduction during the effective period 1
- 82% of patients with degenerative medial meniscus tears report symptom improvement following injection, with 53% maintaining improvement at follow-up 3
When to Offer Corticosteroid Injection
Offer corticosteroid injections for:
- Acute flare of knee pain with meniscal pathology, especially when effusion is present 1
- Meniscal tears coexisting with symptomatic knee osteoarthritis 1
- Patients who have failed initial conservative measures (physiotherapy, NSAIDs, rest) 3
- Isolated degenerative tears of the posterior horn of the medial meniscus show the best response, with 72% achieving complete symptom resolution 3
Critical Safety Considerations and Contraindications
Absolute contraindications:
- Avoid injections within 3 months prior to planned knee replacement surgery due to infection risk concerns 4, 1
Important safety parameters:
- Limit injections to every 3-4 months maximum to minimize adverse outcomes 1
- Diabetic patients must monitor glucose levels for 1-3 days post-injection due to transient hyperglycemia 1
- Advise patients to avoid overuse of the injected joint for 24 hours 1
- Be aware that repeat corticosteroid administration may have negative effects on bone health, joint structure, and meniscal thickness 4
Negative Prognostic Factors
Patients less likely to benefit include those with:
- Knee effusion present before injection (independent risk factor for treatment failure) 2
- Advanced osteoarthritis (Kellgren-Lawrence > III) 2
- Meniscal extrusion 5
- Bone marrow edema 5
- Obesity 5
- Longer duration of clinical symptoms 5
Injection Technique Considerations
For optimal results:
- Hip injections require image guidance for safety, but knee injections do not 4
- Ultrasound-guided perimeniscal injection technique: Triamcinolone Hexacetonide 20 mg/ml comprising 1.5 ml intra-meniscal, 1.5 ml in the meniscal wall, and 2 ml in the peri-meniscal space 2
- Perimeniscal infiltration may minimize complications related to intra-articular penetration 6
When Corticosteroid Injections Fail
If inadequate response after corticosteroid injection:
- Consider hyaluronic acid (viscosupplementation) for persistent knee pain, though evidence is inconclusive 1
- Arthroscopic partial meniscectomy may be considered for meniscal tears with mechanical symptoms after failed conservative treatment 1
- However, note that arthroscopic surgery for degenerative knee disease shows no superiority over conservative management and is generally not recommended 4
- Joint replacement may be considered for refractory pain with radiographic evidence of severe osteoarthritis 1
Important Caveats
While corticosteroid injections provide short-term benefit, they do not alter long-term outcomes and may be less effective than other treatments in the intermediate and long term. 4, 7 The evidence suggests corticosteroids may inhibit healing and reduce tensile strength of tissues, though this concern primarily relates to tendinopathies rather than meniscal pathology. 4
Second injection-free survivorship is only 52% at 5 years, indicating many patients will require repeat treatment. 2