Most meniscal tears in the knees are degenerative and get better with exercise. Some cases are more difficult and don’t improve. Previously, we would offer people keyhole surgery. Now, more doctors are using meniscal injections to help. Are meniscus injections an alternative to surgery?
What is the meniscus?
The meniscus is a type of cartilage that sits in your knee between your femur and tibia. There is a meniscus on the inside (medial) and outside (lateral) of your knee. The menisci act as shock absorbers to protect the joint. So, a tear of the meniscus can lead to symptoms in the knee.
What are the symptoms of a meniscal tear?
A meniscal tear often leads to pain either on the inside or outside of the knee. Usually, pain occurs during activities such as walking, running, or sport. Other symptoms include swelling, a feeling of giving way, and locking of the joint.
We confirm a diagnosis by imaging. X-ray is often used to check for arthritis. However, MRI is the imaging of choice to diagnose a meniscal tear.
Treatment options for meniscal tears
Most people think that meniscal tears need keyhole surgery. But this is not usually the case. Long-term results are not improved with surgery compared to non-surgical options. For example, one study found that there was no significant difference between keyhole surgery and a 12-week exercise program. Surgery is now only indicated in degenerative knees with mechanical symptoms such as locking or giving way. In other words, if surgery is performed for pain only, the results are less predictable. Also, there is some evidence that having keyhole surgery increases your chance of having a knee replacement by 30%. So best to stay away from keyhole surgery if you can.
Initially, we recommend rest, ice, compression, and anti-inflammatory tablets such as ibuprofen. As the pain settles, you should start exercises to build strength in the thigh and leg. Other treatments such as weight loss reduce the forces on the damaged joint. Also, prevention of further trauma can preserve the cartilage for longer.
Most meniscal tears in the knees are degenerative and get better with exercise. Some cases are more difficult and don’t improve. Previously, we would offer these difficult cases keyhole surgery. Now, more doctors are using injections to help with knee pain. Are meniscal injections an alternative to surgery?
Are meniscus injections an option?
More doctors are turning to meniscus injections to help people get better. But what are the options?
Traditionally, we use cortisone in the knee joint to reduce pain. Studies suggest that a cortisone effect can last a month and sometimes longer. In most cases, we inject cortisone into the joint. However, for meniscal tears, an injection into the joint will dilute the cortisone meaning it will have less of an effect on the tear. Some doctors are now injecting cortisone very close to the meniscal tear and getting good results.
What is the key to meniscus injections?
The key is to direct the cortisone as close as possible to the tear. The only way you can do this is by using ultrasound.
One study found that ultrasound results in very accurate injections into meniscal tears.
Another study injected cortisone next to meniscal tears by ultrasound. Not surprisingly, the researchers found that 70% of people had pain relief of greater than 6 weeks. This compares well to an injection into the joint, which had only 3 weeks of relief.
Apart from cortisone, do we have any other meniscal injection options?
Yes. Some doctors are doing platelet-rich plasma injections or PRP for meniscus tears. PRP is good at helping knee arthritis. We think that PRP reduces pain and heals meniscal tears. However, we need more studies to show a positive effect of PRP on meniscus tears.
Other knee conditions: