Most meniscal tears in the knees are degenerative and get better with exercise. However, some cases are more challenging 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 cartilage that sits in your knee between your femur and tibia. There is a meniscus on your knee’s inside (medial) and outside (lateral). 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 walking, running, or sports. Other symptoms include swelling, a feeling of giving way, and locking of the joint.

We confirm a diagnosis by imaging. Weight-bearing X-rays are 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 no significant difference between keyhole surgery and a 12-week exercise program. Surgery is now only for acute traumatic tears or degenerative meniscal tears 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. However, some cases are more challenging and don’t improve. Previously, we would offer these complex 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?

injection for arthritis in knees

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 steroid injection into a knee joint can last a month and sometimes longer. We inject cortisone into a joint to help a meniscus tear in most cases. However, an injection into the joint will dilute the cortisone, meaning it will have less of an effect on the tear. Therefore, some doctors are now injecting cortisone very close to the meniscal tear and getting better results. Overall, steroid injection for meniscus tear is a reasonable option.

What is the key to meniscus injection?

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 guidance.

One study found that ultrasound results in very accurate injections into meniscal tears.

Another study injected cortisone next to meniscal tears by ultrasound. The researchers found that 70% of people had greater than six weeks of pain relief. This result compares well to an injection into the joint, which had only three weeks of relief.

Apart from cortisone, do we have any other meniscus injection options?

Yes. More doctors are doing PRP injections for meniscus tears. PRP is good at helping knee arthritis. We also think that PRP reduces pain and heals meniscal tears. However, we need more studies to show a positive effect of PRP on meniscus tears before we recommend it as a viable option.

Some doctors perform gel injections for meniscus tears, although the evidence is lacking.

Other knee conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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