Most meniscal tears in the knee are degenerative, and most get better with exercise. Some cases are more stubborn and don’t improve. We used to offer these people keyhole surgery — but now, more doctors are using meniscus injections to help. So are meniscus injections an alternative to surgery?
What is the meniscus?
The meniscus is a piece of cartilage that sits in your knee between the thigh bone (femur) and shin bone (tibia). There’s one on the inside (medial) and one on the outside (lateral). The menisci act as shock absorbers to protect the joint, so a tear of the meniscus can cause knee symptoms.
What are the symptoms of a meniscal tear?
A meniscal tear often causes pain on the inside or outside of the knee, usually during walking, running, or sport. Other symptoms include swelling, a feeling of giving way, and locking of the joint.
We confirm the diagnosis with imaging. An X-ray checks for arthritis, while MRI is the imaging of choice to diagnose the tear.
Treatment options for a meniscal tear
Most people assume meniscal tears need keyhole surgery. Usually, they don’t. Long-term results are no better with surgery than with non-surgical treatment — one study found no significant difference between keyhole surgery and a 12-week exercise programme. Surgery is now mainly reserved for knees with mechanical symptoms such as locking or giving way. Where it’s done for pain alone, the results are less predictable. There’s also evidence that keyhole surgery increases the chance of a later knee replacement, so it’s best avoided where possible.
Initially, we recommend rest, ice, compression, and anti-inflammatory tablets such as ibuprofen. As the pain settles, exercises build strength in the thigh and leg. Losing excess weight reduces the forces on the joint, and avoiding further trauma preserves the cartilage for longer.
For the fuller picture on surgery versus rehabilitation, see our guide to a torn meniscus in the knee.
Are meniscus injections an option?
For difficult cases that don’t settle, meniscus injections are increasingly used to relieve knee pain. So what are the options?
Cortisone injections
Traditionally, we use cortisone in the knee joint to reduce pain, and the effect can last a month or longer. But for a meniscal tear, injecting into the joint dilutes the cortisone, so it has less effect on the tear itself. The solution is to inject the cortisone very close to the tear.
The key to a meniscus injection: ultrasound
The key is to direct the cortisone as close as possible to the tear — and the only way to do that accurately is with ultrasound.
One study found that ultrasound produces very accurate injections into meniscal tears. Another injected cortisone next to meniscal tears under ultrasound and found that 70% of people had pain relief lasting longer than six weeks — compared with just three weeks for an injection placed into the joint. Accurate placement makes the difference.
PRP injections
Besides cortisone, some doctors use platelet-rich plasma (PRP) for meniscal tears. PRP is helpful for knee arthritis, and we think it reduces pain and may help heal a meniscal tear — though more studies are needed to confirm the effect.
How much does a meniscus injection cost?
Dr Masci performs the injection as a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. PRP is priced separately. See the full one-stop injection fees here and our clinic locations.
Frequently asked questions about meniscus injections
Are meniscus injections an alternative to surgery?
For many people, yes. Where a degenerative meniscal tear hasn’t settled with rehabilitation, an ultrasound-guided injection close to the tear can relieve pain and help you avoid keyhole surgery — which, for degenerative tears, offers little benefit and may increase the risk of later arthritis. Injections are a genuine alternative for pain-driven tears, though surgery is still needed for true mechanical locking and root tears.
How well does a meniscus injection work?
When cortisone is placed accurately next to the tear under ultrasound, about 70% of people get pain relief lasting more than six weeks — more than double the relief of an injection placed into the joint alone. Combined with rehabilitation, that relief often allows a lasting recovery.
Cortisone or PRP for a meniscal tear — which is better?
Cortisone reduces the inflammation and pain around a tear quickly, and has stronger evidence. PRP aims to support healing and is useful where there’s associated knee arthritis, but the evidence for meniscal tears specifically is still developing. The choice depends on your knee — including whether there’s arthritis — and is best decided at assessment.
Why does the injection need ultrasound?
Because the target is tiny and specific, an injection placed unthinkingly into the joint dilutes the cortisone away from the tear, giving only a few weeks of relief. Ultrasound lets us place it right next to the tear, which is what produces the longer-lasting result.
Is a meniscus injection safe?
Yes, with the usual injection precautions. Risks include a small chance of infection, a temporary cortisone flare, and skin changes — all reduced by using ultrasound. Repeated cortisone injections are used sparingly, as frequent cortisone isn’t good for the joint surface.
Final word from Sport Doctor London about meniscus injections
Most meniscal tears settle with rehabilitation, but for stubborn, painful, degenerative tears, an ultrasound-guided meniscus injection is a genuine alternative to surgery. Placing cortisone accurately next to the tear gives far better and longer-lasting relief than a standard joint injection, and PRP is an option in selected cases. Surgery remains for true mechanical locking and root tears.
To discuss a meniscus injection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
I have had an mri scan on my knee ,it came back meniscus tear & arthritis .if I have private courterzone injection how much would it cost me
It depends on the clinic – the cost can vary from £250 to £700. I’d suggest an injection with ultrasound-guidance.
LM
Great pictures and explanations but can’t surgery be avoided and ultrasound application of cortisone gel be done externally by a physiatrist in the office? Or, is internal saturation of the affected meniscus under ultrasound guidance producing better results?
I suggest injections are done under ultrasound-guidance. It should not be done without imaging.
LM