Steroid Injection for Knee Meniscal Tear

A meniscal tear is a knee injury involving a tear to the tough and rubbery cartilage in the knee called the meniscus. It can be due to age (degeneration) or injury (trauma). 

Meniscal tears come in various shapes and sizes (see image below).

Knee -OA

Causes

 

  • Meniscal tears are commonly caused by:

    • Twisting or rotating the knee while the foot is planted, often during sports or physical activities.
    • Deep squatting or heavy lifting.
    • Ageing and degeneration of cartilage in the knee, making it more prone to injury. Degenerative tears are usually seen in those who are middle-aged (>40 years old), where the tear occurs due to gradual wear and tear of the cartilage (Buchbinder et al,  2016).

Symptoms of a knee joint meniscal tear

 

  • Knee pain on the inner side of the knee joint – if a medial meniscus tear, or the outer side of the knee joint – if a lateral meniscus tear.
  • Catching or locking of knee.
  • Swelling may occur a few hours after an acute injury.
  • Difficulty fully bending or straightening the knee.

Anatomy

The meniscus comprises two crescent-shaped pieces of thick, rubber-like cartilage in the knee joint between the femur (thigh bone) and tibia (shin bone). One is located on the inner side of the knee (medial meniscus) and the other is on the outer side of the knee (lateral meniscus).

It helps by acting as a shock absorber, distributes weight evenly and provides stability to the knee. The meniscus typically has a limited blood supply.  The outer third is known as the “red-red zone” and has the best supply, the middle third is known as the “red-white zone” and has a moderate blood supply, the inner third of the meniscus is known as the “white-white zone” which has no direct blood supply.

Knee Anatomy

How to diagnose

A thorough examination by the physiotherapist including detailed questioning and a physical examination of the knee.

An MRI scan would be required to find out the location of the meniscus tear and what type of tear that’s occurred.

Treatment

 

A study by van de Graaff et al (2022) compared outcomes of physiotherapy treatment or arthroscopic partial meniscectomy for the treatment of traumatic meniscal tears in the young population. They found that at the 24-month follow-up, the outcomes were the same in both groups. 41% of the physiotherapy group opted to have a delayed arthroscopic partial meniscectomy and still had the same outcome as the physiotherapy and early operation group.

Sihvoven et al (2020) also found that having surgery for degenerative meniscus tears is no better than a placebo operation.

Another recent study by Damsted et al (2024) compared rehab and surgery treatment for those with knee pain due to a traumatic or non-traumatic meniscal tear. Patients were aged between 18-40 years old and included all types of meniscal tears except complex and displaced meniscal tears. It found no significant differences in outcomes in both traumatic or non-traumatic meniscal tears if they had surgery or rehab.

It is also important to note that any type of surgery for any meniscal tear will lead to greater risks of knee arthritis after (Persson et al,2018).

    Knee joint meniscal tear and Injection therapy

    If the pain does not settle with physiotherapy treatment, then an injection might be appropriate.

    Two types of injections that may be used alongside physiotherapy treatment are hyaluronic acid (HA) injections and steroid injections.

    Hyaluronic  acid  injection

    Hyaluronic acid is a naturally occurring substance  in the body and is found in high concentrations in the skin, connective tissues, and eyes.  Hyaluronic acid is then injected into the knee joint under ultrasound guidance to help supplement the synovial fluid, improving the knee joints lubricating and shock-absorbing properties. By restoring the viscosity and cushioning  of the joint fluid, the injections can reduce joint pain, improve joint mobility, enhance tissue health and reduce the need for subsequent surgeries like an arthroscopic partial meniscectomy (Berton et al, 2020)

    Some  studies  suggest that  hyalauronic aciid  injections into the knee joint,  promotes tissue healing in the meniscus  (Mazy et  al,2024).

    Dong et al (2023) found that arthroscopic surgery combined with HA injection, has better results than arthroscopy alone. There were better outcomes  on relieving joint pain, improving joint function and mobilitiy with no increase of compliciatiions.

    Steroid injections

    Steroid injections have strong anti-inflammatory properties and used to reduce pain and inflammation in the knee joint. It is injected into the knee under  ultrasound guidance. The injection doesn’t repair the meniscus itself, but it reduces pain, swelling, inflammation and stiffness (Wilderman  et al, 2019). 

    The relief is short-term and can last from a few weeks to several months depending on the severity of the tear and individual response. The goal for a steroid injection is  to manage symptoms while allowing the  body to heal  and delay further invasive treatments, such as surgery.

    If you are experiencing knee pain and want to find out what is causing your symptoms, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 020 3475 5767 or email reception@oxfordcircusphysio.co.uk

    References

    Berton, A., Longo, U.,  Candela, V., Greco, F., Martina, F., Quattrocchi, C. and Denaro,  V. (2020) Quantitative Evaluation of Meniscal  Healing  process  of Degenerative meniscus Lesions Treated with Hyaluronic Acid: A Clinical and  MRI Study. Journal of Clinical Medicine. 9(7) pp.2280.

    Buchbinder, R.,  Harris, I. and Sprowson, A.(2016) Management of degenerative  meniscus tears and the role  of surgery.  British  Journal of Sports Medicine. 50(22) pp.1413-1416.

    Damsted, C., Skou, S., Holmich, P., Lind, M., Varnum, C., Jensen, H., Hansen, M. and Thorlund, J. (2024) Early surgery versus exercise therapy and patient education for traumatic and nontraumatic meniscal tears in young adults – an exploratory analysis from the DREAM trial. Journal of orthopaedic and sports physical therapy. 54(5) pp.340-349.

    Dong,Z., Huang, L. Wu, G., Li,P.  and Wei,X. (2023) Efficacy and  safety  of arthroscopic surgery combined with hyaluronic acid for meniscal injuries: A systematic review and meta-analysis of randomized controlled studies. Journal of Orthopaedic  Surgery. 31(1) doi:10.1177/10225536231156699

    Mazy, D., Wang, J., Dodin,  P., Lu, D., Moldova, f. And Nault,  M-L. (2024) Emerging biologic augmentation strategies for meniscus repair: a systematic review. BMC Musculoskeletal Disorders. 25(1) pp.541.

    Persson, F., Turkiewicz, A., Bergkvist, D., Neuman, P. and Englund, M. (2018) The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population. Osteoarthritis cartilage. 26(2) pp.195-201.

    Sihvonen, R., Paavola, M., Malmivaara, A., Itala, A., Joukainen, A., Kalske, J., Nurmi, H., Kumm, J., Silanpaa, N., Kiekara, T., Turkiewicz, A., Toivonen, P., Englund, M., Taimela, S. and Jarvinen, T. (2020) Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled  FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. British Journal of Sports Medicine. 54 (22) Pp.1332-1339.

    Van der Graff, S., Eigenraam, S., Meuffels, D., van Es, E., Berhaar, J., Jan Hofstee, D., Auw Yang, Kiem., Noorduyn, J., van Arkel, E.,  van de Brand, I., Janssen, R., Liu, W-Y., Bierma-Zeinstra, B. and Reijman, M. (2022) Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial. British Journal of Sports Medicine. 56(5) pp.870-876.

    Wilderman, I.,  Berkovich, R., Meaney, C., Kleiiner,O. And Perelman, V. (2019) Meniscus-Targeted  Injections for Chronic Knee Pain Due to Meniscal Tears of Degenerative  Fraying: A Retrospective Study. Journal of Ultrasound in Medicine. 38(11) pp. 2853-2859.