Survivorship and outcomes of intra- and perimeniscal corticosteroids injections with structured physiotherapy for degenerative medial meniscus tears.

Mabrouk, A.; Onishi, S.; Jacquet, C.; Cavaignac, E.; Guenoun, D.; Ollivier, M.

Survivorship and outcomes of intra- and perimeniscal corticosteroids injections with structured physiotherapy for degenerative medial meniscus tears.

All Authors

Mabrouk, A.

Onishi, S.

Jacquet, C.

Cavaignac, E.

Guenoun, D.

Ollivier, M.

LTHT Author

Mabrouk, Ahmed

LTHT Department

Trauma & Related Services
Orthopaedics

Publication Date

2025

Item Type

Journal Article

Abstract

BACKGROUND: Degenerative medial meniscus tears are a common pathology in the general population. Recent randomized trials demonstrated non-superiority of arthroscopic partial meniscectomy over conservative management. However, there is a paucity of information regarding the outcomes of combined conservative treatments. HYPOTHESIS: It was hypothesized that combined intra- and perimeniscal corticosteroid injections with structured physiotherapy, for degenerative medial meniscus tears, would result in high surgery-free and second injection-free survivorship. METHODS: A retrospective review of 671 patients with symptomatic degenerative medial meniscus tears, who received intra- and perimeniscal corticosteroids injection combined with structured physiotherapy, was conducted. An ultrasound-guided injection of Triamcinolone Hexacetonide 20 mg/ml comprised; 1.5 ml intra-meniscal,1.5 ml in the meniscal wall, and 2 ml in the peri-meniscal space, was performed. Surgery free- and a second injection free-survivorship were analysed. Western Ontario and Macmaster University scores (WOMAC), Tegner activity scores, patient satisfaction, return-to-work status and average time to return to work were recorded. RESULTS: A total of 481 patients who met the inclusion criteria were included. The mean age was 51.1 +/- 7.9 years. At five years post-procedure, surgery-free, and second injection-free survivorship of the ipsilateral knee was 83%, and 52%, respectively. A multivariate analysis adjusting survival on parametric risk factors identified that only effusion before steroid injection was an independent risk factor of treatment failure. At a mean follow-up of 4 +/- 2 years, there was an improvement in WOMAC scores by 5.2 +/- 4.9 for pain, by 2 +/- 2 for stiffness, by 7.3 +/- 7.4 for function, and by 12.4 +/- 12.7 for the global scores. Additionally, there was significant improvement in the Tegner activity scores (All p < 0.001). Knee effusion and advanced osteoarthritis (Kellgren-Lawrence > III) were significantly associated with poorer outcomes; p < 0.003 and p < 0.0004, respectively. CONCLUSION: A combination of intra- and perimeniscal corticosteroid injections and structured physiotherapy for degenerative medial meniscus tears, results in high surgery-free (83%) and second injection-free (52%) survivorship, as well as, effective clinical outcomes and satisfaction at 5 years. LEVEL OF EVIDENCE: IV; Retrospective Case Series.