Injections and physiotherapy: a promising approach for degenerative meniscus tears

A study shows that combining corticosteroid injections with physiotherapy may delay surgery and improve recovery for degenerative meniscus tears.

Degenerative medial meniscus tears are common in people over 40 and often linked to osteoarthritis. While surgery was once the default treatment, recent research has shifted focus to conservative approaches. The study “Survivorship and outcomes of intra- and perimeniscal corticosteroids injections with structured physiotherapy for degenerative medial meniscus tears” offers valuable new data on this topic. This research suggests a new standard in conservative care for this condition.

Why conservative treatment deserves more attention

In the past, arthroscopic meniscectomy (surgical removal of the damaged part of the meniscus) was the go-to solution. However, multiple randomised studies have shown that it is not always more effective than non-surgical treatment, especially in middle-aged patients. Yet, data on the effectiveness of combined conservative treatments has been limited until now.

This study followed 481 patients with symptomatic degenerative medial meniscus tears treated with ultrasound-guided injections of corticosteroids (triamcinolone hexacetonide) combined with structured physiotherapy. The goal was twofold: avoid surgery and prevent the need for further injections.

A clear protocol, measurable results

Each patient received three targeted corticosteroid injections:

• 1.5 ml directly into the meniscus (intra-meniscal),
• 1.5 ml into the meniscal wall,
• and 2 ml in the surrounding (peri-meniscal) area.

This was followed by a structured physiotherapy programme tailored to the patient's needs.

After five years, the results were clear:

• 83% of patients had not needed surgery on the same knee,
• 52% had not required a second injection,
• significant improvement was seen in pain, function, and overall knee scores (WOMAC and Tegner scores),
• only the presence of knee effusion (fluid accumulation) prior to injection was a strong predictor of treatment failure.

Clinical outcomes and satisfaction

In addition to avoiding surgery, patients experienced:

• a reduction in pain scores by an average of 5.2 points (on the WOMAC scale),
• improved function, stiffness and overall satisfaction,
• a significant boost in activity level, as indicated by higher Tegner scores.

However, results were less favourable in patients with advanced osteoarthritis (Kellgren-Lawrence grade III or higher) or existing joint effusion. These factors were independently associated with poorer outcomes and a higher risk of needing surgery.

A shift in treatment philosophy

This study supports a shift in the standard management of degenerative meniscal tears. Rather than defaulting to surgery, a combined approach using image-guided corticosteroid injections and structured physiotherapy may provide lasting results, especially in patients without advanced joint degeneration.

Patients and clinicians should view these results as part of a broader movement toward meniscal preservation and personalised, step-by-step rehabilitation protocols. It is a promising direction, especially for patients hoping to delay or avoid surgery.

To explore the full data and methodology, we recommend consulting the complete study: “Survivorship and outcomes of intra- and perimeniscal corticosteroids injections with structured physiotherapy for degenerative medial meniscus tears”.

If you are looking for expert care in knee surgery and conservative treatment strategies, book an appointment with Professor Cavaignac, whose experience and precision are recognised internationally.

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