Ultrasound-guided meniscal-wall steroid injection for DML significantly reduces the risk of surgery and improves knee function over time.
Degenerative meniscal lesions (DML) are common and challenging to manage conservatively, especially when they cause chronic knee pain without signs of osteoarthritis. A recent clinical study titled “Meniscal-wall ultrasound-guided steroid infiltration for degenerative meniscal lesions (DML) shows low rate of conversion to surgery” provides compelling evidence that ultrasound-guided corticosteroid injections directly targeting the meniscal wall can be a safe and effective solution.
To explore further, you can read more of Professor Étienne Cavaignac’s published studies available on his website.
Degenerative meniscal lesions develop gradually, usually due to age-related changes in the knee’s meniscal tissue. These lesions typically affect the medial meniscus and are often found incidentally during MRI scans. Although not always symptomatic, when pain is present, conservative management is preferred unless mechanical symptoms like locking or catching occur.
The management of DML has historically been difficult due to inconsistent outcomes from surgery and limited guidance in existing clinical protocols. Arthroscopic surgery is not considered beneficial for stable, painful DML without mechanical symptoms, as confirmed by major guidelines. This makes non-surgical treatments essential for symptom control and functional improvement.
The study led by Professor Etienne Cavaignac and his team evaluated the effectiveness of ultrasound-guided corticosteroid injections for DML administered directly at the meniscal wall. This area, rich in free nerve endings, is considered the “trigger zone” responsible for pain in DML. By injecting corticosteroids precisely into this perimeniscal region, the treatment targets inflammation where it originates rather than dispersing into the entire joint.
A total of 187 patients with medial DML (without osteoarthritis) were included in the retrospective study, with a minimum of 24 months’ follow-up. The injection technique was performed under ultrasound guidance, ensuring accuracy and avoiding unnecessary diffusion into unaffected areas.
The results demonstrate the low rate of conversion to surgery, with 95% of patients avoiding surgery at the 24-month mark. This indicates that ultrasound-guided meniscal-wall injections for DML can successfully postpone or eliminate the need for arthroscopic or other surgical interventions in appropriately selected patients.
The clinical assessments showed:
These values reflect substantial symptom relief and functional improvement over an average follow-up of nearly 33 months.
Among patients with a SKV over 90, body mass index (BMI) emerged as the only significant factor associated with an excellent response. Individuals with a lower BMI experienced better functional recovery, with an average BMI of 24.04 compared to 26.23 in others. No significant differences were found in age, job type, sport activity or symptom duration, indicating that BMI is a key modifiable factor to consider in treatment planning.
Traditional intra-articular corticosteroid injections often fail to provide lasting relief in DML cases. This is largely due to the rapid clearance of the drug from the joint space and the fact that these injections do not specifically reach the meniscal pain receptors.
In contrast, targeted meniscal-wall injections for DML allow for:
This study stands out by its strict inclusion and exclusion criteria, avoiding the bias of prior surgeries, traumatic meniscal tears or patients with radiographic osteoarthritis. The injection was administered by a radiologist trained in musculoskeletal procedures, ensuring consistency and safety. By excluding unstable lesions or those with mechanical symptoms, the research focuses on a clearly defined patient group that benefits most from this technique.
The study also highlights the importance of standardised follow-up, conducted either in person or by phone using validated scales (VAS, SKV, Tegner). This ensures a reliable assessment of the treatment’s long-term benefits.
This study confirms that ultrasound-guided meniscal-wall corticosteroid injection for DML is a valuable non-surgical option for patients. It provides long-lasting pain relief, functional improvement and a very low risk of surgical intervention when osteoarthritis is not present.
If you are considering non-surgical treatments for knee pain or wish to explore tailored surgical options, Professor Cavaignac is highly recommended for his advanced, evidence-based approach to patient care.
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