Discover how ultrasound-guided corticosteroid injection targets knee pain at its source for effective treatment of degenerative meniscal tear.
Degenerative meniscal tears are a common cause of knee pain, particularly in older adults. While conservative management is typically the first approach, conventional intra-articular injections often fail to target the root cause of symptoms.
A recent publication by Prof. Etienne Cavaignac and his peers titled “Ultrasound-Guided Injection of a Corticosteroid Technique for the Treatment of Degenerative Meniscal Tear” offers a new, targeted alternative based on precise anatomical injection. This article summarises the findings and techniques from that study.
If you are interested in exploring related treatments and techniques, we invite you to read the other clinical studies by Professor Étienne Cavaignac.
Current standards in degenerative meniscal tear conservative treatment include physical therapy, NSAIDs and corticosteroid injections into the joint. The underlying issue is that the corticosteroid does not remain localised, it is rapidly cleared from the joint via synovial capillaries and lymphatic drainage, and crucially, does not reach the meniscus's pain-sensitive areas.
The new technique involves ultrasound-guided injection directly into the meniscal wall: a more precise, anatomically targeted approach. This is where the tear often causes the most inflammation and where the highest density of nociceptors (pain receptors) is found. By injecting into the meniscal periphery, the corticosteroid acts directly on the trigger zone, reducing inflammation at its source.
The degenerative meniscal tear treatment using ultrasound guidance begins with the identification of key anatomical structures via sonography. The goal is to deliver corticosteroid directly into the perimeniscal area, maximising therapeutic effect while avoiding damage to nearby nerves or vessels.
The medial meniscus is visualised longitudinally and transversely. The perimeniscal capillary plexus, a richly vascularised zone, is especially targeted. This area has healing potential unlike the inner third of the meniscus, which lacks both vascular and nerve supply.
By using a high-frequency 18 MHz probe and a gel pad between the probe and skin, the team ensures optimal needle positioning and real-time visual confirmation. The anterior aspect of the medial collateral ligament serves as a reliable landmark for transducer placement.
Bright echoes on ultrasound confirm the diffusion of corticosteroid between the meniscal wall and capsule (this is the therapeutic zone).
Several studies using cadaveric models have confirmed the safety and precision of this targeted technique. The vascularised outer third of the meniscus also contains the majority of pain fibres, making it the optimal site for corticosteroid delivery.
This ultrasound-guided degenerative meniscal tear treatment offers:
Patients undergo a 4-week physical therapy plan post-injection. This includes massage, cryotherapy and exercises to improve joint mobility and strengthen the quadriceps. The goal is to restore functional stability and avoid further joint degeneration.
While this method presents a promising new direction in the degenerative meniscal tear treatment, it requires specific skills:
Table summaries in the original publication also highlight key pitfalls (e.g. improper needle placement) and pearls (e.g. use of Doppler to locate vessels).
Ultrasound-guided injection into the meniscal wall is a targeted, effective conservative treatment for patients suffering from degenerative meniscal tear. Unlike traditional joint injections, this method addresses the actual pain trigger zone with precision and minimal risk.
For expert care, precision and innovation in meniscal treatment, we highly recommend consulting Professor Cavaignac, who is recognised for his work in orthopaedic surgery and knee care.
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