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

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.