Six major portals of approach to the knee joint for its aspiration or injection have been described: the lateral and medial mid-patellar (MMP) and patellofemoral; the superolateral and superomedial; and anterolateral and anteromedial (inferolateral and inferomedial) approaches.
The sterile needle is inserted either lateral to the patellar tendon (for the anterolateral approach) or medial to the tendon (for the anteromedial approach), approximately 1 cm above the tibial plateau, and directed 15-45° from the anterior knee surface vertical midline toward the intra-articular joint space.
Cortisone Injections
Also known as corticosteroids or steroid injections, cortisone is a potent anti-inflammatory medication. It is the most common knee injection used to treat osteoarthritis of the knee.
Hydrocortisone injections are used to treat swollen or painful joints, such as after an injury or if you have arthritis. The hydrocortisone is injected directly into the painful joint. This is called an intra-articular injection.
Where is the most painful place to get a cortisone shot? The most painful place to get a steroid (cortisone) shot is into the palm, sole, or into any small space (such as an ankle joint). The size (length) and gauge (width) of the needle can also factor into the amount of pain you experience.
What is SYNVISC? SYNVISC is a viscosupplement injection that supplements the fluid in your knee to help lubricate and cushion the joint, and can provide up to six months of osteoarthritis knee pain relief with three injections.
Administered as a series of 3 injections directly into the knee (one every 7 days), GELSYN-3 works to increase the levels of healthy hyaluronic acid in the affected joint. The hyaluronic acid in GELSYN-3 safely reduces joint pain and stiffness.
Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.
Genicular nerve radiofrequency ablation is a minimally invasive treatment for knee pain due to osteoarthritis of the knee, and can significantly reduce pain, especially for adults who are 50 and older.
How Does Medicare Cover Knee Injection Treatment? Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible.
What is ZILRETTA? ZILRETTA® (triamcinolone acetonide extended-release injectable suspension) is an extended-release corticosteroid approved to manage osteoarthritis knee pain. The benefits and risks of repeat injections have not been demonstrated. Who should not receive ZILRETTA?
The injection consists of two medications: Cortisone (a steroid) and Marcaine (a numbing agent). It is recommended that you refrain from any high level activities using your knee for approximately 48 hours. Routine activities including walking are permitted.
Do knee injections hurt? Receiving knee injections is similar to receiving any other kind of shot. There may be a slight pinch followed by mild discomfort, but overall the injection takes very little time and isn't very painful.
To give yourself an injection you will use your thigh. Use the middle outer part of the thigh to inject. The best area is one hand length below the hip and one hand length above the knee. Use a 20–22-gauge, 1-1½ needle.
An injection of corticosteroids or hyaluronic acid may reduce inflammation and ease pain. Other more experimental injections—such as platelet-rich plasma or stem cells—may relieve pain and encourage healing in damaged soft tissues.
While knee injections are typically safe and risk of complication is quite low, there are some potential adverse effects. These include: Infection. Soreness at the injection site (usually short-lived)
Hyaluronic acid (viscosupplementation) injections tend to work more slowly than cortisone—the full effects may not be felt for about 2 weeks—but the effects may last longer. The primary goal of a hyaluronic acid injection is to lubricate the knee joint.
Do not strain your knee joint for two days after receiving this medicine. Avoid activities such as jogging, soccer, tennis, heavy lifting, or standing on your feet for a long time. Temporary pain or swelling in the knee joint may occur after receiving hyaluronic acid injection.
All knee injections carry a risk of infecting the knee joint. This can happen if there are germs on the needle that is used for the injection. Joint infections are very rare, but they can cause serious problems.
Cortisone injections tend to work quickly, and provide relief, but this can be as short as a few weeks or as long as several months. The gel injections tend to be effective for about 50% of patients, but for those that it works well for those patients tend to see improvement in VAS scores for at least 4-6 months.
Most people see pain lessening and their mobility improving for several months, often as much as 6 months. The key concern here is that the use of these knee injections has to be limited because of the medication within them. They can only be used 2 or 3 times a year for most people.
The idea behind these injections is that they will temporarily restore the natural function of the knee by injecting a substance which will provide cushioning and reduce bone-on-bone contact. Individual responses vary, but many patients experience months, if not potentially a year or more of relief.
There's concern that repeated cortisone shots might damage the cartilage within a joint. So doctors typically limit the number of cortisone shots into a joint. In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year.