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What Are The Different Types Of Knee Injections

Do You Need Imaging Guidance To Inject A Knee

The Top 5 Types of Knee Injections Explained from an AZ pain center (602) 507-6550

Do not allow a physician or other provider to inject your knee without either ultrasound or x-ray guidance, as blind injections have a significant miss rate. This means that the doctor wont actually get the substance in your knee joint. In order to see how difficult it can be to inject a knee properly using ultrasound, see a course I taught physicians below:

Orthopedic Surgery & Sports Medicine Located In Bozeman Mt

Knee pain is a common problem that can affect your ability to work, exercise, and enjoy your daily activities. If you suffer from chronic or persistent knee pain, the specialists at Alpine Orthopedics and Sports Medicine offer safe and effective knee injections. Located in Bozeman, Montana, the practice has in-office diagnostics to determine the underlying cause of your knee pain and the most effective treatment. To learn more about knee injections, call the office or request an appointment online today.

In The Past Your Doctor May Have Recommended Against The Use Of Cortisone Because It Was Clear To Him Or Her That There Was A Knee Surgery In Your Future

In the past, your doctor may have recommended against the use of cortisone because it was clear to him or her that there was a knee surgery in your future. The concern is if you get cortisone injections into your knee prior to surgery, you will have a greater risk of complications after the surgery. There is a lot of debate around this subject. Some doctors say avoid the cortisone, other doctors are saying it is okay to get one shot to hold you over until you can get surgery or maybe the cortisone will reduce your inflammation enough after the first shot that you will have some degree of pain relief and comfort for a few months, a year, maybe longer.

We are going to start with cortisone because cortisone was the injection of choice. Much has changed.

In a January 2021 paper from doctors at Northwestern University McGaw Medical Center, Rutgers School of Medicine, and Boston College, a current guideline was given for the use of cortisone: The paper appeared in the journal Pain Physician and included the following observations.

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Therapeutic Injections For Knee Arthritis

Therapeutic knee injections can reduce painful symptoms related to knee osteoarthritis. Injections are often used in conjunction with other nonsurgical treatmentssuch as physical therapy, bracing or medications.

Knee injections typically deliver medicine directly inside the knee joint capsule. Ultrasound may be used to help guide placement of an injection.

in the Arthritis-healthInjections Health Center

This page describes different injections available, including cortisone, hyaluronic acid, platelet rich plasma , and stem cell injections, as well as prolotherapy. A physician and patient can discuss these options and decide which, if any, therapy is most appropriate.

The Current Literature Demonstrates The Potential Benefits Of Utilizing Concentrated Bone Marrow Aspirate For The Repair Of Cartilaginous Lesions Bony Defects And Tendon Injuries

Arthritis Blog

Doctors in New Jersey at the Department of Orthopedic Surgery, Jersey City Medical Center published their findings in support of this research, in the World Journal of Orthopedics, here is what the paper said:

  • The current literature demonstrates the potential benefits of utilizing concentrated bone marrow aspirate for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. The studies have demonstrated using concentrated bone marrow aspirate as an adjunctive procedure can result in cartilage healing similar to that of native hyaline tissue, faster time to bony union, and a lower rate of tendon re-rupture.

A June 2018 study in the journal Arthritis and Musculoskeletal Disorders presents the short-term progress of 15 patients with knee osteoarthritis through four bone marrow concentrate treatments.

  • Patients underwent four bone marrow concentrate treatments on average 14 days after 1st treatment, 21 days after the second treatment, and 33 days after the third treatment. The last follow-up was conducted on an average of 86days after the first treatment.

Patients experienced statistically significant improvements in active pain and functionality scores after the first treatment.

  • On average, patients experienced:
  • an 84.31% decrease in resting pain,
  • a 61.95% decrease in active pain,
  • and a 55.68% increase in functionality score at the final follow-up.

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Research: Prolotherapy Treatments For Patients With Knee Osteoarthritis Showed Significant Improvement In Scores For Pain Function And Range Of Motion

In February 2020, Lisa May Billesberger, MD a private practice physician in Canada teamed with Duke Anesthesiology, Duke University School of Medicine to offer a current assessment of injectable treatments for Knee Osteoarthritis. Here are the summary points on Prolotherapy.

  • Prolotherapy is a relatively simple and inexpensive treatment with a high safety profile, is something that could easily be performed in the primary care setting, and is thus worth consideration.
  • The exact mechanism of Prolotherapy is not well understood, but it is thought to induce a pro-inflammatory response that results in the release of growth factors and cytokines, ultimately resulting in a regenerative process within the affected joint.
  • Injection of the hyperosmolar dextrose solution might also hyperpolarize nociceptive pain fibers by forcing open potassium channels, resulting in reduced pain perception.
  • In sum, Prolotherapy likely provides at least some benefit, although the quality of available data makes this statement hard to prove and it certainly does not cause harm.

Other Injections: Hyaluronic Acid Botox And More

Some people have used other types of injections for OA of the knee.

However, experts from the American College of Rheumatology and the Arthritis Foundation dont currently recommend using these, as theres not enough evidence that they work.

Examples of other types of injections include:

  • hyaluronic acid injections, also known as viscosupplementation

You may not know exactly what type of injection youre receiving or what the effect might be.

Always discuss the pros and cons of any treatment with your doctor before starting, so that you can make an informed decision.

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Patients Undergoing Treatment For Knee Osteoarthritis With Prp Can Be Expected To Experience Improved Clinical Outcomes When Compared With Hyaluronic Acid

There is a lot of research comparing PRP to hyaluronic acid. Here are some of the papers:

An April 2020 study led by the Department of Orthopedics, University of Colorado School of Medicine, published in The American Journal of Sports Medicine suggested: Patients undergoing treatment for knee osteoarthritis with PRP can be expected to experience improved clinical outcomes when compared with hyaluronic acid.

Doctors writing in the September 2019 issue of the World Journal of Orthopedics offered these findings in assessing PRP versus hyaluronic acid injections over four, eight, and twelve-week follow-ups after treatments.

  • The effectiveness of PRP treatment in patients with knee osteoarthritis was significantly greater than in the hyaluronic acid group. In addition, two injections of PRP were more effective at each follow-up than a single injection.

In February 2020, a multi-national team of researchers published findings in the European Journal of Orthopaedic Surgery & Traumatology comparing intra-articular knee injection of PRP and hyaluronic acid and investigating clinical outcomes and pain at both 6 and 12 months.

  • Here researchers examined 1,248 cases 636 PRP, 612 hyaluronic acids. The results of this systematic review and meta-analysis suggest that PRP is superior to hyaluronic acid for symptomatic knee pain at 6 and 12 months.

The Efficacy Of Intra

Dr. Garlick, Types of Knee Injections – Florida Orthopaedic Institute

An August 2021 paper from the Department of Orthopaedic Surgery, Rush University Medical Center published in The American Journal of Sports Medicine compared the effectiveness of PRP against other knee injections in younger patients and those without severe degenerative changes. The reason? the efficacy of intra-articular injections as a nonoperative modality for treating symptomatic knee osteoarthritis-related pain while maintaining function has become a subject of increasing interest.

In this study the following treatments were compared:

  • Hyaluronic acid.
  • and plasma rich in growth factors .

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Cortisone Injections Before Knee Surgery Lead To Greater Post

In August 2021, research led by the Department of Orthopaedics, University of Colorado School of Medicine and published in the Orthopaedic Journal of Sports Medicine suggested that patients undergoing knee arthroscopy who receive an intra-articular corticosteroid injection during the perioperative period can be expected to experience significantly higher postoperative infection rates when compared with patients not receiving an injection. Furthermore, patients receiving a corticosteroid injection pre- or intraoperatively may experience significantly higher rates of postoperative infection when compared with patients receiving an injection postoperatively.

For a more detailed discussion on cortisone please see our article: Alternatives to cortisone shots.

Where Can Subcutaneous Injections Be Administered

If youre prescribed an injection that you have to administer yourself at home then its likely itll be a SC injection. This type of injection is used to administer medications like insulin for diabetes, hormone injections for fertility treatment and blood thinning agents to prevent blood clots.

SC injections need to be injected into an area on the body with subcutaneous fat. It is recommended that you inject a SC injection into:

  • The lower abdomen , except for the 2 inches area around the navel
  • The front or outer sides of the thighs
  • The upper area of the buttock
  • The upper outer area of the arms

When selecting an injection site take care to avoid areas where the skin is sunken or lumpy, or areas where you might inject into a muscle rather than subcutaneous tissue. Also avoid sites where the skin is injured or damaged.

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Side Effects Of Knee Osteoarthritis Injections

Potential side effects of these knee osteoarthritis injections include joint swelling and pain. They can’t be used by people with skin or joint infections. In addition, most varieties are made from processed chicken or rooster combs and should not be used in people with egg or poultry allergies. Euflexxa, however, is safe to use in people with egg allergies.

Occasionally, a severe reaction with swelling, redness, and pain, called a pseudoseptic reaction, can occur with some forms of these viscosupplementation materials.

How Does Prolotherapy Work In Your Knees

types of knee injections

In this section, we will discuss Prolotherapy knee osteoarthritis injections. Prolotherapy is a remarkable treatment in its simplicity. The treatment can help many patients avoid joint replacement. But it is not a miracle cure. The research and evidence for how Prolotherapy may help you are presented here and intermingled with our own 27+ years of empirical observation of patient benefit.

In 2016, our Caring Medical research team published our study, A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain in the journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. In this review, we examined the research in the use of dextrose Prolotherapy for the treatment of tendinopathies, knee and finger joint osteoarthritis, and spinal/pelvic pain due to ligament dysfunction. In our section on knee pain, we referred to a study by Dr. Fariba Eslamian and Dr. Bahman Amouzandeh of Tabriz University of Medical Sciences. This is what they published in the journal Therapeutic Advances in Musculoskeletal Disease.

Prolotherapy has been reported as a useful method in the treatment of chronic musculoskeletal and joint diseases. It is proposed that Prolotherapy causes mild inflammation and cell stress in the weakened ligament or tendon area, releases cytokines and growth factors, and induces a new healing cascade in that area, which leads to activation of fibroblasts, generation of collagen precursors, and strengthening of the connective tissue.

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Ten Patients Underwent Intra

A September 2021 study published in The Archives of Bone and Joint Surgery was designed to compare the effectiveness of intra-articular injection of PRP with hyaluronic acid on mild to moderate knee osteoarthritis.

How the study was conducted:

  • Ten patients underwent intra-articular PRP injection and 10 others received hyaluronic acid injection.
  • At baseline visit and one, three, and six, and 12 months post-injection, clinical assessments were performed using standardized patient self-reporting scores for pain, function, and disability.
  • Physical examinations of the knee, including crepitation and range of motion were performed at each visit.


  • The PRP treatment was ascertained to be safe and caused no adverse effects. Significant improvements in the majority of patients were seen in pain and function.
  • The hyaluronic acid injection, however, caused only one months significant improvement in the majority of patient-reported outcomes.
  • In the majority of visits, the extent of improvements in pain and function were significantly greater in PRP recipients, compared to hyaluronic acid recipients.
  • The ROM in both groups slightly increased after interventions.
  • The frequency of coarse crepitation, which was detected in 100% of the patients in both groups at the baseline visit, decreased significantly to fine crepitation at the first follow-up visit in 80% and 40% of the PRP and hyaluronic acid recipients, respectively.

In Clinical Observations At Caring Medical The Benefit Is Seen In Injecting Bone Marrow Directly After Extracting It

The theory is that the number of stem cells is not as important as how long they live in their natural environment. In other words, when the bone marrow is directly injected, the source of stem cells is fresh and has great potential for healing. We also believe that the body knows best it can use these immature cells to regenerate all injured tissues in the joint.

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You Are Sitting In The Orthopedists Office: The Discussion Turns To Cortisone

If you have been to your orthopedist recently and are planning treatment options or surgical options you may have been given a paper handout or webpage to visit or verbal advice on what to expect if you are getting a cortisone injection into your knee.

You may have been told:

The cortisone injection is to help you now, it is not a permanent solution.

  • It is to hold you over until a more effective plan can be introduced.

Physical therapy may be an option instead of the cortisone injection

  • You may then be suggested to physical therapy or continued physical therapy. As we will see below, research suggests that physical therapy would work better than cortisone. But while that may be true for some, it is likely that you are at the cortisone or repeated cortisone injection stage because physical therapy has not worked for you. So you have been to physical therapy and it has not helped you. That is why you are getting the cortisone shot. In fact, you may have tried, yoga, stretching, exercise, and massage for knee pain, and these treatments just didnt help.

Amniotic Or Umbilical Cord Tissue

What Type Of Knee Injection Will Help? [6 Options For Chronic Knee Pain]

These therapies are all derived from birth tissues that are normally considered medical waste. The amniotic sac surrounds the baby and yields amniotic membrane/fluid and the umbilical cord connects the baby to the mother and yields umbilical cord blood and Whartons Jelly. These products are sold to doctors either dehydrated or frozen.

Many providers claim that these are stem cell therapies, but while fresh birth tissues can yield stem cells, once sourced, transported, processed, frozen, and shock thawed no MSCs survive . They do contain growth factors, but even these levels are oftentimes lower than those found in PRP. However, they may also contain unique growth factors that could help cartilage.

Right now, we have little research that these vastly different products help knee arthritis. However, some research does exist. For example, a high-level trial of ReNu showed good short term 6-month results in knee arthritis. These procedures are not covered by insurance and are expensive. However, there is basic science data that the base materials used in some of these products may help cartilage.

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Hyaluronic Acid Injections Or Viscosupplementation For Knee Osteoarthritis: What To Expect When Getting Gel Injections In Knee

Much like cortisone, it is very likely that this knee injection treatment has been explained to you already by your orthopedist. It is a conservative care plan to help you try to manage along until you can get a knee surgery scheduled or you are trying to do everything you can to avoid the knee surgery.

Also like cortisone, you may have already had viscosupplementation and the effects and benefits have now worn off and you need to treat your knee differently. For some people, they may not even be reading this sentence because they have moved down the article to other treatments because this one is no longer an option for them.

What are Hyaluronic acid injections or Viscosupplementation?

The explanation that you may have been given is that hyaluronic acid injections will provide a gel-like cushion in your knee, getting between the shin and thigh bones to alleviate your bone-on-bone situation. The injections increase the volume of the protective synovial fluid in the knee.

  • The treatment is therefore referred to as Viscosupplementation because you are supplementing the viscosity or the thick, sticky, gel-like properties of the synovial fluid. Hyaluronic acid is naturally occurring in the synovial fluid of the knee.

Injections For Arthritis In Knees: What Is Available

Arthritis occurs when the cartilage of the joint wears away exposing bone. This bone exposure leads to pain, swelling and reduced function. Generally, simple treatments such as exercise, medications, and weight loss have the best effect on arthritis. However, in difficult cases, we use injections for arthritis in knees to help with these simple treatments. So, what are the options for knee joint injections and how do you decide?

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Hyaluronic Acid Injections For Knee Arthritis

A hyaluronic acid injection delivers lubricating fluid into the knee joint. The goal is to temporarily lubricate the knee joint, thereby decreasing knee pain and inflammation, improving knee function, and perhaps even slowing the degeneration process.

Prolotherapy typically involves 15-20 injections into the affected soft tissue. This image shows prolotherapy being administered to the knee’s patellar tendon. To treat knee osteoarthritis, prolotherapy injections may be made to other nearby tissues.

The goal of prolotherapy is to stimulate natural tissue repair in the body. During treatment, a physician will inject an irritant, such as a dextrose solution, into the arthritic knee joint and surrounding tissues. Several injectionsperhaps 15 or 20will be made during one treatment session.

Prolotherapy temporarily increases inflammation. The hope is that the additional inflammation will facilitate further healing.

Some clinical research studies suggest prolotherapy is effective in treating knee osteoarthritis,1,2 but these studies vary in quality. Prolotherapy is controversial and not considered standard practice.

Prolotherapy is not appropriate for most people with inflammatory forms of arthritis, such as rheumatoid arthritis or gout.


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