Ultrasound-Guided Knee Joint Injections

We perform diagnostic ultrasound and ultrasound guided steroid injections for a variety of knee problems.

Knee pain is a common problem with multiple possible causes. Conditions that can potentially result in knee pain include:

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Frequently asked questions about knee pain and injections

What knee conditions can be successfully managed with an injection?

Knee osteoarthritis

Knee joint osteoarthritis is among our practice's most common indications for injection therapy. Generally, there are 3 types of injections used to manage knee osteoarthritis. These include corticosteroid (cortisone), hyaluronic acid and platelet-rich plasma (PRP) injections. Please use the links below to learn more about knee osteoarthritis and the available treatment options.

Meniscal tears

The menisci are small ligaments inside the knee joint that act as a shock absorbent and provide stability to the joint. They can undergo a tear secondary to a knee injury, or this can happen over time as part of the wear-tear process of the knee joint (referred to as a degenerative meniscal tear). If surgical management of a meniscal tear is not indicated or not preferred, there is a role for injection therapy (usually corticosteroid or hyaluronic acid injections) for treating the pain associated with the meniscal tear. Sometimes, knee joint degenerative changes might be associated with the meniscal tear, which would also benefit from the injection treatment. To find out more, please read our article about meniscal tears.

Baker's cyst

Baker’s cysts are localised fluid build-up at the back of the knee. They are secondary to an underlying knee condition (like knee osteoarthritis). They can be uncomfortable and restrictive, especially if they are sizeable. Injection therapy can be useful for the management of Bake’s cyst. Usually, ultrasound-guided aspiration of the Baker’s cyst, followed by a knee joint steroid injection, is performed if the cyst is symptomatic. Please read our article about Baker’s cyst to find out more.

IT band friction syndrome

The iliotibial (IT) band is a tendinous structure that runs at the front/outer aspect of the knee joint. The IT band will rub against bone (the lateral femoral condyle) in IT band friction syndrome. Ultrasound-guided corticosteroid injection allows for accurate steroid placement to the exact site of friction. This can be diagnostic (help confirm the diagnosis) and therapeutic (help reduce the inflammation and pain, to allow for effective rehabilitation). Please read our article about IT band friction syndrome to find out more.

Fat pad impingement

In this condition, there is an impingement of Hoffa’s fat pad (The deep fat pad around the knee joint), usually between the patella (the knee cap) and the femur. If conservative treatment and physiotherapy are ineffective, an ultrasound-guided corticosteroid injection can help reduce inflammation and pain within the fat pad. This would help confirm the diagnosis and allow for effective rehabilitation. To find out more, please read our article about Fat pad impingement.

Patellar tendinosis

Patellar tendinosis refers to painful inflammation of the tendon located just below the knee cap. This is usually seen in sports involving repetitive jumping activity. In cases resistant to physiotherapy and rehabilitation, an ultrasound-guided injection may be indicated. Usually, Platelet-rich plasma (PRP) injections are the treatment of choice for the management of patellar tendinosis. To find out more, Please read our article about patellar tendinosis.

Pes anserine bursitis

This refers to inflammation of the tendons that run at the inner aspect of the knee joint, usually associated with a build-up of fluid at the site of inflammation (referred to as bursitis). This is one of the common conditions we see in our practice, causing pain at the inner aspect below the level of the knee joint. An ultrasound-guided corticosteroid injection is usually effective in managing pes anserine bursitis. To find out more, please read our article about Pes anserine bursitis.

Prepatellar bursitis

Prepatellar bursitis refers to the painful fluid accumulation at the front of the knee joint. Ultrasound-guided aspiration (removal of the fluid using ultrasound guidance), usually combined with a corticosteroid injection at the same time, is usually effective in helpful for the treatment. To find out more, please read our article about prepatellar bursitis.

What are the different types of knee injections?

Different types of injection therapy are used to manage knee joint pain. The type of treatment will depend on the underlying condition, severity, previous treatments and your aims. Generally, there are 3 types of injection options used to manage the different knee conditions mentioned above:

Steroid injections have an anti-inflammatory effect to help reduce the pain and swelling associated with the condition and allow for a more effective rehabilitation program. Intra-articular hyaluronic acid injections aim to support the joint fluid's lubricant and shock absorbent effect. Platelets-rich plasma (PRP) injections have a high concentration of different growth factors that can help the healing process when injected into a joint or tendon. Please click the relevant links to read more about these different treatment options.

Do I need a knee joint injection?

This depends on the diagnosis, severity of the condition and previous trialled treatment options. To get the correct diagnosis, you must be assessed by an experienced practitioner (a knee specialist doctor or an experienced physiotherapist). In most cases, imaging will be needed to confirm the diagnosis and assess the severity of the condition. A weight-bearing x-ray of the knee is the most common imaging assessment performed, mainly when there is suspicion of knee osteoarthritis (wear and tear changes). Ultrasound helps assess the superficial soft tissues around the knee (like ligaments and tendons). It is also very useful to assess for any fluid build-up around the knee joint (like joint effusion, which refers to fluid within the joint or a Baker’s cyst, which refers to fluid accumulation at the back of the knee). MRI is more beneficial for assessing the deep structures (the menisci and the articular cartilage).

Generally, the management of most knee conditions starts with physiotherapy treatment and progressive rehabilitation. The duration of this depends on the condition. Knee injections will be considered if the above response is poor or unsatisfactory. Indications for injection therapy include severe persistent knee pain refractory to conservative treatment and affecting your sleep, routine daily activities or hobbies like sports. Injection therapy can be very useful in reducing pain and improving function, allowing for more effective rehabilitation. We always advise performing knee injections under ultrasound guidance by an experienced doctor to ensure accurate delivery of the medicine to the targeted area.

Should knee injections be done under ultrasound guidance?

There is a variety of problems that can cause knee pain. Ultrasound guidance ensures the needle is placed accurately into the exact area causing the pain. Many studies have shown the benefits of using ultrasound guidance (more accuracy, more efficacy, and fewer side effects and complications compared to unguided injections).

How many knee injections can I have?

We advise reducing the number of knee injections if possible, by combining any injection therapy with an effective physiotherapy programme to address the underlying cause. Repeated knee joint steroid injection should be avoided if the previous injection was less than 3-4 months ago.

Are knee injections painful?

Pain is very subjective and people have different pain thresholds. Generally, knee injections are well-tolerated and the majority of patients experience very little or no pain during the procedure. The corticosteroid is usually mixed with a local anaesthetic (numbing medicine) to enhance pain relief.

How long should I rest after a knee injection?

Usually, we advise patients to rest for 48-72 hours after having a knee injection. This can vary depending on the type of treatment and severity of the condition. Usually, patients who have an intra-articular corticosteroid injection into the knee joint are usually advised to rest for 48 hours, while patients who have a PRP treatment for the patellar tendon may be advised to rest for at least a week.