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Revisiting Intraarticular Corticosteroid Injections and Sports Medicine: Outcomes and Perioperative Considerations

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Abstract

Intraarticular corticosteroid injections are commonly administered by physicians to provide analgesia for acute athletic injuries, though there is an increasing body of literature that has illuminated substantial risks to the soft tissues. A review of Clinical Key, MEDLINE, and PubMed databases from 2012 to 2020 was performed using search terms, including corticosteroid, shoulder arthroscopy, knee arthroscopy, hip arthroscopy, intraarticular, and injections. The references of pertinent articles were reviewed for other relevant sources. Corticosteroid injections can provide reliable pain control in athletes for various pathologies affecting the shoulder, knee, and hip. The use of these medications has demonstrated efficacy in some disorders, whereas the clinical benefit for others remains questionable. Intraarticular injections to the shoulder, knee, and hip are all associated with increased risks to the soft tissues, which must be considered and weighed heavily, especially in an athlete. Perioperative corticosteroids confer an increased risk of surgical site infection after knee, shoulder, and shoulder arthroscopy. Subacromial injections confer an increased risk for revision rotator cuff repair if given within 6 months of surgery, but are safe if given at least 1 month postoperatively. Hip injections for chondral pathology perform significantly better than those for labral injuries.

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References

  1. Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol. 2006;148:245–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hollander JL, Brown EM Jr, Jessar RA, Brown CY. Hydrocortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent. J Am Med Assoc. 1951;147:1629–35.

    Article  CAS  PubMed  Google Scholar 

  3. Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21:571–6.

    PubMed  Google Scholar 

  4. Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med. 2015;3:2325967115581163.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Weber AE, Trasolini NA, Mayer EN, Essilfie A, Vangsness CT Jr, Gamradt SC, et al. Injections prior to rotator cuff repair are associated with increased rotator cuff revision rates. Arthroscopy. 2019;35:717–24.

    Article  PubMed  Google Scholar 

  6. Wang D, Camp CL, Ranawat AS, Coleman SH, Kelly BT, Werner BC. The timing of hip arthroscopy after intra-articular hip injection affects postoperative infection risk. Arthroscopy. 2017;33:1988–94 e1981.

    PubMed  Google Scholar 

  7. Tassiulas I, Wilder R, Boumpas D, editors. Chapter 34: corticosteroids. Philadephia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  8. Cole BJ, Schumacher HR Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13:37–46.

    Article  PubMed  Google Scholar 

  9. Creamer P. Intra-articular corticosteroid injections in osteoarthritis: do they work and if so, how? Ann Rheum Dis. 1997;56:634–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Boumpas DT, Chrousos GP, Wilder RL, Cupps TR, Balow JE. Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates. Ann Intern Med. 1993;119:1198–208.

    Article  CAS  PubMed  Google Scholar 

  11. Derendorf H, Mollmann H, Gruner A, Haack D, Gyselby G. Pharmacokinetics and pharmacodynamics of glucocorticoid suspensions after intra-articular administration. Clin Pharmacol Ther. 1986;39:313–7.

    Article  CAS  PubMed  Google Scholar 

  12. Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 2007;8:63.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Moore G, editor. Chapter 35: arthrocentesis technique and intraarticular therapy. Philadephia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  14. Yaftali NA, Weber K. Corticosteroids and hyaluronic acid injections. Clin Sports Med. 2019;38:1–15.

    Article  PubMed  Google Scholar 

  15. Genovese MC. Joint and soft-tissue injection: a useful adjuvant to systemic and local treatment. Postgrad Med. 1998;103:125–34.

    Article  CAS  PubMed  Google Scholar 

  16. Tempfer H, Gehwolf R, Lehner C, Wagner A, Mtsariashvili M, Bauer HC, et al. Effects of crystalline glucocorticoid triamcinolone acetonide on cultered human supraspinatus tendon cells. Acta Orthop. 2009;80:357–62.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim IB, Jung DW. An intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity. Am J Sports Med. 2018;46:2192–202.

    Article  PubMed  Google Scholar 

  18. Cole BF, Peters KS, Hackett L, Murrell GA. Ultrasound-guided versus blind subacromial corticosteroid injections for subacromial impingement syndrome: a randomized, double-blind clinical trial. Am J Sports Med. 2016;44:702–7.

    Article  PubMed  Google Scholar 

  19. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376:1751–67.

    Article  CAS  PubMed  Google Scholar 

  20. Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis. 2009;68:1843–9.

    Article  CAS  PubMed  Google Scholar 

  21. Hart L. Corticosteroid and other injections in the management of tendinopathies: a review. Clin J Sport Med. 2011;21:540–1.

    Article  PubMed  Google Scholar 

  22. Shin SJ, Do NH, Lee J, Ko YW. Efficacy of a subacromial corticosteroid injection for persistent pain after arthroscopic rotator cuff repair. Am J Sports Med. 2016;44:2231–6.

    Article  PubMed  Google Scholar 

  23. Werner BC, Cancienne JM, Burrus MT, Griffin JW, Gwathmey FW, Brockmeier SF. The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in Medicare patients. J Shoulder Elb Surg. 2016;25:390–7.

    Article  Google Scholar 

  24. Forsythe B, Agarwalla A, Puzzitiello RN, Sumner S, Romeo AA, Mascarenhas R. The timing of injections prior to arthroscopic rotator cuff repair impacts the risk of surgical site infection. J Bone Joint Surg Am. 2019;101:682–7.

    Article  PubMed  Google Scholar 

  25. Kew ME, Cancienne JM, Christensen JE, Werner BC. The timing of corticosteroid injections after arthroscopic shoulder procedures affects postoperative infection risk. Am J Sports Med. 2019;47:915–21.

    Article  PubMed  Google Scholar 

  26. Bonnevialle N, Bayle X, Faruch M, Wargny M, Gomez-Brouchet A, Mansat P. Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder? J Shoulder Elb Surg. 2015;24:1257–62.

    Article  Google Scholar 

  27. Dolkart O, Chechik O, Bivas A, Brosh T, Drexler M, Weinerman Z, et al. Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: biomechanical studies in rats. J Shoulder Elb Surg. 2017;26:1789–93.

    Article  Google Scholar 

  28. Maman E, Yehuda C, Pritsch T, Morag G, Brosh T, Sharfman Z, et al. Detrimental effect of repeated and single subacromial corticosteroid injections on the intact and injured rotator cuff: a biomechanical and imaging study in rats. Am J Sports Med. 2016;44:177–82.

    Article  PubMed  Google Scholar 

  29. Ramirez J, Pomes I, Cabrera S, Pomes J, Sanmarti R, Canete JD. Incidence of full-thickness rotator cuff tear after subacromial corticosteroid injection: a 12-week prospective study. Mod Rheumatol. 2014;24:667–70.

    Article  CAS  PubMed  Google Scholar 

  30. Traven SA, Brinton D, Simpson KN, Adkins Z, Althoff A, Palsis J, et al. Preoperative shoulder injections are associated with increased risk of revision rotator cuff repair. Arthroscopy. 2019;35:706–13.

    Article  PubMed  Google Scholar 

  31. Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Adverse impact of corticosteroid injection on rotator cuff tendon health and repair: a systematic review. Arthroscopy. 2019.

  32. Lattermann C, Jacobs CA, Proffitt Bunnell M, Huston LJ, Gammon LG, Johnson DL, et al. A multicenter study of early anti-inflammatory treatment in patients with acute anterior cruciate ligament tear. Am J Sports Med. 2017;45:325–33.

    Article  PubMed  Google Scholar 

  33. Wilderman I, Berkovich R, Meaney C, Kleiner O, Perelman V. Meniscus-targeted injections for chronic knee pain due to meniscal tears or degenerative fraying: a retrospective study. J Ultrasound Med. 2019;38:2853–9.

    Article  PubMed  Google Scholar 

  34. Garrett WE Jr, Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ, et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: part-II, certification examination case mix. J Bone Joint Surg Am. 2006;88:660–7.

    Article  PubMed  Google Scholar 

  35. Rasmussen S, Lorentzen JS, Larsen AS, Thomsen ST, Kehlet H. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy. Acta Orthop Scand. 2002;73:175–8.

    Article  PubMed  Google Scholar 

  36. Kizilkaya M, Yildirim OS, Dogan N, Kursad H, Okur A. Analgesic effects of intraarticular sufentanil and sufentanil plus methylprednisolone after arthroscopic knee surgery. Anesth Analg. 2004;98:1062–5 table of contents.

    Article  CAS  PubMed  Google Scholar 

  37. Cancienne JM, Gwathmey FW, Werner BC. Intraoperative corticosteroid injection at the time of knee arthroscopy is associated with increased postoperative infection rates in a large Medicare population. Arthroscopy. 2016;32:90–5.

    Article  PubMed  Google Scholar 

  38. Cancienne JM, Kew ME, Smith MK, Carson EW, Miller MD, Werner BC. The timing of corticosteroid injections following simple knee arthroscopy is associated with infection risk. Arthroscopy. 2019;35:1688–94.

    Article  PubMed  Google Scholar 

  39. Blanco I, Krahenbuhl S, Schlienger RG. Corticosteroid-associated tendinopathies: an analysis of the published literature and spontaneous pharmacovigilance data. Drug Saf. 2005;28:633–43.

    Article  CAS  PubMed  Google Scholar 

  40. Chen SK, Lu CC, Chou PH, Guo LY, Wu WL. Patellar tendon ruptures in weight lifters after local steroid injections. Arch Orthop Trauma Surg. 2009;129:369–72.

    Article  PubMed  Google Scholar 

  41. Iizuka M, Yao R, Wainapel S. Saphenous nerve injury following medial knee joint injection: a case report. Arch Phys Med Rehabil. 2005;86:2062–5.

    Article  PubMed  Google Scholar 

  42. Kontovazenitis PI, Starantzis KA, Soucacos PN. Major complication following minor outpatient procedure: osteonecrosis of the knee after intraarticular injection of cortisone for treatment of knee arthritis. J Surg Orthop Adv. 2009;18:42–4.

    CAS  PubMed  Google Scholar 

  43. Habib GS, Bashir M, Jabbour A. Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee. Ann Rheum Dis. 2008;67:1790–1.

    Article  CAS  PubMed  Google Scholar 

  44. Xu C, Peng H, Li R, Chai W, Li X, Fu J, et al. Risk factors and clinical characteristics of deep knee infection in patients with intra-articular injections: a matched retrospective cohort analysis. Semin Arthritis Rheum. 2018;47:911–6.

    Article  PubMed  Google Scholar 

  45. Qvistgaard E, Christensen R, Torp-Pedersen S, Bliddal H. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthr Cartil. 2006;14:163–70.

    Article  CAS  Google Scholar 

  46. Subedi N, Chew NS, Chandramohan M, Scally AJ, Groves C. Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis. Clin Radiol. 2015;70:1276–80.

    Article  CAS  PubMed  Google Scholar 

  47. Lai WC, Arshi A, Wang D, Seeger LL, Motamedi K, Levine BD, et al. Efficacy of intraarticular corticosteroid hip injections for osteoarthritis and subsequent surgery. Skelet Radiol. 2018;47:1635–40.

    Article  Google Scholar 

  48. Deshmukh AJ, Panagopoulos G, Alizadeh A, Rodriguez JA, Klein DA. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis? Skelet Radiol. 2011;40:1449–54.

    Article  Google Scholar 

  49. Krych AJ, Sousa PL, King AH, Engasser WM, Levy BA. Intra-articular diagnostic injection exhibits poor predictive value for outcome after hip arthroscopy. Arthroscopy. 2016;32:1592–600.

    Article  PubMed  Google Scholar 

  50. Kivlan BR, Martin RL, Sekiya JK. Response to diagnostic injection in patients with femoroacetabular impingement, labral tears, chondral lesions, and extra-articular pathology. Arthroscopy. 2011;27:619–27.

    Article  PubMed  Google Scholar 

  51. Lynch TS, Steinhaus ME, Popkin CA, Ahmad CS, Rosneck J. Outcomes after diagnostic hip injection. Arthroscopy. 2016;32:1702–11.

    Article  PubMed  Google Scholar 

  52. Byrd JWT, Bardowski EA, Civils AN, Parker SE. The safety of hip arthroscopy within 3 months of an intra-articular injection. J Bone Joint Surg Am. 2019;101:1467–9.

    Article  PubMed  Google Scholar 

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This article is part of the Topical Collection on Surgery

Study Design: Clinical review; Level of Evidence: Level 4

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Haskel, J.D., Kaplan, D.J., Kirby, D.J. et al. Revisiting Intraarticular Corticosteroid Injections and Sports Medicine: Outcomes and Perioperative Considerations. SN Compr. Clin. Med. 3, 870–878 (2021). https://doi.org/10.1007/s42399-021-00758-x

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