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Thursday, June 09, 2011

What are the risks of injecting cortisone into the groove under the knee cap?

Hi Gary. I'm a long time middle and long-distance runner now in my late 40s and was wondering about the risks of cortisone injected into the space between the patella and femoral end where the groove is? I've worn off the cartilage to the bone in an area about 5 mm in diameter.

I take glucosamine/chondroitin, ibuprofen occasionally, and have had a Synvisc shot in that area (6 mo. ago). I run about 5 days/wk for a total of 20-25 mi and about half of that on soft surfaces and half on pavement. Anything you could tell me would be helpful. Thank you.
For some reason cortisone injections are back in high fashion.  Cortisone injections are now the most common inquiry I receive nowadays.  Is it because it is a procedure that wannabe surgeons (who never quite made the grade) can apply in the comfort of their consulting rooms? Is it because it is lucrative procedure?  Is it because it is a quick-fix solution with consequences that show up long after there can be any kind of come back?

Cortisone injections to the articular surfaces of the knee joint may give relief but potentially at a huge cost in the form of accelerated loss of joint surface tissues and further erosion of any bone that is already exposed.  You see, the way cortisone works is it kills off the tissue that is causing pain.  Dead tissue won't hurt but this is only buying the recipient a little time while the wear and tear continues (painlessly for a while).  Eventually there will be no option other than to stop running altogether and  to start saving for that Zimmer Frame!  If there is too much wear then even extended rest will not stop or reverse the further loss of healthy joint tissue.  There is a tipping point of no return and my advice is to stay well short of that. - wherever that point may be.  Your knees must serve you for 100 years, so it is madness to ruin them so early in your journey through life.  Love them and they will serve you well.

If you have wear and tear under the knee I suggest you consider doing something else other than running that is knee friendly, activities such as kayak paddling, mountain biking and swimming.  If you are going to run, keep the duration to about 40 minutes three times a week and do your main exercise riding a bike or paddling.  This is what I am doing myself after having had two major knee operations.  At 58 years my knees are feeling better than they were at 30 years.

I suggest that you find a good running coach who is familiar with "funny running" sprint drills.  The idea is not to turn you into a sprinter but to teach you drills that improve running style (Best described as "running tall").  Most older runners tend to run with their bottoms dragging behind them and never fully extending at the knees and hips.  This running style is not only inefficient but also wear-some on the knee caps.

Glucosamine and chondroitin when taken daily may assist but the benefits may not be seen for at least three months, so keep taking these.

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1 comment:

KingArthurUSA said...

I hope everyone has the opportunity to read Gary's article on cortisone and view the picture of bone lost. ( I have it on my website) There is no quick fix, but athletes rely on the the so called experts to guide them. Andy Murray,number 4 in the world professional tennis player, recently had 2 injections administered into his elbow 30 minutes before a tennis match. Health is wealth