The guidelines outlined by the New York State Workers Compensation Board provide general principles for therapeutic injections in the context of knee injuries. These directives aim to assist healthcare professionals in determining appropriate strategies for administering therapeutic injections as part of a comprehensive care plan for individuals with knee injuries.
Healthcare practitioners specializing in therapeutic injections for knee injuries can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for incorporating these injections into the treatment of knee injuries in their patients.
It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the use of therapeutic injections for knee injuries should involve collaboration between the patient and their healthcare provider.
Therapeutic Injections
Delivery of anesthetic and/or anti-inflammatory medications to the painful structure characterizes therapeutic injections. These injections offer various potential advantages. Ideally, they should: (a) reduce inflammation in a specific target area; (b) alleviate secondary muscle spasm; (c) provide relief from pain; and (d) support therapy focused on functional recovery. Diagnostic and therapeutic injections are best utilized early and selectively to establish a diagnosis and aid in rehabilitation. Overuse or use outside a monitored rehabilitation program may significantly diminish their value. Contraindications include general factors such as local or systemic infection, bleeding disorders, allergy to medications used, and patient refusal. Specific contraindications may be applicable to individual injections.
Soft Tissue Joint Injections
Recommended for select patients as clinically indicated. Indications encompass the use of soft tissue and joint injections for analgesic or anti-inflammatory purposes. Injections into the tendon are not advised. Frequency should not exceed two to three times annually, with one or two injections typically sufficient. Time to produce the desired effect is immediate with local anesthetic or within three days with corticosteroids. Optimum/maximum duration is limited to three injections annually at the same site. It is recommended to maintain a minimum of three weeks between injections.
Trigger Point Injections
Not recommended.
Prolotherapy (Sclerotherapy), Protein Rich Plasma (PRP)
Not recommended.
Intra-Capsular Acid Salts – Viscosupplementation
This serves as a treatment for osteoarthritis or degenerative changes in the knee joint. Recommended for select patients as clinically indicated. Indications suggest considering these injections as a therapeutic alternative for patients who have not responded to non-pharmacological and analgesic treatment, especially if non-steroidal anti-inflammatory drug treatment is contraindicated or surgery is not an option. The utility of viscosupplementation in severe osteoarthritis and its efficacy beyond six months are not well known. Frequency involves one series of injections per product instructions. If the initial use results in decreased symptoms and increased function, repeat use may be considered after six months if symptoms recur. Optimum duration varies, and efficacy beyond six months is uncertain.
