Speaker: Combination injection is better than corticosteroid to treat athletes’ achy knees
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NASHVILLE, Tenn. — To mitigate the downsides of corticosteroid injections, a presenter, here, said she uses injections in professional athletes with “achy knees” that combine platelet-rich plasma, hyaluronic acid and ketorolac.
In a presentation at the Biologic Association Summit portion of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting, Robin V. West, MD, discussed the pros and cons of corticosteroids, hyaluronic acid (HA), ketorolac and PRP injections in athletes with achy knees and in professional athletes in particular.
“My go-to injection for achy knees in the professional athlete, is the combination of platelet-rich plasma, hyaluronic acid and ketorolac. I have selected this combination injection for these young professional athletes because corticosteroid is not a good option. Corticosteroid has shown to produce cartilage necrosis and increased blood glucose levels. Therefore, corticosteroid injections are not great options for our young patients and for professional athletes,” West told Healio Orthopedics.
West, who is president of Inova Musculoskeletal Line, chair of Inova Sports Medicine and an Orthopedics Today Editorial Board Member, said, “This combination injection works well clinically because ketorolac decreases synovitis and is quick acting, and the hyaluronic acid and PRP can lead to chondrocyte proliferation in vitro. The risks of these medications are much lower than corticosteroid injections alone.”
Despite few investigations to date into the particular combination injection that West uses, she said it is known to provide clinical pain relief, improved function and its risk for cartilage necrosis is low.
The PRP and HA in West’s injection of choice for achy knees can produce proliferation of chondrocytes as has been seen in in vitro studies, she said. “It can help the cartilage grow.”
“PRP clinically has been shown to reduce pain, as well as reduce synovial thickness,” which is associated with knee synovitis and inflammation, West said.
Concerning the deleterious effect of corticosteroids on cartilage viability, the rate of cartilage death with corticosteroids is reduced when these are mixed with PRP, according to West.
She said she injects athletes’ knees once weekly for 3 weeks with her go-to combination injection of PRP, HA and ketorolac. Most patients respond within 24 hours. “The combination seems to work better,” West said.
Research has shown the viscoelastic properties of HA are reduced when formulations with a concentration less than 1% are used and mixed with PRP, she noted. Therefore, West recommended only using HA “with a higher concentration.”
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West RV. Achy knees in the NBA, NFL, NHL, MLS, MLB: What is your go-to injection? Presented at: American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting; July 7-11, 2021; Nashville, Tennessee.
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