Injection

Injection therapies play an important role in treating arthritis, tendinitis, and other common sports injuries. Depending on the specific diagnosis and treatment location, injections may be performed in the clinic under ultrasound guidance or in the operating room using fluoroscopic (X-ray) guidance to improve precision and safety.

Corticosteroid injections are anti-inflammatory medications injected into or around a joint to reduce inflammation and relieve pain. They are commonly used to treat conditions such as osteoarthritis, bursitis, and inflammatory tendon disorders.

Clinical studies demonstrate that intra-articular corticosteroid injections can provide short-term pain relief and improved function, particularly in knee osteoarthritis, with benefits typically lasting 4–12 weeks (McAlindon et al., 2017; Bannuru et al., 2015). Because corticosteroids primarily reduce inflammation rather than address underlying structural degeneration, symptom relief may be temporary.

While corticosteroid injections can provide effective short-term pain relief, they are used judiciously because repeated injections may have potential effects on joint and tendon health. Some studies suggest that repeated intra-articular corticosteroid injections may be associated with accelerated cartilage loss in knee osteoarthritis (McAlindon et al., 2017). Corticosteroids can also weaken tendon tissue, and injections near certain tendons have been associated with higher rates of subsequent tendon rupture or surgical repair, particularly with repeated use (Dean et al., 2014). For this reason, corticosteroid injections are typically used selectively as part of a comprehensive treatment plan.

Corticosteroid injections are widely accepted treatments and are typically covered by most insurance plans when medically indicated.

Hyaluronic acid injections (viscosupplementation) are used to treat knee osteoarthritis. Hyaluronic acid is a naturally occurring component of synovial fluid that contributes to the viscoelastic properties of the joint environment. In osteoarthritis, both the concentration and molecular weight of hyaluronic acid in synovial fluid decrease.

Injected HA may help modulate joint inflammation and improve the biomechanical properties of synovial fluid, leading to modest improvements in pain and function in selected patients with mild to moderate knee osteoarthritis (Bannuru et al., 2015; Altman et al., 2015). However, results across studies are mixed, and some clinical guidelines recommend selective rather than routine use.

Insurance coverage varies, but most insurance plans cover hyaluronic acid injections only for knee osteoarthritis.

Platelet-Rich Plasma (PRP) is an orthobiologic therapy derived from the patient’s own blood. After processing, the platelet-rich portion contains growth factors and bioactive proteins that may support tissue healing and modulate inflammation.

PRP has been studied for several orthopaedic conditions, including tendon injuries and knee osteoarthritis. Multiple randomized trials and meta-analyses suggest PRP may improve pain and function in knee osteoarthritis and may provide longer symptom relief compared with corticosteroid or hyaluronic acid injections in some patients (Dai et al., 2017; Belk et al., 2021). However, variability in preparation methods and study design continues to limit standardization.

PRP has also been used in the treatment of chronic tendon injuries such as lateral epicondylitis (tennis elbow), patellar tendinopathy, and Achilles tendinopathy. Platelets contain growth factors that may help stimulate tissue healing and reduce inflammation within degenerative tendons. Several randomized controlled trials have shown PRP may provide improved pain relief and functional outcomes compared with corticosteroid injections for chronic lateral epicondylitis, particularly in the longer term (Mishra et al., 2014; Krogh et al., 2013). While results across studies remain variable, PRP may be considered in patients with persistent tendon symptoms that have not improved with conservative treatment.

Because PRP is considered a biologic therapy, most insurance plans do not cover PRP injections, and they are typically an out-of-pocket treatment. PRP injections can be performed in the clinic, and our current out-of-pocket cost starts at $750 per treatment.

Bone marrow aspirate concentrate (BMAC) is a biologic treatment derived from a patient’s own bone marrow, typically harvested from the pelvis. The bone marrow is processed to concentrate mesenchymal stromal cells, progenitor cells, and growth factors that may help support tissue repair.

BMAC is currently being investigated for cartilage injuries, osteoarthritis, and tendon pathology. Early clinical studies have shown promising improvements in pain and function in selected patients with knee osteoarthritis and cartilage defects, though high-quality long-term evidence remains limited (Hernigou et al., 2014; Chahla et al., 2020).

Because BMAC is considered a regenerative biologic treatment, it is not covered by insurance and is typically paid for out of pocket. This procedure must be performed in the operating room, and out-of-pocket costs vary depending on the surgical facility.