Cortisone injections have several advantages[1]. They:
- Are inexpensive,
- Are easy to perform,
- Carry a low risk of immediate complications,
- Often cause a reduction of pain[2].
And that’s also why they’re a go-to treatment for many different injuries, but will a cortisone shot help patellar tendonitis?
Before continuing, read the full disclaimer here.
As you know I’m not a doctor, so if you have an injury or suspect that you have an injury, get treated by a doctor in person. This video and all the others on my channel are just for educational purposes and they’re not medical advice.
Cortisone for Patellar Tendonitis?
Okay so the sake of argument, let’s say Jeff, a very good friend of mine, calls me and says:
“Martin, my doctor diagnosed me with patellar tendonitis and offered me a cortisone shot. What would you do?”
I would tell Jeff that I could be wrong, but to my knowledge cortisone injections can make people with patellar tendonitis feel better for a few weeks.
However, this short-term improvement comes at the cost of a worse long-term outcome[3] and a higher risk of setbacks[4].
The Research
If you look through the research on cortisone injections for patellar tendonitis or similar injuries you’ll find that
- They impair collagen synthesis in the tendon[5]
- Compared to placebo injections, cortisone shots led to worse clinical outcomes after 1 year[6]
- In one study, 72% of the cortisone injection group suffered a setback[7]
- CSI also lead to a higher risk of tendon rupture[8] by reducing failure stress of the tendon[9]
- Repeated cortisone injections led to lower bone quality[10]
Research findings like these have caused experts to joke that “corticosteroids are [an] ideal treatment for people you don’t like.”
And anecdotally, I also know a small number of athletes that have suffered a tendon tear after repeated cortisone injections for their patellar tendonitis. All of them were competitive athletes that used the cortisone shots to keep playing at a high level.
That’s why I would tell my friend Jeff that if I was in his shoes, I’d try conventional treatments first:
What to Try First
Icing for pain, activity modification to deal with an irritated tendon, and then slow strengthening exercises at a level that his tendons can tolerate to begin building them up again.
But if he still decides to take the cortisone shot, I’d ask him to stop sports for a few weeks and to then focus on strengthening exercises.
I would tell him “Don’t let the reduced pain trick you into overdoing it.” Because the worst decision Jeff could make would be to take the shot and to then stay active in sports.
The cortisone wouldn’t magically heal his tendon, but it could make his knees feel a lot better and you can see how that’s a dangerous combination.
So for someone like Jeff, who just has patellar tendonitis, a cortisone shot would not help in the long term.
If other conditions are involved, like fat pad inflammation for example, cortisone may be useful, but that’s a decision the treating physician has to make.
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References
[1] Angelo de Carli et al., “Calcific tendinitis of the shoulder,” Joints 2, no. 3 (2014): 133.
[2] U. Fredberg et al., “Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study,” Scandinavian journal of rheumatology 33, no. 2 (2004); Brett M. Andres and George A. C. Murrell, “Treatment of tendinopathy: what works, what does not, and what is on the horizon,” Clinical orthopaedics and related research 466, no. 7 (2008): 1542.
[3] M. Kongsgaard et al., “Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy,” Scandinavian journal of medicine & science in sports 19, no. 6 (2009).
[4] U. Fredberg et al., “Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study,” Scandinavian journal of rheumatology 33, no. 2 (2004); L. Bisset et al., “Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial,” BMJ 333, no. 7575 (2006).
[5] M. Kongsgaard et al., “Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy,” Scandinavian journal of medicine & science in sports 19, no. 6 (2009).
[6] Brooke K. Coombes et al., “Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial,” JAMA 309, no. 5 (2013).
[7] L. Bisset et al., “Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial,” BMJ 333, no. 7575 (2006).
[8] Jianying Zhang, Camille Keenan, and James H.-C. Wang, “The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury,” Journal of orthopaedic research : official publication of the Orthopaedic Research Society 31, no. 1 (2013).
[9] Ronald Hugate et al., “The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons,” The Journal of bone and joint surgery. American volume 86-A, no. 4 (2004).
[10] Eran Maman et al., “Detrimental Effect of Repeated and Single Subacromial Corticosteroid Injections on the Intact and Injured Rotator Cuff,” The American journal of sports medicine 44, no. 1 (2016).