The Impact of Corticosteroid Injections on Knee Osteoarthritis Progression and Management: A Systematic Review

Nicholas Zapata

Co-Presenters: Hussnain Shakeel, Peter Lazaris, Ali Tejaoglu

College: College of Health Professions and Human Services

Major: DPT.PHYSTHERAPY

Faculty Research Mentor: Bishnoi, Alka  

Abstract:

Knee osteoarthritis (OA) is a prevalent musculoskeletal condition and a leading cause of pain, functional limitation, and reduced quality of life among middle-aged and older adults. Intra-articular corticosteroid injections are commonly used to manage symptoms; however, uncertainty remains regarding their clinical effectiveness beyond short-term relief. While previous studies have examined pain outcomes following injection, variability in reported functional and quality-of-life (QOL) outcomes warrants further synthesis of the evidence.The purpose of this systematic review was to evaluate the effectiveness of intra-articular corticosteroid injections in reducing pain, improving function, and enhancing quality-of-life in individuals with knee osteoarthritis. A systematic review was conducted using PubMed, CINAHL, Cochrane Library, Google Scholar, ProQuest, and EBSCO databases. Peer-reviewed studies published between 2010 and 2025 were included if they evaluated intra-articular corticosteroid injections in adults aged 45 years or older with knee OA. Primary outcomes included pain measured using the Visual Analog Scale (VAS), when secondary outcomes included functional performance assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and patient-reported quality-of-life measures when available. Due to heterogeneity in study designs and outcome measures, findings were synthesized by identifying common trends and themes.Across ten included studies, corticosteroid injections consistently produced clinically meaningful short-term reductions in pain, exceeding the minimal clinically important difference within 2–6 weeks following injection. Functional outcomes demonstrated a similar pattern, with improvements peaking between 4–8 weeks. Evidence indicated minimal sustained benefit beyond 3–6 months for pain, function, or QOL. Adverse events were generally mild, however; observational analyses suggested potential long-term structural joint concerns associated with repeated injections.Overall, intra-articular corticosteroid injections provide effective short-term symptom relief for individuals with knee OA but do not demonstrate sustained long-term benefits. These injections may be most appropriate as a short-term adjunct to facilitate participation in conservative interventions such as physical therapy. Clinicians should exercise caution with repeated injections and prioritize long-term management strategies including exercise, weight management, and activity modification.