NCT06527235

Meniscal INfiltration of Corticosteroid Guided With Ultra Sonography

Efficacy of Ultrasound-monitored Meniscal Wall Betamethasone Infiltration on Pain in Relation to Degenerative Meniscal Injury: a Randomized, Double-blind, Placebo-controlled Multicenter Trial.

• Status: Recruiting
• Phase: Phase 3
• Study type: Interventional
• Enrollment: 152 (estimated)
• Sponsor: University Hospital, Toulouse · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

The value of corticosteroid infiltration of the meniscus wall in the therapeutic strategy is not clearly defined: the data in the literature on the effectiveness of corticosteroid infiltration are heterogeneous and of low level of proof. We hypothesize that corticosteroid infiltration of the meniscal wall under ultrasound control would be effective for rapid relief of degenerative meniscal pain. The main objective is to evaluate the efficacy of ultrasound-guided meniscal wall infiltration of betamethasone versus ultrasound-guided meniscal wall infiltration of placebo, at 1 month, on meniscal pain in the treatment of meniscal pain of degenerative origin in adult.

Detailed description

"Meniscal pain" is a very frequent cause of consultation in orthopedics, rheumatology or sports medicine. The management of degenerative meniscal lesions has been the subject of a consensus conference by the French Authority (2008) and a recommendation by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA 2017), which propose symptomatic medical treatment before any surgical management. Conservative medical treatment is the first-line treatment for most patients with symptomatic meniscal injuries with a wide range of therapies including rehabilitation, oral nonsteroidal anti-inflammatory drugs, joint injections of corticosteroid, hyaluronic acid, or platelet concentrates, as well as injection of corticosteroids into the posterior meniscal wall. In the therapeutic arsenal, corticosteroid infiltrations of the posterior meniscus wall are those that have been the subject of the most clinical studies, yet the data in the literature on the efficacy of these corticosteroid infiltrations are of low level of evidence. This is why the European Society of Musculoskeletal Radiology's Delphi-based consensus group on musculoskeletal imaging (ESSR) is encouraging the development of clinical research in this field with a placebo control group, in order to allow an objective validation of perimeniscal corticosteroid injection procedures in the treatment of meniscal pain of degenerative origin. The present study is a multicenter randomized controlled trial in double blind (patient and evaluator) versus placebo. Only the physician performing the infiltration will know the status of the group assigned to the patient (experimental or placebo). Enrollment will be prospective from the active line of patients followed in the investigating centers. A telephone pre-inclusion visit will be done at least 7 days before the inclusion visit. The inclusion visit, randomization (stratified on the centre) and infiltration will be performed on the same day. The follow-up will include a consultation at 1 month and two phone call at 7 days and 3 months.

Conditions

• Meniscus Lesion

Interventions

Type	Name	Description
DRUG	ultrasound-guided betamethasone infiltration of the meniscal wall	The perimeniscal injections will be guided by ultrasound with an 18 megahertz (MHz) linear probe under strict aseptic conditions. Doppler will be systematically used before the injection to identify the medial or lateral inferior geniculate artery. The first step will consist of local anesthesia with 2 ml of lidocaine injected into the subcutaneous tissues and close to the meniscus wall using a 25-gauge needle. Using an in-plane approach, a 21-gauge needle will be positioned under ultrasound guidance in the medial or lateral wall of the meniscus. Once the needle touches the meniscus wall, it will be withdrawn 1 mm, and a 1-ml injection of betamethasone into the meniscus wall will be performed.
DRUG	ultrasound-guided isotonic saline (placebo) infiltration of the meniscal wall	The perimeniscal injections will be guided by ultrasound with an 18 MHz linear probe under strict aseptic conditions. Doppler will be systematically used before the injection to identify the medial or lateral inferior geniculate artery. The first step will consist of local anesthesia with 2 ml of isotonic saline injected into the subcutaneous tissues and close to the meniscus wall using a 25-gauge needle. Using an in-plane approach, a 21-gauge needle will be positioned under ultrasound guidance in the medial or lateral wall of the meniscus. Once the needle touches the meniscus wall, it will be withdrawn 1 mm, and a 1-ml injection of betamethasone into the meniscus wall will be performed.

Timeline

• Start date: 2025-03-06
• Primary completion: 2028-06-01
• Completion: 2028-06-01
• First posted: 2024-07-30
• Last updated: 2025-12-04

Locations

1 site across 1 country: France