Return to Sport Using Corticosteroid Injections for Knee Pain in Triathletes

Abstract

Introduction Despite the prevalence of corticosteroid injections in athletes, little is known about their efficacy in triathletes. We aim to assess attitudes, use, subjective effectiveness, and time to return to sport with corticosteroid injections compared to alternative methods in triathletes with knee pain. Methods This is an observational study during the COVID-19 pandemic. Triathletes answered a 13-question survey posted to three triathlon-specific websites. Results Sixty-one triathletes responded, 97% of whom experienced knee pain at some point in their triathlete career; 63% with knee pain received a corticosteroid injection as treatment (average age 51 years old). The most popular attitude (44.3%) regarding corticosteroid injections was "tried them, with good improvement". Most found the cortisone injection helpful for two to three months (28.6%), or more than one year (28.6%); of individuals who found the injections useful for more than one year, four-eight (50%) had received multiple injections during that same period. After injection, 80.6% returned to sport within one month. The average age of people using alternative treatment methods was 39 years old; most returned to sport within one month (73.7%). Compared to alternative methods, there was an ~80% higher odds of returning to sport within one month using corticosteroid injections; however, this relationship was not significant (OR=1.786, p=0.480, 95% CI:0.448-7.09). Conclusion This is the first study to examine corticosteroid use in triathletes. Corticosteroid use is more common in older triathletes and results in subjective pain improvement. A strong association does not exist for a quicker return to sport using corticosteroid injections compared to alternative methods. Triathletes should be counseled on the timing of injections, duration of side effects, and be aware of potential risks.

Assessment of the Effectiveness of Corticosteroid Infiltrations in the Ignace Deen University Hospital Center in Conakry

“…Indeed, corticosteroid infiltration into a joint gives rise to the following effects: attenuation of the local inflammatory response by inhibition of the recruitment of inflammatory cells (leukocytes, neutrophils) and mediators of the inflammatory reaction (prostaglandins and interleukins-1); reduction of synovial blood flow and local synthesis of collagen as well as inflammatory cells. All of this helps reduce pain and local inflammation [ 1 ]. Also, the divergence of the main indications found in the different studies may be linked to the socio-epidemiological realities of each country.…”

“…As for frequency, corticosteroid infiltration depends on the importance of the inflammatory phenomenon, the pathology and the place of injection; for example, osteoarthritis of the knee requires a joint infiltration of corticosteroids to be repeated after six to 12 weeks while tendonitis of the supraspinatus of the shoulder requires a joint infiltration of corticosteroids per week for three weeks [ 1 , 19 , 20 ].…”

“…Corticosteroid infiltration is a medical procedure which consists of the injection of a corticosteroid locally, into a painful site [ 1 ]. This site can be a joint, a bursa, a synovial sheath, a canal, epidural or peritendinous [ 1 , 2 ].…”

“…Corticosteroid infiltration is a medical procedure which consists of the injection of a corticosteroid locally, into a painful site [ 1 ]. This site can be a joint, a bursa, a synovial sheath, a canal, epidural or peritendinous [ 1 , 2 ]. This analgesic technique, regularly practiced by specialists in rheumatology, known since the 1950s, is part of the therapeutic arsenal and is offered in numerous indications, particularly when it comes to treating a single-joint disorder as in osteoarthritis or pauci-articular outbreaks of inflammatory rheumatism; in abarticular conditions (bursitis, tendinopathy, ligamentitis, chronic nerve compressions) [ 1 , 3 , 4 ].…”

“…This analgesic technique, regularly practiced by specialists in rheumatology, known since the 1950s, is part of the therapeutic arsenal and is offered in numerous indications, particularly when it comes to treating a single-joint disorder as in osteoarthritis or pauci-articular outbreaks of inflammatory rheumatism; in abarticular conditions (bursitis, tendinopathy, ligamentitis, chronic nerve compressions) [ 1 , 3 , 4 ]. The corticosteroids used depend on the joint [ 1 , 5 , 6 ]. In situ injection of synthetic corticosteroids is effective due to its anti-inflammatory effect [ 3 , 7 ].…”