What Happens During a Knee PRP Injection Procedure

Chronic knee pain is one of the most common musculoskeletal complaints, especially among adults over 60. While many patients find relief through physical therapy, medications, or injections like corticosteroids or hyaluronic acid (“gel”), others continue to struggle with persistent discomfort that interferes with daily life. For these individuals, regenerative medicine techniques such as platelet-rich plasma (PRP) therapy are emerging as promising alternatives.

In this case, we explore a 62-year-old male patient with ongoing medial knee pain and how a targeted, image-guided regenerative approach was used to address multiple underlying issues.

Understanding the Patient’s Symptoms

The patient presented with chronic pain localized along the medial (inner) joint line of the knee. This is a common area for degenerative changes and soft tissue injuries, particularly involving the meniscus or joint cartilage. Despite trying conservative treatments, he experienced little to no relief and preferred to avoid traditional steroid or gel injections.

Given the persistence of his symptoms, advanced imaging was the next logical step.

MRI Findings: Identifying the Root Causes

An MRI of the knee revealed several important findings that helped guide treatment:

• Complex medial meniscus tear: This type of tear is often degenerative and can cause pain, catching, or stiffness in the knee.
• Bone marrow edema of the medial tibial plateau: This finding indicates inflammation or stress within the bone and closely matched the patient’s area of pain.
• Mucoid degeneration of the ACL (anterior cruciate ligament): While there was no instability or tear, this condition reflects chronic degeneration within the ligament.
• Ganglion cyst from the tibiofibular joint: Initially suspected to be a Baker’s cyst, ultrasound confirmed that the fluid collection originated from the tibiofibular joint.

Each of these findings contributed to the patient’s symptoms and required a comprehensive, targeted treatment approach.

Why Regenerative Medicine?

Rather than masking pain temporarily, regenerative medicine aims to promote healing within damaged tissues. Platelet-rich plasma (PRP), derived from the patient’s own blood, contains growth factors that may support tissue repair, reduce inflammation, and improve overall joint function.

Because this patient wanted to avoid steroids and had multiple areas of pathology, PRP offered a versatile and minimally invasive option.

A Multi-Targeted Treatment Strategy

This case highlights the importance of treating not just one issue, but all contributing factors. Using a combination of ultrasound and fluoroscopic guidance, several targeted interventions were performed:

1. Meniscus Injection

The complex meniscus tear was treated with PRP to support healing and reduce inflammation within the joint.

2. ACL Treatment

Although the ACL was stable, mucoid degeneration can still cause pain and dysfunction. A PRP injection was administered directly into the ligament to promote tissue health and potentially slow degeneration.

3. Bone (Intraosseous) Injection

The area of bone marrow edema in the medial tibial plateau was treated with an intraosseous PRP injection. This advanced technique delivers healing factors directly into the bone, targeting a common but often overlooked pain generator.

4. Tibiofibular Joint Injection

The ganglion cyst was traced back to the tibiofibular joint. Treating the joint itself with PRP helped address the underlying cause of the fluid buildup.

5. Cyst Aspiration

Unlike typical fluid-filled cysts, this ganglion cyst contained thick, gelatinous material. A larger 18-gauge needle was required to effectively aspirate (drain) the substance under ultrasound guidance.

The Role of Imaging Guidance

Precision is critical when performing regenerative procedures. In this case:

• Ultrasound was used to visualize soft tissue structures, guide needle placement, and assist with cyst aspiration.
• Fluoroscopy (live X-ray imaging) ensured accurate delivery of PRP into deeper joint and bone structures.

This dual-modality approach enhances both safety and effectiveness.

What Makes This Approach Unique?

Many knee pain treatments focus on a single structure, such as injecting steroids into the joint space. However, knee pain is often multifactorial, especially in older adults. This case demonstrates a more comprehensive strategy that:

• Targets multiple pain generators simultaneously
• Uses the patient’s own biologic material (PRP)
• Avoids corticosteroids and their potential side effects
• Addresses both soft tissue and bone-related sources of pain

What Patients Should Know

While regenerative treatments like PRP are promising, they are not a one-size-fits-all solution. Outcomes can vary depending on the severity of the condition, overall health, and adherence to post-procedure recommendations.

Patients considering PRP for knee pain should:

• Undergo proper imaging (MRI or ultrasound) for accurate diagnosis
• Seek care from providers experienced in image-guided injections
• Understand that healing may take weeks to months
• Combine treatment with appropriate rehabilitation when recommended

Final Thoughts

Chronic knee pain can be complex, especially when multiple structures are involved. This case highlights how advanced diagnostics and regenerative medicine can be combined to create a personalized treatment plan tailored to the patient’s specific condition.

By addressing the meniscus, ligament, bone, and joint abnormalities all at once, this approach offers a more complete solution—one that goes beyond symptom relief and focuses on long-term healing.

If you’ve been struggling with persistent knee pain and haven’t found relief with traditional treatments, it may be time to explore whether regenerative medicine is right for you.

Watch the Full Video Here