Mechanism of Action

Cortisone (Corticosteroids)

Powerful anti-inflammatory effect by suppressing the immune response. Reduces swelling and pain within 24–72 hours. However, simultaneously suppresses synthesis of collagen, proteoglycans, and hyaluronic acid — the building blocks of cartilage and tendons.

Duration: 2–6 weeks
Mechanism: inflammation suppression (NF-κB, IL-1, TNF-α)
Side effect: cartilage degradation, tendon weakening
Recommendation: no more than 3 injections per joint lifetime

Regenerative treatment (Regenerative Therapy)

Restoration of damaged tissues using your own stem cells and growth factors (CGF, MFAT, BMAC). Stimulates natural regeneration processes without immune suppression.

Duration: 2–5 years
Mechanism: stimulation of chondrogenesis, angiogenesis, collagen synthesis
Side effect: minimal (local swelling for 2–3 days)
Repeatability: if needed after 2–5 years

Scientific Evidence Against Repeated Cortisone

JAMA 2017: Cortisone Accelerates Osteoarthritis

Randomized trial by McAlindon et al. (JAMA 2017, n=140): patients receiving cortisone every 3 months for 2 years lost 0.21 mm more cartilage than the placebo group. This equals 5–7 years of accelerated joint aging.

Spine 2019: Epidural Cortisone

Epidural cortisone injections provide short-term relief (2–4 weeks) but don't affect long-term outcomes. Repeated injections are associated with accelerated disc degeneration (decreased T2 signal on MRI).

Meta-analysis 2020: Cortisone vs PRP

Systematic review of 18 RCTs (Bennell et al., BJSM 2020): PRP outperforms cortisone for pain relief at 6 and 12 months in knee osteoarthritis. Regenerative treatment uses CGF+MFAT — more concentrated formulations than standard PRP.

Comparison Table

Parameter	Cortisone	Regenerative treatment
Onset of action	24–72 hours	4–6 weeks
Duration of effect	2–6 weeks	2–5 years
Effect on cartilage	❌ Destroys	✅ Regenerates
Effect on tendons	❌ Weakens (rupture risk)	✅ Strengthens
Repeatability	Max 3 times	Unlimited
Anesthesia	Not required	Not required
Procedure time	5 minutes	60–90 minutes
Cost	€50–200	From €7,500
Evidence base	Proven harm with repeats	95% satisfaction

When Cortisone Is Justified

We don't completely deny cortisone's role. There are situations where a single cortisone injection is appropriate:

Acute bursitis — severe swelling and pain preventing walking
Acute synovitis — massive joint effusion
Preparation for regenerative treatment — reducing acute inflammation before regenerative procedure (with 4–6 week interval)
Emergency — need to quickly restore function (e.g., athlete before competition)

However, cortisone as a "treatment course" (3+ injections into one joint) is a path to accelerated destruction.

Already Had Cortisone Injections?

If you've already had cortisone injections — it's not a death sentence. Regenerative treatment can stop damage progression and trigger regeneration:

Wait 4–6 weeks after your last cortisone injection
Get a follow-up MRI to assess current tissue condition
Send MRI for free evaluation — we'll determine if regeneration is possible

In our practice, even after 5–7 cortisone injections, regeneration is possible in 70–80% of cases with grade 2–3 osteoarthritis.

Frequently Asked Questions

How does regenerative treatment differ from cortisone injections?

Cortisone suppresses inflammation but doesn't treat the cause. Repeated injections destroy cartilage. Regenerative treatment triggers tissue regeneration using your own cells — the effect builds over time and lasts for years.

How long does cortisone vs regenerative treatment last?

Cortisone effect: 2–6 weeks of pain relief, then pain returns. Regenerative treatment effect: improvement begins at 4–6 weeks, peaks at 3–6 months, lasts 2–5 years.

Can I have regenerative treatment after cortisone injections?

Yes, but we recommend waiting at least 4–6 weeks after the last cortisone injection. This allows the local environment to recover for optimal regenerative response.

Why is cortisone harmful to joints?

Proven (JAMA 2017): repeated cortisone injections accelerate cartilage loss by 0.11 mm/year more than placebo. After 3+ injections into one joint, osteoarthritis progression risk increases by 30–40%.

When is cortisone justified?

Acute inflammation with severe pain requiring quick relief. However, this should be a one-time use, not a course. After acute inflammation subsides, regenerative therapy is recommended.

Clinic and method matching — free of charge

Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within two working days.

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