Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

Botox® is better known as a muscle paralyzer or relaxer and can help with muscle pain or spasms, in knee pain, it also works primarily as a “nerve blocker.” Therefore Botox® does not offer a repair of a damaged knee rather it is a suppressor of symptoms.

Some people do find pain relief. While there is not, however, a lot of research to support the use of Botox® for knee pain, some studies suggest benefits and other comparative studies pitting Botox® against other treatments seem so-so.

In July 2019 researchers published data to suggest the benefits of Botox® in the journal Toxicon. (1) This journal studies the use of toxins in medicine.

Here are the learning points:

• In recent years, there is a growing interest in new medical applications of botulinum toxin, including pain control, osteoarthritis treatment, and wound healing. While clinical applications of botulinum toxin seem promising, existing evidence regarding the therapeutic effects is still inadequate. The aim was to assess the efficacy of a single injection of botulinum toxin into the knee joint cavity to reduce pain in elderly people.
• The researchers carried out a single-group clinical trial – Thirty participants (24 women) more than 50 years of age with knee osteoarthritis were included.
• The patients received a single injection containing 250 units of Dysport (= 100 units of botulinum neurotoxin type A) diluted with 5 ml of normal saline.

What the researchers wanted to measure was:

• Improvement in knee pain
• How the patients felt about their knee pain and function.
• A single follow-up was taken 4 weeks after the injection.
  • The patients said their joint pain and stiffness, sports, the severity of symptoms, quality of life, and daily activities were improved.
• The researchers concluded that botulinum neurotoxin type A is an effective and safe initial treatment of knee osteoarthritis with clear clinical advantages.

A January 2023 paper in the journal Toxicon (2) examined the data from seven previously published studies comprising 548 patients on the effectiveness of Botulinum Toxin type A (BTA) for knee osteoarthritis symptoms. Compared with the control (saline) groups of the studies, Botulinum Toxin type A (BTA) injection exhibited greater pain reduction at four weeks posttreatment but not 8-24 weeks posttreatment. Additionally, no differences were found between Botulinum Toxin type A (BTA) injection versus control intervention on functional improvement at all time points assessed (at 4, 8, 12, and 24 weeks.) There was no significant difference in adverse event rate between the Botulinum Toxin type A (BTA) injection and the control group. This meta-analysis did suggest that intra-articular Botulinum Toxin type A (BTA) injection could be an effective and safe strategy for the analgesic treatment of knee osteoarthritis in the short term.

Comparing Botox® to other knee injection treatments

A June 2019 study in the journal Clinical Rehabilitation (3) compared the effectiveness of intra-articular injection of Botulinum toxin type A (Botox), triamcinolone hexacetonide (cortisone), and saline in primary knee osteoarthritis. The study found that cortisone injections had higher effectiveness than Botox or saline (placebo) in the short-term assessment (four weeks) for pain in movement.

An April 2024 study in the journal Toxicon (4) compared intraarticular botulinum toxin type A to corticosteroid and hyaluronic acid. Data from six randomized control studies and 348 patients was analyzed.

In patient reported outcomes, intraarticular botulinum toxin type A showed similar effectiveness to corticosteroid as reported by patient self-reported outcomes in changes of pain, stiffness  and function. Intraarticular botulinum toxin type A was shown to be more effective than hyaluronic acid in improving pain.

An September 2020 study in the International journal of rehabilitation research (5) compared the effectiveness of f  botulinum neurotoxin type A , hyaluronic acid and prolotherapy over 120 patients. Results showed botulinum neurotoxin and dextrose prolotherapy were the most, and hyaluronic acid was the least efficient treatments for controlling pain and recovering function in patients. An intra-articular injection of botulinum toxin type A or dextrose prolotherapy is effective first-line treatments. In the next place stands physical therapy particularly if the patient is not willing to continue regular exercise programs.

An April 2025 study in the journal Toxicon (6) evaluated the effect of a single dose of 100U botulinum neurotoxin-A in patients with early knee osteoarthritis. Patients received a single dose of 100U IncobotulinumtoxinA in the retro-patellar bursa and received nutritional and physical rehabilitation indications. Patients were evaluated at baseline and at days 5, 30, 60, and 90 after injection. IncobotulinumtoxinA treatment significantly reduced pain in all treated patients at day 90 compared to day 0. 

Other articles 

Prolotherapy Knee Injections : Prolotherapy is a non-surgical injection treatment that introduces small amounts of an irritant solution (simple dextrose) into the knee with the goal of helping the immune system rebuild the soft connective tissue of the knee ligaments and knee tendons to restore stability to the knee and alleviate pain and improve function. The research is well documented and will be presented below. Prolotherapy does not work for every patient.

Chronic Knee Pain and Knee Instability : In this article, we will discuss the degenerative knee disease process that leads to knee instability. We will spend some time talking about the knee ligaments. As you will see in the research and clinical case histories below. The knee ligaments are often the most over looked, unless you have a ACL or other ligament rupture, component of knee instability.

When stem cell therapy will not work for your knee pain : If you are reading this article, it is very likely that you are exploring stem cell therapy for your degenerative knee condition or for the knee problems or surgical recommendations of knee replacement for a loved one. Either you or your loved one is in a lot of pain now, and maybe right now is not the right time to get a knee replacement. When opting for regenerative medicine injections, providers and patients have to have a realistic idea of just how effective or ineffective these treatments can be.

Adipose-derived stem cells, Microfragmented Fat, or Lipogems for knee osteoarthritis? : If you
Lipoaspirate or Adipose-derived stem cell therapy is a regenerative injection treatment that may stimulate the repair of osteoarthritic cartilage and bone through the use of liposuction aspirates (fat stem cells). Liopgems are better understood as an FDA-approved device that may make it easier for your doctor to inject adipose stem cells.

References

1 Najafi S, Sanati E, Khademi M, Abdorrazaghi F, Mofrad RK, Rezasoltani Z. Intra-articular botulinum toxin type A for treatment of knee osteoarthritis: Clinical trial. Toxicon. 2019 Jul 1;165:69-77. [Google Scholar]
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