Cingal® Injection for Knee Osteoarthritis
Cingal® is a single injection for knee osteoarthritis that combines two established treatments: a steroid to settle inflammation quickly, and hyaluronic acid to lubricate and cushion the joint for longer. At Meyer Physio it is given under live ultrasound guidance, and only after your knee has been examined and scanned, so the decision rests on what is actually causing your pain.
What is Cingal?
Cingal contains two ingredients in a single injection:
- A steroid (triamcinolone hexacetonide). This is the same type of medicine used in a steroid injection, sometimes called a cortisone injection. It calms inflammation inside the joint and usually starts to ease pain within days.
- Hyaluronic acid. Your joints make this lubricant naturally. In Cingal it is cross-linked, a form designed to stay in the joint for longer and support it over the following months.
Cingal is CE-marked for the treatment of pain caused by osteoarthritis of the knee.
Who is Cingal suitable for?
Cingal is generally used for mild to moderate knee osteoarthritis, in people who:
- are no longer getting enough relief from over-the-counter painkillers
- want to stay active and put off surgery for as long as possible
- would rather have one injection that works quickly and keeps working than choose between fast relief and lasting relief
Whether it is the right choice for you depends on what the examination and diagnostic ultrasound scan show, how worn the joint is, and how you have responded to any previous injections.
Which joints can Cingal treat?
Cingal is CE-marked for osteoarthritis of the knee, and the knee is where it is mainly used. It can sometimes be considered for other joints, such as the hip or shoulder, depending on your assessment. For those joints we will also discuss whether a hyaluronic acid injection or a steroid injection on its own would suit you better.
How does Cingal work?
Osteoarthritis reduces both the amount and the quality of hyaluronic acid in the joint fluid, the substance that keeps it thick, slippery and shock-absorbing. At the same time, inflammation inside the joint adds to the pain, swelling and stiffness.
Cingal treats both at once. The steroid settles the inflammation, which is why relief can come quickly. The hyaluronic acid restores some of the lubrication and cushioning, which is what makes the effect last. Cingal eases the symptoms of osteoarthritis; it does not reverse the changes in the joint.
How is Cingal different from a steroid or hyaluronic acid injection?
A steroid injection on its own usually works quickly, but the effect tends to wear off sooner. Hyaluronic acid on its own takes longer to help, but its effect lasts longer. Cingal combines the two, aiming for earlier relief than hyaluronic acid alone and longer-lasting benefit than a steroid on its own.
It is one of several injection options for an arthritic knee. Others include hyaluronic acid on its own and Arthrosamid®, a hydrogel given as a single injection and intended to last considerably longer. Which suits you best is decided at your assessment.
How effective is Cingal?
In the main clinical trial, 368 people with mild to moderate knee osteoarthritis were given a single injection of Cingal, of the same hyaluronic acid without the steroid, or of a saline placebo. Cingal reduced pain significantly more than the placebo, and the benefit was still present at 26 weeks. Over the first three weeks it also relieved pain better than hyaluronic acid alone; after that, the two performed similarly.1
Results still vary from person to person. Some people get substantial relief and move noticeably better; others benefit less. It is worth discussing what is realistic for your knee before going ahead, which is part of what the assessment is for. More detail on the clinical studies is on the manufacturer’s Cingal website.
How is the injection given?
Your knee is examined and scanned first. Where Cingal is the right next step, we explain what it involves, what it is likely to achieve and what the risks are, and give you written information to take away. The injection is arranged once you have had time to consider it. If you already have a confirmed diagnosis, or you are returning for a repeat injection, it can often be arranged sooner.
The injection itself takes a few minutes. Cingal is injected into the knee joint through a fine needle under live ultrasound guidance, so it reaches the joint space rather than the tissue around it. No general anaesthetic is needed.
How long does Cingal take to work?
Most people notice their pain easing within a few days, as the steroid takes effect. The hyaluronic acid builds its effect over the following weeks.
How long does Cingal last?
In the clinical trial, the benefit of a single injection was still present at 26 weeks, about six months. If Cingal works well for you, it can be repeated after roughly six months, depending on your knee and on clinical advice.
After your injection
Your knee may be slightly swollen or tender for a day or two. Avoid strenuous activity for about 48 hours; light everyday activity is usually fine straight away. You will be given specific aftercare instructions at your appointment.
Side effects and safety
Both ingredients have been used in joint injections for decades, and side effects are usually mild and short-lived. The most common is temporary pain, swelling or stiffness in the knee. Infection and allergic reactions are rare.
Because Cingal contains a steroid, the precautions for a steroid injection also apply. Please tell us before the injection if you:
- have diabetes, as the steroid can raise your blood sugar for a few days
- take blood-thinning medication
- have an infection, or have recently taken antibiotics
- are on a waiting list for a knee replacement, as a steroid is normally not injected into a joint in the three months before it is replaced
What does Cingal cost?
The fee covers the Cingal itself, the sterile consumables and delivery of the injection under ultrasound guidance; there is no separate charge for the guidance. Current fees are on our price list. You do not need a GP referral.
Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175]. Last reviewed: 1 November 2026.
1 Hangody L, et al. Intraarticular injection of a cross-linked sodium hyaluronate combined with triamcinolone hexacetonide (Cingal) to provide symptomatic relief of osteoarthritis of the knee: a randomized, double-blind, placebo-controlled multicenter clinical trial. Cartilage. 2018;9(3):276–283. doi:10.1177/1947603517703732
Cingal® is a registered trademark of Anika Therapeutics, Inc. Product images © Anika Therapeutics, Inc.