Published on August 22, 2013.
Stem Cells for Meniscal Repair
If you suffer from chronic knee problems, you know that cartilage has no capacity to repair itself and meniscal tissue has limited ability to regenerate its own damaged tissue. This is why researchers are looking at stem cells.
In new research, scientists looked at rabbits with massive meniscal defects. Their goal was to see if a single stem cell injection would improve the defect. This is what they said: “(stem cells) injected into the knee adhered around the meniscal defect, and promoted meniscal regeneration in rabbits.” This also lead to a preservtion of the articular cartilage and subchondral bone. 1
We see many patients with a date for meniscal surgery already planned who would like to avoid the surgery. One reason is the connection between Meniscal surgery and osteoarthritis.
“Osteoarthritis is the most common joint disease in the world, and the knee is the most affected joint. It is a multifactorial disease in which degenerative factors, genetics, hormonal and mechanical factors are involved.
Several at-risk situations are particularly well identified: the anterior cruciate ligament rupture, meniscectomy, knee injuries, varus or valgus knee malalignment and obesity. The reconstruction of the anterior cruciate ligament is intended to limit the risk of secondary meniscal lesion.
No long-term study found any evidence that surgery would prevent knee osteoarthritis.
The extent of the meniscectomy should be kept to a minimum to prevent the risk of secondary osteoarthritis. It is essential to promote programs against obesity by targeting priority patients who have other risk factors such as a history of meniscectomy or knee injury, or knee malalignment.” 2
“Meniscal tears are common orthopaedic injuries that can manifest with significant pain and mechanical symptoms. The treatment of meniscal tears has evolved from total meniscectomy to partial meniscectomy and meniscal repair. Preserving the meniscus is ideal because the loss of any portion of the meniscus can lead to significantly increased articular cartilage contact stresses compared with the intact state.”3
As many of you who follow our practice know, I am a competitive athlete and love sports. Unfortunately, sometimes playing too hard does lead to injury that needs repair. A patient recently came in with a torn meniscus. This is an injury I had myself and like our patient, wanted to also avoid a surgery.
Prolotherapy and Platelet Rich Plasma treatment
This patient was in his 60’s/ He knew that surgical treatment of a torn meniscus especially in an older individual could lead to an earlier degeneration of the knee which would lead to knee replacement.
This has been shown in studies where a fake surgery of the meniscus called a Sham surgery did perform better than a real surgery to the meniscus.
Our patient was aware of this data and chose to have both Prolotherapy and Platelet Rich Plasma treatment for his meniscal problem.
The patient limped into the office and also used a cane at home. Fortunately, after three treatments of his knee, he is now having substantially less pain and also is not using a cane at all when walking. His knee bends fully and he feels much more stable.
As I often like to share stories with my patients, I told him of how several months ago I had torn my meniscus during sports training. My knee was swollen and I had severe pain any time I twisted it or went up and down the stairs. Being a doctor who believes in regeneration rather than excision of a problem, I decided to treat myself with both Platelet Rich Plasma and Prolotherapy for my knee pain. Fortunately, now I am able to do all of the activities that I love and can cycle, run and do all of my cross-training with ease. Furthermore, I never had to go through any of the rehabilitation or post-surgical ache that patients often have to go through with surgery.
The Platelet Rich Plasma and Prolotherapy have definitely been very successful for me and I am so happy that I have the ability to treat myself and to help cure my own problems. I also feel very fortunate that I am involved in the field of regenerative orthopedic medicine and now through Prolotherapy, Platelet Rich Plasma and stem cell treatments have the ability to heal injuries rather than just to remove tissue surgically. I think Prolotherapy and Platelet Rich Plasma are really exemplary treatments as an alternative for medial meniscal surgery.
1. Hatsushika D, Muneta T, Horie M, Koga H, Tsuji K, Sekiya I. Intraarticular injection of synovial stem cells promotes meniscal regeneration in a rabbit massive meniscal defect model. J Orthop Res. 2013 Sep;31(9):1354-9. doi: 10.1002/jor.22370. Epub 2013 Apr 17.
2. Flouzat-Lachaniette CH. At-risk situations for knee osteoarthritis. Rev Prat. 2012 May;62(5):630-4.
3. Delos D, Rodeo SA. Enhancing meniscal repair through biology: platelet-rich plasma as an alternative strategy. Instr Course Lect. 2011;60:453-60.