Most meniscus injuries occur due to sharp twisting movements often during sports . A tear can also result from a simple movement such as twisting the knee while the foot is caught on something. Other knee injuries, such as torn ligaments, may occur at the same time as a meniscus tear. The meniscus of older individuals, or those who have been previously “scoped” or used steroid injections, contains tissue that has degenerated and may tear more easily, and may occur as a result of even minor “awkward” movements. This degenerative process of the meniscus is usually present with osteoarthritis of the knee – unfortunately often accelerated by “treatments” the patients have received along the course of their injury – NSAIDs, cortisone, arthroscopy etc.
By strengthening structural weaknesses in the body, as Prolotherapy does, pain associated with a torn meniscus may be alleviated permanently and the patient is able to return to full activities and/or sports.
Ross Hauser, MD, medical director of Caring Medical recently published an article in the Journal of Prolotherapy showing the benefits of Prolotherapy as a first line treatment for meniscus tears. If you are trying to manage a torn meniscus but are not having success, feel free to contact Dr. Hauser’s office at drhauser@caringmedical.com.
For a list of other doctors performing Prolotherapy, see www.getprolo.com.
Meniscus injuries are a common cause of knee pain, accounting for one sixth of knee surgeries. Tears are the most common form of meniscal injuries, and have poor healing ability primarily because less than 25% of the menisci receive a direct blood supply. While surgical treatments have ranged from total to partial meniscectomy, meniscal repair and even meniscus transplantation, all have a high long-term failure rate with the recurrence of symptoms including pain, instability, locking, and re-injury. The most serious of the long-term consequences is an acceleration of joint degeneration. This poor healing potential of meniscus tears and degeneration has led to the investigation of methods to stimulate biological meniscal repair. Research has shown that damaged menisci lack the growth factors to heal. In vitro studies have found that growth factors, including platelet derived growth factor (PDGF), transforming growth factor (TGF), and others, augment menisci cell proliferation and collagen growth manifold. Animal studies with these same growth factors have confirmed that meniscal tears and degeneration can be stimulated to repair with various growth factors or solutions that stimulate growth factor production. The injection technique whereby the proliferation of cells is stimulated via growth factor production is called Prolotherapy. Prolotherapy solutions can include dextrose, human growth hormone, platelet rich plasma, and others, all of which stimulate connective tissue cells to proliferate.
A retrospective study was done involving 24 patients, representing 28 knees, whose primary knee complaints were due to meniscal pathology documented by MRI. The average number of Prolotherapy visits was six and the patients were followed on average 18 months after their last Prolotherapy visit. Prolotherapy caused a statistically significant decline in the patients’ knee pain and stiffness. Starting and ending knee pain declined from 7.2 to 1.6, while stiffness went from 6.0 to 1.8. Prolotherapy caused large improvements in other clinically relevant areas such as range of motion, crepitation, exercise, and walking ability. Patients stated that the response to Prolotherapy met their expectations in 27 out of the 28 knees (96%). Only one out of the 28 patients ended up getting surgery after Prolotherapy. Based on the results of this study, Prolotherapy appears to be an effective treatment for meniscal pathology. While this is only a pilot study, the results are so overwhelmingly positive that it warrants using Prolotherapy as first-line therapy for meniscal pathology including meniscal tears and degeneration.
Read the entire Journal of Prolotherapy article.
If you are suffering from knee pain and/or meniscal tear, you may want to give Prolotherapy a try. It’s a great alternative to arthroscopy/knee surgery – and the recovery time is much quicker. For a listing of doctors who perform Prolotherapy, see www.getprolo.com.
Feb 2010 the CDC and the Arthritis Foundation announced a major initiative to dramatically reduce the impact of osteoarthritis on Americans. Arthritis is already one of the nation’s most common cause of disability. The article states that 46 million people have arthritis and an estimated 67 million will be affected by 2030. The article goes on toe state that the prevalence is escalating and the average annual costs are around $5700/person/year. Dr. John Klippel, MD, president of the Arthritis Foundation is quoted as saying, “Now is the time that we as a nation must invest our resources in the prevention of osteoarthritis…This national public health agenda with the CDC and the new public awareness campaign with the Ad Council will dispel the myth that osteoarthritis is an inevitable part of aging and will call on the nation and individuals to take proven steps to prevent and decrease the pain and disability of arthritis.”
The article goes on the discuss the agenda – which includes self management education, physical activity, injury prevention, and weight management.
Unfortunately, what this article fails to mention is the ligament injury connection to osteoarthritis. Osteoarthritis (OA) or degenerative joint disease (DJD) is more common than all the other types of arthritis combined. It is well-established that injury to a joint increases the chances that the joint will develop osteoarthritis over time. Precipitating causes include sudden impact or trauma, overuse or repetitive motion injuries, biomechanical abnormalities (congenital or acquired), ligamentous injury, joint hypermobility, obesity, intra-articular or systemic corticosteroids, avascular necrosis, and hereditary factors. Osteoarthritis, though the accepted term used to describe degenerative joint disease, is misleading because it primarily relates to cartilage, not bone, and involves degeneration, not inflammation. A lack of understanding about the development of osteoarthritis has resulted in a broad array of symptom-based treatment options such as rest, ice, heat, analgesics, anti-inflammatories, narcotics, braces and wraps, physical therapy and exercise, chiropractic, viscosupplementation, corticosteroid injections, and surgery. While advances have been made in joint replacement, cartilage repair, cartilage replacement, and spinal procedures, treatments to limit or even reverse articular cartilage breakdown have been lacking. Being that ligament injury, excess laxity, joint hypermobility, and clinical instability are known to be major causes of osteoarthritis, any treatment which can address restoration of ligament function would help reduce the incidence, pain, and dysfunction of osteoarthritis.
The Feb 2010 Journal of Prolotherapy issue contains a full article on the ligament injury connection to osteoarthritis.
