Meniscus surgery or stem cell therapy? Which one leads to arthritis?
A popular surgery to repair meniscal tears may increase the risk of osteoarthritis and cartilage loss in some patients, according to research presented today at the annual meeting of the Radiological Society of North America (RSNA). The findings show that the decision for surgery requires careful consideration in order to avoid accelerated disease onset, researchers said.
“Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function,” said Frank W. Roemer, M.D., from Boston University School of Medicine in Boston and the University of Erlangen-Nuremberg in Erlangen, Germany. “However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”1
In the latest research, doctors says that multiple injections of stem cells into severely damaged meniscal tissue should be considered as a new strategy in order to regenerate a meniscus with extensive defects. Using animal models, researchers found stem cell injections produced good results in massive tears.2
For the athlete and very active patient, the bucket handle meniscus tear is very common. What is not common is the bucket handle meniscus tear repair recommendation that does not include removing meniscal tissue. If you received this diagnosis you know that a large portion of the meniscus has been torn and that the flap or tear makes the meniscus resemble a bucket handle.
In the past, surgery would be recommended to remove that tissue, but now the recommendations are to try to allow the meniscus to heal first. This is where dextrose Prolotherapy, Stem Cell Therapy and Platelet Rich Plasma therapy can help.
New and recent research suggests that not only does Platelet Rich Plasma Therapy regrow new cartilage cells, but it can also help prevent further cartilage deterioriation. 3,4
Surgery to remove cartilage?
The knee is protected by the articular cartilage, that is the cartilage the covers the top of the shin bone and the bottom of the thigh bone, and by the meniscus.
Often we see patients who have been recommended to meniscectomy, the removal of partial or all of the meniscus of the knee. But why remove such a valuable piece of knee protection? Because some physicians believe that the meniscus, does not have the ability to be repaired, either by regular body repair mechanisms or surgery. So it is shaved, smoothed, or partially removed. Years ago, when a meniscus was injured, the standard protocol was complete removal. Many of these patients were forced to have knee replacement years later because of the severe pain from the meniscus removal.
“meniscal resection leads to long-term destabilization and degradation of the articular surfaces Autologous blood products including PRP may be one initial, simple, route to improve healing.”5
Stem Cell Therapy for bucket handle meniscus tear repair
Stem cell therapyand Platelet Rich Plasma injections have been instrumental in avoidance of needless knee surgeries. Many of my patients have already had one or two or three knee surgeries by the time they see us in hopes of avoiding a knee replacement. See our article on Stem Cell Injections for knee cartilage repair.
2. Hatsushika D. et al. Repetitive allogeneic intraarticular injections of synovial mesenchymal stem cells promote meniscus regeneration in a porcine massive meniscus defect model. Osteoarthritis Cartilage. 2014 Apr 30. pii: S1063-4584(14)01066-8. doi: 10.1016/j.joca.2014.04.028. [Epub ahead of print]
3. Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, Shieh YH, Wu CH, Deng WP. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011 Sep;32(25):5847-54. Epub 2011 May 25.
4. van Buul GM, et al. Platelet-Rich Plasma Releasate Inhibits Inflammatory Processes in Osteoarthritic Chondrocytes. Am J Sports Med. 2011 Nov;39(11):2362-70. Epub 2011 Aug 19.
5. Ahmad Z. et al. The role of platelet rich plasma in musculoskeletal science JRSM Short Rep. 2012 June; 3(6): 40.