In this article Marc Darrow, MD explains the use of PRP or Platelet Rich Plasma Therapy for Meniscal Tears.
A patient will come in to an examination. He/she will report that they are thinking of a partial meniscectomy because that will help save their knee and aleviate the symptoms.
The meniscus or menisci are the thick, strong, cartilage-like shock absorbers that cushion and pad the knee between the thigh (femur) and shin (tibia) bones. Shaped like the letter “C,” the meniscus of each knee provides stability in carrying the weight of the body or in gliding through the knee’s many range of motions.
The meniscus can become problematic either through traumatic injury, or age and wear and tear.
Wear and tear can occur in runners, people who have jobs that require a lot of physical activity where stresses to the knees are applied, or in older people where the degeneration of the cartilage causes tearing in the meniscus.
Meniscus injuries in sports are often caused by impact or in sharp cutting or turning when the meniscus can become trapped between the femur and the tibia. Typically an injury to the meniscus will occur in combination with ligament injuries, especially the MCL (medial collateral ligament).
What are symptoms and signs of meniscal tears?
- On and off swelling of the knee
- Pain with running or walking
- Clicking or popping noise especially on stairs
- Giving way or buckling
- The knee locks up and cannot be straightend out. This usually occurs from the meniscus tear causing an obstruction by folding back over itself.
In the past a patient presenting themselves to an orthopedic physicians with meniscal damage would find themselves in the operating room to have their entire meniscus removed. It was thought that meniscal cartilage or any cartilage for that matter could not be repaired. That a doctor, leaving the meniscus in the knee was just setting the patient up for long-term pain.
Removing the meniscus was causing arthritis
Despite a landmark paper in 1948 that warned surgeons that removing the meniscus was causing arthritis. The surgeries continued. (1)
By the mid 1980′s this thinking had evolved enough that thinking even partial meniscal removal would be detrimental. “It is now well established that the meniscus performs a number of roles that are important to the efficient performance of the knee joint. Of particular importance is the recognition of its load-bearing function and its stabilization of the joint during flexion-extension…Total meniscectomy is not a benign procedure. Partial excision has less deleterious effects on the joint. Surgical repair of meniscus lesions has now emerged as a procedure of some significance and laboratory research suggests that a solution to this problem may be within reach.” (2)
This was back in 1987 and that surgical solution remains elusive. However in the two decades that followed, doctors became keenly aware that meniscal removal of any type should be a last resort. This has lead to the emergence other types of treatments for the repair of the meniscal tissue – including Platelet Rich Plasma Therapy.
Suddenly, a wealth or research came out supporting PRP’s ability to save the meniscus.
“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.” (3)
“It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing—Patelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.”(4)
“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. However, most of the meniscus has a limited ability to heal because of poor vascularity (circulation) — Platelet-rich plasma is the latest technique to be evaluated for augmenting meniscal healing. Activation of the platelets leads to the local release of growth factors—These growth factors have been associated with the initiation of a healing cascade leading to cellular chemotaxis, angiogenesis, collagen matrix synthesis, and cell proliferation.”(5) What these researchers are trying to tell you is that PRP has healing factors that can repair meniscal tears.
1. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948 Nov;30B(4):664-70.
2. Ghosh P, Taylor TK. The knee joint meniscus. A fibrocartilage of some distinction. Clin Orthop Relat Res. 1987 Nov;(224):52-63.
3. Ahmad Z. et al. The role of platelet rich plasma in musculoskeletal science JRSM Short Rep. 2012 June; 3(6): 40.
4. Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH. A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears. Med Sci Monit. 2012 Aug;18(8):HY47-50.
5. Delos D, Rodeo SA. Enhancing meniscal repair through biology: platelet-rich plasma as an alternative strategy. Instr Course Lect. 2011;60:453-60.