Stem Cell Therapy and Platelet Rich Plasma Therapy – Meniscus Surgery Options

Revision Knee Surgery

Dr. Marc Darrow Stem Cell Therapy

In a new report – Investigators confirm findings that  Stem Cell Therapy stimulates the regeneration of meniscal tissue. Specifically with regard to post-meniscectomy meniscus growth with stem cells.1

This is an important finding in that surgery to repair meniscal tears may increase the risk of osteoarthritis and cartilage loss in some patients. The findings show that the decision for surgery requires careful consideration in order to avoid accelerated disease onset, researchers said.2

This is not new news – a landmark paper in 1948 that warned surgeons that removing the meniscus was causing arthritis. The surgeries continued. 3

The rush to meniscus surgery was the gold standard of care because meniscus healing is at best limited. While the red zone meniscus, the outer portion has good regenerative properties because of good blood circulation – the inner portions including the middle region or red–white zone and the innermost white–white zone have poor intrinsic healing owing to their poor avascular nature or blood supply. But as research shows the  consequences of meniscal surgery has lead to more conservative approaches being considered. See Meniscus repair using mesenchymal stem cells – a comprehensive review

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. ”4

Often we see patients who have been recommended to meniscectomy or already had the procedure. Meniscetomy is the the removal of part 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

Research says Stem Cell Therapy can be effective in meniscal repair even after surgery!

There are limited treatment options for tissue restoration and the prevention of degenerative changes in the knee. Stem cells have been a focus of intense preclinical research into tissue regeneration but limited clinical investigation. In a randomized, double-blind, controlled study, the safety of the intra-articular injection of human mesenchymal stem cells into the knee, the ability of mesenchymal stem cells to promote meniscus regeneration following partial meniscectomy, and the effects of mesenchymal stem cells on osteoarthritic changes in the knee were investigated.

A total of fifty-five patients at seven institutions underwent a partial medial meniscectomy. A single superolateral knee injection was given within seven to ten days after the meniscectomy. Patients were randomized to one of three treatment groups:

  • Group A, in which patients received an injection of 50 × 106 allogeneic mesenchymal stem cells;
  • Group B, 150 × 106 allogeneic mesenchymal stem cells;
  • and the control group, a sodium hyaluronate (hyaluronic acid/hyaluronan) vehicle control.

Patients were followed to evaluate safety, meniscus regeneration, the overall condition of the knee joint, and clinical outcomes at intervals through two years. Evaluations included sequential magnetic resonance imaging (MRI).

There was significantly increased meniscal volume  determined by quantitative MRI in 24% of patients in Group A and 6% in Group B at twelve months post meniscectomy.

No patients in the control group met the 15% threshold for increased meniscal volume. Patients with osteoarthritic changes who received mesenchymal stem cells experienced a significant reduction in pain compared with those who received the control, on the basis of visual analog scale assessments. There was evidence of meniscus regeneration and improvement in knee pain following treatment with allogeneic human mesenchymal stem cells. These results support the study of human mesenchymal stem cells for the apparent knee-tissue regeneration and protective effects.6

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.

Recent research suggests that not only does Platelet Rich Plasma Therapy regrow new cartilage cells, but it can also help prevent further cartilage deterioriation.7-8

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1. McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42. doi: 10.1097/JSA.0000000000000073. PUBMED Meniscus Growth With Stem Cells

2. Common Knee Surgery May Lead to Arthritis and Cartilage Loss Press Release

3. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948 Nov;30B(4):664-70.

4 Ghosh P, Taylor TK. The knee joint meniscus. A fibrocartilage of some distinction. Clin Orthop Relat Res. 1987 Nov;(224):52-63.

5. Ahmad Z. et al. The role of platelet rich plasma in musculoskeletal science JRSM Short Rep. 2012 June; 3(6): 40.

6. angsness CT Jr, et al. Adult Human Mesenchymal Stem Cells Delivered via Intra-Articular Injection to the Knee Following Partial Medial Meniscectomy: A Randomized, Double-Blind, Controlled Study. J Bone Joint Surg Am. 2014 Jan 15;96(2):90-8. doi: 10.2106/JBJS.M.00058.

6. 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.

7. 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.

8. Hauser R, Phillips H, Maddela HS. Hilary J. The Case for Utilizing Prolotherapy as First-Line Treatment for Meniscal Pathology: A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears and Degeneration. Journal of Prolotherapy. 2010;(2)3:416-437.