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Degenerative meniscal treatment – Prolotherapy
Meniscus Degeneration Leads to Articular Cartilage Degeneration
The menisci of the knee play a vital role in load transmission, shock absorption, and joint stability. A recent study has confirmed that the knee menisci are active participants in the development of knee osteoarthritis (OA).1 In this study, menisci and articular cartilage specimens were collected from OA patients who underwent joint replacement surgery and lower limb amputation surgery patients for osteosarcoma (normal control specimens), and then graded. The meniscus cells were expanded in culture and subsequently, the gene expression of the meniscus cells was examined.
The researchers from the Department of Orthopaedic Surgery at Carolinas Medical Center found a significant direct relationship between the grade of menisci and articular cartilage degeneration. In this present study, more than 85% of the OA patients who underwent joint replacement surgery showed severe degenerative menisci, indicating that meniscal degeneration is common in OA patients. Thus, there is a strong association between meniscus damage and cartilage loss.
The researchers then went to the next level to assess whether OA meniscal cells are different from normal meniscal cells and may play a role in the development of OA. They examined the differential gene expression between OA meniscal cells and normal control meniscal cells. They found that many of the genes (actually 13 of 18 genes) that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 and prostaglandin E synthase, were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that the manner of gene detection is disease specific. In other words, most likely the meniscal cells play an active role in the development of OA.
Prolotherapy for degenerative knee pain
What does this mean for the person with a degenerated knee? More injections are needed! Osteoarthritis of the knee (and elsewhere) is not merely an articular cartilage disease, but a disease of the whole joint. It involves the menisci, subchondral bone, stem cells, ligaments, synovium, joint fluid, and other components of the joint. As such, whatever treatment is given for degenerative knee arthritis should be comprehensive. Experienced Prolotherapists use comprehensive Hackett-Hemwall Prolotherapy to treat many of the structures of the degenerated joint, including the menisci, articular cartilage, ligaments, tendons and the synovium, and joint fluid. This is one of the reasons so many injections are given per patient and why so much solution is used. For extreme cases of joint degeneration, stem cell injection therapy or Bone Marrow Prolotherapy is used. In this procedure bone marrow (with its stem cells) is used as the proliferant for inside the joint. It has been shown in other studies that bone marrow stem cells can be used to regenerate meniscus tissue. The extent of joint degeneration will determine what solutions are used and how many visits are needed. Contact us for more information.
For more information, read our paper on the case for using Prolotherapy as a first line treatment for meniscus tears published in the Journal of Prolotherapy.
1Sun Y, Mauerham DR, Honeycutt PR. Analysis of meniscal degeneration and meniscal gene expression. BMC Musculoskeletal Disorders. 2010; published online January 28, 2010 doi: 10.1186/1471-2474-11-19. Open Access article.