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SUMMARY

Meniscus injuries are a common cause of knee pain. Tears are the most common form of meniscal injuries, and have a 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, one of the most serious longterm sequelae of surgeries for meniscus tears is an acceleration of joint degeneration. This poor healing potential of meniscal tears 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 can be stimulated to repair with various growth factors or solutions that stimulate growth factor production. Platelet Rich Plasma Prolotherapy (PRPP) has been shown to be effective in these five cases of MRI-documented meniscal tears in returning these patients to activity and athletic sports. While more controlled studies need to be completed, the clinical evidence shows that PRPP is a reasonable approach to meniscal injury and should be considered as first-line treatment for meniscal injuries.

ABOUT THE AUTHORS

Ross A. Hauser, MD received his undergraduate degree from University of Illinois. He graduated from the University of Illinois College of Medicine in Chicago and did his residency at Loyola/Hines VA in Physical Medicine and Rehabilitation. He is the Medical Director of Caring Medical and Rehabilitation Services in Oak Park, Illinois and is passionate about prolotherapy and natural medicine. He and his wife Marion, have written seven books on prolotherapy, including the national best seller “Prolo Your Pain Away! Curing Chronic Pain with Prolotherapy,” now in its third edition, a four-book mini series of Prolotherapy books, and a 900-page epic sports book on the use of prolotherapy for sports injuries. Dr. Hauser may be reached at 715 Lake St., Suite 600, Oak Park, IL 60301; 708-848-7789; www.caringmedical.com.

Hilary J. Phillips received her Associate of Science degree from Triton College, in River Grove, Illinois. Her previous medical experience includes volunteering at Beulah Land Natural Medicine Clinic and working as medical assistant in skilled care geriatric nursing. She also served as a medical assistant for over a year at Caring Medical and Rehabilitation Services. Hilary is currently a student at North Park University where she is pursuing a Bachelor of Science degree in chemistry.

Havil S. Maddela currently works as a medical assistant at Caring Medical and Rehabilitation Services in Oak Park, Illinois. He is currently enrolled in the pre-med program at Loyola University, Chicago where he graduated in May 2010 with a degree in biology. He worked in a medical missionary clinic during his high school years as well. He hopes to attend Medical School in the fall of 2010. He may be reached at 715 Lake St., Suite 600, Oak Park, IL 60301; 708-848-7789; www.caringmedical. com.

BIBLIOGRAPHY

  1. Baker BE et al. Review of meniscal injury and associated sports. Am J Sports Med. 1985. 13(1): 1-4.
  2. DeFrances CJ et al. 2006 National Hospital Discharge Survey. National Center for Health Statistics. National Health Statistics Reports, No. 5. 2008.
  3. Owings MF et al. Ambulatory and inpatient procedures in the United States, 1996. Vital and health statistics. Series 13. No 139. Hyattsville, Md.: National Center for Health Statistics. November 1998. (DHHS publication no (PHS) 99-1710.)
  4. Hoser C et al. Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage. J Bone Joint Surg Br. 2001. 83-B(4): 513-516.
  5. Tapper EM et al. Late results after meniscectomy. J Bone Joint Surg Am. 1969. 51-A(3): 517-603.
  6. Sharma L et al. Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Arthritis & Rheumatism. 2008. 58(6): 1716-1726.
  7. Brindle T et al. The meniscus: review of basic principles with application to surgery and rehabilitation. Journal of Athletic Training. 2001. 36(2): 160-169.
  8. King D. The function of semilunar cartilages. J Bone Joint Surg Am. 1936. 18(4): 1069-1076.
  9. Brantigan OC et al. The mechanics of the ligaments and menisci of the knee joint. J Bone Joint Surg Am. 1941. 23:44-66.
  10. Last RJ. Some anatomical details of the knee joint. J Bone Joint Surg. 1948. 30(4): 683-688
  11. Bourne RB et al. The effect of medial meniscectomy on strain distribution in the proximal part of the tibia. J Bone Joint Surg Am. 1984. 66-A(9): 1431-1437.
  12. Messner K et al. The menisci of the knee joint: anatomical and functional characteristics, and a rationale for clinical treatment. J Anat. 1998. 193:161-178.
  13. Davies DV et al. The blood supply of the synovial membrane and intra-articular structures. Ann R Coll Surg Engl. 1948. 2(3): 142-156.
  14. Trias A. Effect of persistent pressure on articular cartilage: an experimental study. J Bone Joint Surg. 1961. 43-B(2): 376-386.
  15. Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg. 1982. 64-A(3): 460-466.
  16. Greis PE et al. Meniscal injury I: basic science and evaluation. J Am Acad Orthop Surg. 2002. 10(3): 168-176.
  17. Shakespeare DT et al. The bucket-handle tear of the meniscus: a clinical and arthrographic study. J Bone Joint Surg Br. 1983. 65-B(4): 383-387.
  18. Andrish H. Meniscal injuries in children and adolescents: diagnosis and management. J Am Acad Orthop Surg. 1996. 4(5): 231-237.
  19. Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008. 359(11): 1108-1115.
  20. Arnoczky SP et al. Microvasculature of the human meniscus. Am J Sports Med. 1982. 10(2): 90-95.
  21. King D. The healing of semilunar cartilages. J Bone Joint Surg Am. 1936. 18(2):333-342.
  22. Drosos GI et al. The causes and mechanism of meniscal injuries in the sporting and non-sporting environment in an unselected population. The Knee. 2003. 11: 143-149.
  23. Petersen W et al. Age-related blood and lymph supply of the knee menisci. Acta Orthop Scand. 1995. 66(4): 308-312.
  24. Belzer JP et al. Meniscus tears: treatment in the stable and unstable knee. J Am Acad Orthop Surg. 1993. 1(1): 41-47.
  25. Scott GA et al. Combined posterior incision and arthroscopic intra-articular repair of the meniscus: an examination of factor affecting healing. J Bone Joint Surg Am. 1986. 68(6): 847-861.
  26. O’Donoghue DH. Surgical treatments of fresh injuries to the major ligaments of the knee. J Bone Joint Surg Am. 1950. 32: 721-738.
  27. Shelbourne KD et al. The O’Donoghue triad revisited: combined knee injuries involving anterior cruciate and medial collateral ligament tears. Am J Sports Med. 1991. 19: 474-477.
  28. De Pablos Fernandez J et al. The O’Donoghue terrible triad observations on 34 anterior cruciate ligament (ACL) injuries in adolescents and pre-adolescents. J Bone Joint Surg Br. 2006. 88-B: 118.
  29. Cipolla M et al. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Knee Surg, Sports Traumatol, Arthroscopy. 1995. 3: 130-134.
  30. Yaniv M, et al. The discoid meniscus. J Child Orthop. 2007. 1(2): 89-96.
  31. Smillie IS. The congenital discoid meniscus. J Bone Joint Surg. 1948. 30-B(4): 671-682.
  32. Rohren EM et al. Discoid lateral meniscus and the frequency of meniscal tears. Skeletal Radiology. 2001. 30(6): 316-320.
  33. Major NA et al. MR imaging of the knee: findings in asymptomatic collegiate basketball players. AJR. 2002. 179:641-644.
  34. Takeda Y. MRI high-signal intensity in the menisci of asymptomatic children. J Bone Joint Surg. 1998. 80B: 463-467.
  35. Quinn SF et al. Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy? Radiology. 1991. 181(3): 843-847.
  36. Stanitski CL. Correlation of arthroscopy and clinical examination with magnetic resonance imaging findings in injured knees in children and adolescents. Am J Sports Med. 1998. 26(1): 2-6.
  37. Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008. 359P: 1108-1115.
  38. McCarty EC et al. Meniscal tears in the athlete: operative and non-operative management. Phys Med Rehabil Clin N Am. 2000. 11(4): 867-880.
  39. Jorgensen U et al. Long-term follow-up of meniscectomy in athletes. J Bone Joint Surg. 1987. 69-B(1): 80-83.
  40. Lohmander LS et al. The long-term consequences of anterior cruciate ligament and meniscal injuries: osteoarthritis. Am J Sports Med. 2007. 35: 1756-1769.
  41. McCann L et al. Influence of the meniscus on friction and degradation of cartilage in the knee joint. Available at: http://www.ncbi.nlm.nih.gov/pubmed/ 19328878. Accessed June 4, 2009.
  42. Aglietti P et al. Arthroscopic meniscectomy for discoid lateral meniscus in children and adolescents: a 10-year follow-up. Am J Knee Surg. 1999. 12(2):83-87.
  43. Hanna F. Factors influencing longitudinal change in knee cartilage volume measured from magnetic resonance imaging in healthy men. Annals of Rheumatic Diseases. 2005. 64: 1038-1042.
  44. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg. 1948. 30-B(4): 664-670.
  45. Gelber AC et. al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine. 2000. 133(5): 321-328.
  46. Appleyard RC et al. Biomechanical, histological, and immunohistologial studies of patellar cartilage in an ovine model of osteoarthritis induced by later meniscectomy. Osteoarth & Cartilg. 1999. 7(3):281-294.
  47. Cincuttini FM et al. Rate of knee cartilage loss after partial meniscectomy. J Rheumatology. 2002. 29(9): 1954-1956.
  48. Raynauld JP et al. Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes. Arthritis Research & Therapy. 2006. 8(1): R21.
  49. Wluka A et al. Knee cartilage loss in symptomatic knee osteoarthritis over 4.5 years. Arthritis & Research Therapy. 2006. 8(4): R90.
  50. Johnson RJ et. al. Factors affecting late results after meniscectomy. J Bone Joint Surg. 1974. 56-A(4): 719-729.
  51. Tapper EM et al. Late results after meniscectomy. J Bone Joint Surg Am. 1969. 51-A(3): 517-603.
  52. Williams RJ et al. MRI evaluation of isolated arthroscopic partial meniscectomy patients at minimum five-year follow up. Hosp for Spec Surg (HSS) J. 2007. 3(1): 35-43.
  53. Hede A, et al. Partial versus total meniscectomy: a prospective, randomized study with long-term follow- up. J Bone Joint Surg. 1992. 74-B(1): 118-121.
  54. McGinity JB et al. Partial or total meniscectomy: a comparative analysis. J Bone Joint Surg Am. 1977. 59-A(6): 763-766.
  55. McNicholas MJ et al. Total meniscectomy in adolescents: a thirty-year follow-up. J Bone Joint Surg Br. 2000. 82-B(2): 217-221.
  56. Roos E. Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol. 2005. 17(2): 195- 200.
  57. Allen PR et al. Late degenerative changes after meniscectomy: factors affecting the knee after operation. J Bone Joint Surg. 1984. 66-B(5): 666-671.
  58. Englund M, et al. Patellofemoral osteoarthritis coexistent with tibiofemoral osteoarthritis in a meniscectomy population. Ann Rheum Dis. 2005. 64: 1721- 1726.
  59. Jackson JP. Degenerative changes in the knee after meniscectomy. Brit Med J. 1968. 2: 525-527.
  60. Rangger C. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med. 1995. 23(2): 240-241.
  61. Roos H et al. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty- one years, compared with matched controls. Arthritis & Rheumatism. 1998. 41(4): 687-693.
  62. Dandy DJ et al. The diagnosis of problems after meniscectomy. J Bone Joint Surg. 1975. 57-B(3): 349-352.
  63. Neuman P et al. Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med. 2008. 36: 1717-1725.
  64. Hoshino A et al. Impact-absorbing properties of the human knee. J Bone Joint Surg. 1987. 69-B(5): 807-811.
  65. Wilson W et al. Pathways of load-induced cartilage damage causing cartilage degeneration in the knee after meniscectomy. J Biomechanics. 2003. 36: 825-851.
  66. Baratz MA et al. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee: a preliminary report. Am J Sports Med. 1986. 14: 270-275.
  67. Lee SJ et al. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med. 2006. 34(8): 1334-1344.
  68. Hunter DJ et al. The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. Arthritis & Rheumatism. 2006. 54(3): 795-801.
  69. Sandell L, et al. Articular cartilage and changes in arthritis: cell biology of osteoarthritis. Arthritis Research & Therapy. 2001. 3(2): 107-113.
  70. Hede A et al. Articular cartilage changes following meniscal lesions: repair and meniscectomy studied in rabbit knee. Acta Orthop Scand. 1991. 62(4):319-322.
  71. Krause WR et al. Mechanical changes in the knee after meniscectomy. J Bone Joint Surg Am. 1976. 58- A(5): 599-604.
  72. Greis PE et al. Meniscal injury II: management. J Am Acad Orthop Surg. 2002. 10(3): 177-187.
  73. Cannon WD et al. Meniscal repair: part II: arthroscopic repair techniques. J Bone Joint Surg Am. 1994. 76: 294-311.
  74. O’Shea JJ et al. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med. 2003. 31(2): 216-219.
  75. Bach BR et al. Arthroscopic meniscal repair: analysis of treatment failures. J Knee Surg. 2005. 18(4).
  76. Abdelkafy A et. al. Two to nineteen years followup of arthroscopic meniscal repair using the outsidein technique: a retrospective study. Arch Ortho and Trauma Surg. 2007. 127(4): 245-252.
  77. Hamberg P et al. Suture of new and old peripheral meniscus tears. J Bone Joint Surg Am. 1983. 65- A(2): 193-197.
  78. Kurosaka M et. al. Repeat tears of repaired menisci after arthroscopic confirmation of healing. J Bone Joint Surg Br. 2002. 84-B(1): 34-37.
  79. Falazare JJ et al. Meniscal repair of the knee. Orthopaedics. 2002. 32: 199-206.
  80. Pujol N et al. Meniscal healing after meniscus repair: a CT arthrography assessment. Am J Sports Med. 2008. 36(8): 1489-1495.
  81. Rockborn P et al. Results of open meniscus repair: long-term follow-up study with a matched uninjured control group. J Bone Joint Surg Br. 2000. 82- B(4): 494-498.
  82. DeHaven KE et al. Open meniscus repair. Am J Sports Med. 1989. 17(6): 788-795.
  83. DeHaven KE et al. Long-term results of open meniscal repair. Am J Sports Med. 1995. 23: 524-530.
  84. Eggli S et. al. Long-term results of arthroscopic meniscal repair: an analysis of isolated tears. Am J Sports Med. 2008. 36: 1489-1495.
  85. Morgan CD et al. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med. 1991;19:632-638.
  86. Rubman MH, et al. Arthroscopic repair of meniscal tears that extend into the avascular zone: a review of 98 single and complex tears. Am J Sports Med. 1998. 26:87-95.
  87. Krych AJ et al. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Am J Sports Med. 2008. 36(7): 1283-1289.
  88. Farr J et al. Current meniscal allograft transplantation. Sports Med Arthroscop Rev. 2004. 12(1): 69- 82.
  89. Noyes FR et al. Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg. 2004. 86-A(7): 1392-1404.
  90. Cole B et al. Allograft meniscal transplantation: background techniques and results. J Bone Joint Surg. 2002. 84A: 1236-1250.
  91. Peters TJ et al. Studies on the chemical composition of the menisci of the knee joint with special reference to the horizontal cleavage lesion. Clinical Orthopaedics. 1972. 86: 245-252.
  92. Rodkey WG. Basic biology of the meniscus and response to injury. Instructional Course Lecture. 2000. 49:189-193.
  93. Crane D et al. Platelet rich plasma (PRP) matrix grafts. Pract Pain Manag. 2008. 8(1): 12-26,
  94. McDevitt CA et al. The ultrastructure and biochemistry of meniscal cartilage. Clinical Orthopaedics. Mar 1990. 252: 8-18.
  95. Bhargava MM et al. The effect of cytokines on the proliferation and migration of bovine meniscal cells. Am J Sports Med. 1999. 27: 636-643.
  96. Spindler KP et al. Regional mitogenic response of the meniscus to platelet-derived growth factor (PDGFAB). J Orthopaed Research. 2005. 13: 201-207.
  97. Bhargava MM et al. Effect of hepatocyte growth factor and platelet-derived growth factor on the repair of meniscal defects. In Vitro Cellular & Developmental Biology-Animal. 2005. 41(8/9): 305-310.
  98. Murray MM et al. Enhanced histologic repair in a central wound in the anterior cruciate ligament with a collagen-platelet-rich plasma scaffold. J Orthopaed Research. 2007. 25: 1007-1017.
  99. Tumia NS et al. Promoting the proliferative and synthetic activity of knee meniscal fibrochondrocytes using basic fibroblast growth factor in vitro. Am J Sports Med. 2004. 32: 915-920.
  100. Hashimoto J et al. Meniscal repair using fibrin sealant and endothelial growth factor. Am J Sports Med. 1992. 20: 537-541.
  101. Pangborn CA et al. Growth factors and fibrochondrocytes in scaffolds. J Orthopaed Research. 2010. 23: 1184-1190.
  102. Pangborn CA et al. Effects of growth factors on meniscal fibrochondrocytes. Tissue Engineering. 2005. 11: 1141-1148.
  103. Tumia NS et al. Platelet derived growth factor-AB enhances knee meniscal cell activity in vitro. The Knee. 2009. 16: 73-76.
  104. Webber RJ et al. Cell culture of rabbit meniscal fibrochondrocytes: proliferative and synthetic response to growth factors and ascorbate. J Orthopaed Research. 2005. 3: 36-42.
  105. Izal I et al. In vitro healing of avascular meniscal injuries with fresh and frozen plugs treated with TGFBA and IGF-1 in sheep. Intl J Experimental Pathology. 2008. 1: 426-434.
  106. Martinek V et al. Second generation of meniscus transplantation: in vivo study with tissue engineered meniscus replacement. Arch Orthopaed Trauma Surg. 2006. 126: 228-234.
  107. Sclafani AP et al. Modulation of wound response and soft tissue ingrowth in synthetic and allogenic implants with platelet concentrate. Arch Facial Plast Surg. 2005. 7: 163-169.

 

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