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The Daily Prolonews – Meniscal Treatment – April 6, 2012
Knee Surgery vs. Prolotherapy
THE REDZONE OF THE MENISCUS IS THE MOST IMPORTANT PART TO PRESERVE DURING ARTHROSCOPY BUT PROLOTHERAPY IS A BETTER OPTION!
Although I write about the negative aspects of arthroscopy, trust me if I had a complete anterior cruciate ligament (ACL) tear I would have it arthroscopically repaired. I guess my main criticism with arthroscopy is the fact that most folks going in for arthroscopy have the notion that the doctor is going to make the joint “healthier.” In reality, however, almost every study has shown “clean out” arthroscopy doesn’t help or in many instances sets the stage for osteoarthritis (OA) to develop.
Stem Cell Therapy for a Torn Meniscus
The meniscus is essential to knee function. There are two menisci in each knee, lining the inner surface and absorbing the shock in between the upper and lower leg bones. A torn meniscus is a common sports injury and source of chronic pain. The standard therapy for a torn meniscus is a partial or total meniscectomy – in other words they take some or the entire meniscus out. But as we already stated, the meniscus acts as a shock absorber in the knee. It also provides stabilization. So removing a torn meniscus removes shock absorption and stability. The results are instability in the knee, extra force on the cartilage of the knee, and inevitable degeneration of cartilage leading to osteoarthritis of the knee. Clearly a meniscectomy is not the answer to a torn meniscus.
Torn meniscus surgery alternative
When a meniscal injury is suffered, surgery offers two options. Remove the damaged parts and weaken the knee or meniscal transplant surgery which itself has a documented high rate of failure. In the article below, Ross Hauser, M.D., a leading Prolotherapy doctor from Oak Park, Illinois, explains Prolotherapy treatment as a meniscal surgery alternative.
Meniscus Injury
Ross Hauser, M.D.
Meniscus Defined
Meniscus tears are the second most common type of knee injury, the first being ligament strains and tears. However, meniscus tears are particularly interesting because they are drastically on the rise. It’s estimated that one sixth of knee surgeries are performed for lesions on the meniscus, and many more go untreated every year. However, not all meniscus tears look exactly the same.
Menisci are c-shaped fibrocartilages that rest under the kneecap. They provide stability and fluid for the knee joint as well as shock absorption. Menisci also ensure that the thigh and shin bones don’t rub against each other. Quite a lot of functions for such small pieces of cartilage!
Types of Meniscus Tears
Menisci have two zones. The red zone is outside and the white zone is inside. Meniscus tears are characterized by their placement in these two zones. For example, a longitudinal, or bucket handle, tear is a tear that tears vertically in either zone. It does not cut across the meniscus, but rather tears so that the curve looks like a bucket handle.
A radial tear, on the other hand, is a tear that extends across both zones, starting at the red zone and then extending downward into the white zone. Radial tears are also called parrot beak tears because they make an open, angular shape that looks like a bird’s beak.
A horizontal tear (or flap tear) is the exact opposite of a longitudinal tear; it cuts across the meniscus, as opposed to running alongside it.
An oblique tearis a tear that is diagonal across the meniscus. When any of these patterns combine it is called a complex tear.
Partial or Full Thickness Tears
The other classification of meniscus tears is related to the depth of the tear. Tears are considered to either be partial thickness tears or full thickness tears. This is exactly what it sounds like. Partial thickness tears are tears that only extend part way across the meniscus, while full thickness tears extend fully across. So, if you have a full thickness flap tear, then it is a tear that cuts across the meniscus completely.
Prolotherapy for Meniscus Tears
Prolotherapy is a extremely effective non surgical option for treating all types of meniscus tears. In fact, in a study done by Dr. Hauser and our clinic Caring Medical, published in the Journal of Prolotherapy, 27 out of 28 patients with all types of meniscus tears showed improvement and the Prolotherapy treatments met their expectations for healing. You can read the entire study published in the Journal of Prolotherapy here. We concluded from this study that Prolotherapy, also known as regenerative injection therapy, should be a first-line treatment option for torn menisci. Dr. Hauser provides comprehensive Prolotherapy here at Caring Medical. Depending on the severity of your tear or injury, Dr. Hauser will tailor the Prolotherapy solution to best suit your needs. In other words, we can use basic dextrose Prolotherapy, sodium morrhuate, PRP (platelet rich plasma), or stem cell bone marrow Prolotherapy depending on your needs. We specialize in the complicated cases! Not only is the tear itself treated with Prolotherapy, but the surrounding knee structures that stabilize the knee are always treated as well. If you do not treat the entire area, then the underlying reason the meniscus tore in the first place never gets addressed – which is joint instability. Knee Prolotherapy by Dr. Hauser involves many injections, therefore. Not just one.
Knee injuries not only leave the patient in pain, but lead to osteoarthritis and eventual joint replacement.
Prolotherapy provides pain relief and stability.
Why Surgery May Not Heal Your Meniscus Tear
When surgeons surgically “repair” a meniscus tear, they nearly always simply remove the part of the meniscus that is torn, because the meniscus heals terribly on its own because it does not have a good blood supply. When using Prolotherapy as an alternative means of healing, however, the meniscus heals amazingly well, because Prolotherapy stimulates healing. Of the above patients, 96% were helped by Prolotherapy.
Prolotherapy research – Knee Pain
The Journal of Prolotherapy is offering free online access to complete Prolotherapy research articles.
In this article
Researchers investigated the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved knee pain at a charity clinic in rural Illinois. Eighty patients were studied, representing a total of 119 knees, that were treated quarterly with Prolotherapy. On average, 15 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment.
The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy.
More than 82% showed improvements in walking ability, medication usage, athletic ability, anxiety, depression, and overall disability with Prolotherapy.
Ninety-six percent of patients felt Prolotherapy improved their life overall. Conclusion: In this study, patients with unresolved knee pain, treated with dextrose Prolotherapy, showed improvements in many clinically relevant parameters and overall quality of life.
Read the entire Prolotherapy and knee pain study
Bone marrow injections for cartilage repair
Direct uncultured bone marrow cells regenerate articular cartilage in animal study
The question still remains, “Is Bone Marrow Prolotherapy the very best type of stem cell therapy?” Let’s put it another way, “Is direct bone marrow injection the best way to introduce stem cell therapy into a joint?” Let’s take a look at why these researchers give a resounding “yes” answer to that question.
Researchers from the Graduate School of Human Comprehensive Sciences, at the University of Tsukuba Japan have successfully regenerated articular hyaline cartilage by using uncultured bone-marrow-derived cells.1 The researchers wanted to determine if autologous (cells from the same animals) bone marrow cells could regenerate articular cartilage. To determine this they generated large full-thickness articular cartilage defects in the knees of 48 Japanese white rabbits. The animals were divided into four groups: the uncultured bone marrow cell group; the peripheral blood cell group; a fibrin group (gel used in the study); or a control group, where nothing was done. The knees of the rabbits were studied 3 months after the treatments were given. The articular cartilage underwent histological and histochemical investigation (under the microscope). So what did placing bone marrow cells do to the articular cartilage in this study?
According to the authors, “In the bone marrow cell group, regeneration of cartilage could be detected in almost all of the sections…the percentages of Safranin-O-stained areas (stains for cartilage granules) with respect to the regenerated soft tissue area were significantly higher in the bone marrow cell group than in the other groups.’1 They also noted “…our group has reported that autologous bone marrow-derived culture-expanded cartilage repair. Comparing these latter results with those of the bone marrow cell group (direct bone marrow injection) there was no significant difference in any criteria….In conclusion, the transplantation of autologous uncultured bone marrow-derived mononuclear cells contributes to articular cartilage repair. The easy and safe method used in this study is potentially viable for clinical application.”
The question still remains does bone marrow have to be cultured to get more stem cells to make it effective? Our experience at Caring Medical is no, just like these researchers found. They found, as we surmise, that the stem cells in human bone marrow are smart enough to find the injured area and start proliferating, differentiating and proliferating the necessary cells to make the tissue that is degenerated or torn. In other words, the body knows best. Direct bone marrow injection for the regeneration of tissue such as articular cartilage and meniscus works in humans and there is no reason it won’t work in people. We hope to be one of the centers to prove it!
1Chang F, Ishii T, Yania T. Repair of large full-thickness articular cartilage defects by transplantation of autologous uncultured bone-marrow-derived mononuclear cells. Journal of Orthopaedic Research. 2008;26:18-26.
Ross A. Hauser, M.D.
Dr. Hauser the Medical Director of the comprehensive Prolotherapy, PRP, and Bone Marrow Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.
Meniscus Tear Treatment
A meniscus tear often happens as a result of a sports injury. If the knee joint is bent and twisted, this can lead to a meniscus tear. Older people who have brittle cartilage can also suffer from a meniscus tear. The femur (thigh bone) and tibia (shin bone) are protected from impact by a tough cartilage covering called the menisci, one resting on the inside and one on the outside of your knee. This cartilage within the joint provides cushioning to protect the bones from the regular trauma of walking, running and other sports. Even a miniscule tear in the meniscus can cause pain, which is why the overall health of your knee relies heavily on functionality of the meniscus. Most people who have any kind of meniscus tear (partial or full thickness) end up getting surgery, but many end up regretting it because they are still left with pain and instability.
Diagnosis
Most patients with meniscus tears come to the office having had x-rays or MRIs and are looking to avoid surgery or a repeat surgery. Anyone with a meniscus injury should seek a Prolotherapy consultation with an experienced Prolotherapy doctor prior to undergoing any surgical intervention!
When I examine a patient, a meniscus injury is suspected if the patient reports a “catching sensation” in the knee or if the knee must be “jiggled” to produce full range of motion. Articular cartilage injuries may exhibit similar symptoms and the patients may actually be facing both problems. But either way, they are both successfully treated here at Caring Medical!
Treatment
Contrary to popular belief, surgery does not have to be an option for your torn meniscus. In fact, our success rate with treating meniscus tears with Hackett-Hemwall Prolotherapy is outstanding, and we have published some of these results in a remarkable study showing how patients with meniscus tears avoided surgery. The Hackett-Hemwall method of Prolotherapy treats the entire area – injecting not only the torn meniscus, but the surrounding weakened ligaments/tendons that most likely lead to the joint instability that lead to the tear in the first place. We also practice what we call comprehensive Prolotherapy at Caring Medical, meaning we individualize the Prolotherapy solution to the patients’ individual needs. In the case of meniscus tears, sometimes a stronger proliferating solution is required, including the use of HGH (human growth hormone), PRP (platelet rich plasma), or even possibly bone marrow stem cell injections, depending on the severity of the injury.
Thus, it is our opinion that the best approach to treating meniscus tears is to stimulate meniscus repair with Prolotherapy. Unlike the traditional modern medicine approach, Prolotherapy heals the meniscus because it stimulates fibroblastic growth of new, stronger meniscus tissue, thereby repairing the area. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments, tendons, and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.
At Caring Medical we have published numerous articles and scientific editorial papers on the negative long term effects of knee surgery, particularly where any tissue is removed, such as a meniscectomy. Unfortunately many patients come to us after they have had an arthroscopy for the torn meniscus, thinking that the orthopedist was just going to “clean things up” when in reality, not only were things “cleaned up” but they were also removed, thus leaving the patients with weak, unstable joints that soon after surgery develop pain!
Prevention If you sustained a meniscus tear and you have not treated it or you received surgery, you are more likely to have further complications such as accelerated degeneration and arthritis in the future.
First, come to see us for Prolotherapy in order to stabilize and repair the knee forever. Second, be careful with the activities that you do and be cognoscente of proper technique in all that you do, such as using proper lifting, turning, and running form. Remember that movement nourishes the body, so don’t just sit on the couch and hope your knees are nourished. Start with walking, elliptical, swimming, and cycling to build up your strength. Treat your knees right and you will enjoy years of pain free mobility!
Ross A. Hauser, M.D
Dr. Hauser the Medical Director of the comprehensive Prolotherapy, PRP, and Bone Marrow Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois treating meniscal injury and knee pain. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.
