Here are some fact mentioned by Dr. Christopher Centeno, the pioneer of orthobiologics and cell therapies in the USA,that we need to remember when considering this issue of menicus tear and how to treat it.
a) In middle aged and older patients, meniscus tear are as common and as important as
wrinkles. They are simply a sign of aging.
b) Tears and all sorts of other serious finding exist in the knees of many patients without pain.
c) The most common surgical procedure used to treat meniscus tear has been shown in many
studies not to work!
d) Back in 2008 researchers publishing in the New England Journal of Medicine reported that
most people over age 35 without knee pain had everything from meniscus tears to cartilage
loss on their MRI’s.
e) New studies in 230 knees, using the most powerful Tessla MRI machines showed
abnormalities in 97% of non-painful knees. 30% had meniscus tears. About 1/3 had severe
cartilage lesions and 1/5 had tendon damage.
So now with the above facts in mind,be aware that having a meniscus tear does not equate to needing surgery or treatment. Furthermore, even if you have a meniscus tear with pain, stay away from surgery! The most common surgery performed for these tears is an Arthroscopic Partial Meniscectomy and it has been shown not to work in several studies.
So now you may be asking yourself what can be done if your knee hurts? Here are the choices with its pros and cons!
1.- Steroid injections. Cortisone injectionscan reduce inflammation but do not work as good as previously though and most importantly they damage cartilage!
2.- Viscosupplementation. Basically is an injection of a lubricating gel in the knee. There are several products in the market. Among them, Orthovisc, Sinvisc, Supartz and Euflexa. Overall they seem to work for about six months and ussually the first time around is the most succesful.
3.- Prolotherapy. Consist of a series of injection of hypertonic glusose injected under
fluoroscopic guidance in precise locations called the enthesis. Not covered by insurance just like PRP and sometimes it is combined with PRP. It is cheaper than PRP per injections but not as effective.
4.- PRP or Platelet Rich Plasma. PRP is a cell based procedure that we have been doing in our office for about eight years with great succes. It is an office based procedure. Some of our patient have been local physicians that have avoided surgery and are very happy with the results. A venipuncture is required. Sixty ml of your own blood are drawn and then by centrifugingthe blood, the platelets are concentrated to make the PRP. These platelets in the PRP when injected into your knee release growth factors that can help to reduce sweeling and help damaged cartilage cells. This injections unfortunately are not yet covered by most insurance plans, with cost ranging between $1000 to $ 2000 per PRP injections. Studies show that PRP beats Vicoscupplementation. At our office we have tried to make this top of the line treatment as affordable as possible for our patients.
(1) Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis [published correction appears in N Engl J Med. 2013 Aug 15;369(7):683]. N Engl J Med. 2013;368(18):1675–1684. doi:10.1056/NEJMoa1301408
(2) Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369(26):2515-24. doi: 10.1056/NEJMoa1305189.
(3) Sihvonen R, Englund M, Turkiewicz A, Järvinen TL; Finnish Degenerative Meniscal Lesion Study Group. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med. 2016 Apr 5;164(7):449-55. doi: 10.7326/M15-0899.
(4) Xing D, Wang B, Zhang W, Yang Z, Hou Y1,2, Chen Y, Lin J. Intra-articular platelet-rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations. Int J Rheum Dis. 2017 Nov;20(11):1612-1630. doi: 10.1111/1756-185X.13233