Meniscal Injury
Read Dr. Hauser's article ground-breaking study on the use of Prolotherapy as a first line treatment for meniscal tears and degeneration. It was published in the July 2010 issue of The Journal of Prolotherapy and is titled 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.
To read the article in its entirety, please click on this link.
The menisci consist of semilunar fibrocartilage, partly filling the space in the knee between the femoral and tibial bones. Four principal functions are ascribed to the menisci:
1. To spread a thin film of synovial fluid which provides nutrition to the articular cartilage
2. To act as shock absorbers
3. To increase the stability of the knee joint
4. To aid in the complex rotary mechanics of the knee joint. Meniscus injuries occur in most sports, but most commonly occur in contact sports, especially football.
They often occur in combination with ligament injuries, particularly when the medial meniscus is involved. This is partly because the medial meniscus is attached to the medial collateral ligament and partly because tackles are often directed towards the lateral side of the knee, causing external rotation of the tibia. Injury to the medial meniscus is about five times more common than injury to the lateral meniscus. By knowing the function of the meniscus, it is possible to predict what will happen when meniscal tissue is shaved or removed.
Since it provides some of the nutrition to the articular cartilage, its removal will aid in the demise of the cartilage. If the cartilage is damaged, then the pressures on the bone will be too great and arthritis will soon follow. This is not the only reason why articular cartilage damage is sure to follow after meniscectomy. The removal of the menisci allows too much pressure to be put on the articular cartilage, thus lessening the shock absorption. This is why cartilage damage and proliferative arthritis must be the end result of meniscal removal. No other option is available. If the surgeon removes the meniscus, arthritis is the end result. If that were not enough, the menisci aid in the stability of the knee. If they are removed, the knee is left with too much motion and becomes unstable. This also increases the likelihood of articular cartilage damage and subsequent arthritis. Arthroscopic shaving and removal of the meniscus would therefore be expected to result in the progression of arthritis in the knee. Prolotherapy, on the other hand, would be expected to heal the meniscus, since Prolotherapy stimulates the body to repair the injured tissue.
Prolotherapy given to the injured menisci stimulates fibroblastic growth of new stronger meniscal tissue, thereby repairing the area. This makes a lot more sense than its removal. Menisci are normally shaved or removed because they are believed to repair so poorly. Menisci, like many of the soft tissues treated with Prolotherapy, have a poor blood supply. This lack of circulation is a main reason why they heal so poorly. The best treatment option is to increase the circulation to the damaged menisci. Athletes with meniscal injuries are generally given RICE treatment, which dramatically further decreases circulation to the damaged menisci. The MEAT protocol and Prolotherapy, on the other hand, improves blood circulation to the damaged area and stimulates repair.
Partial Meniscectomy: More Arthritic Changes Result Luis Bolano, M.D., and associates at the Oklahoma Center for Athletes and the University of Oklahoma wanted to determine the long-term results of arthroscopic partial meniscectomy. They noted that the short-term results of arthroscopic partial meniscectomy had been excellent-to-good in 80 to 95 percent of patients in the already published studies. What they found surprised them. The patients, many of whom were athletes, were functioning fairly well. Eighty percent experienced satisfactory results, 66 percent maintained their activity levels, but 26 percent decreased their activity levels after the surgery. Despite the apparent success of the surgery, almost all of the patients showed arthritic changes on x-ray. Forty-one percent had advanced arthritis. The problem with arthroscopic surgery is that it does not induce the healing of the menisci. The athlete feels better for a while, but the injured tissue remains injured. This causes the arthritic process to start immediately. If left unchecked, the athlete's abilities will decline, symptomatology will increase, and more arthroscopic or orthopedic surgeries will follow. If the athletes want this, then by all means, continue to be scoped.
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