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Platelet Rich Plasma Prolotherapy as First-line Treatment for Meniscal Pathology

Ross Hauser, MD Phillips H, Maddela H. Platelet Rich Plasma Prolotherapy as first-line treatment for meniscal pathology. Practical Pain Management. 2010;July/August:53-64.

Animal research together with five patient case reports demonstrate that platelet rich plasma prolotherapy (PRPP) is effective in the treatment of MRI-documented meniscal tears.

Meniscus injuries are a common cause of knee pain, accounting for a large number of surgeries in the U.S. annually. While surgical treatments range from total to partial meniscectomy, meniscal repair and even meniscus transplantation, all have a high long-term failure rate with the recurrence of symptoms. The most serious of the long-term post-surgical consequences is an acceleration of joint degeneration. The poor healing potential of meniscus tears, along with the consequence of post-surgical joint degeneration, has led to the investigation of methods to stimulate non-surgical, biological meniscal repair. While platelet rich plasma prolotherapy (PRPP) has been studied for many types of connective tissue injuries, no study has focused specifically on its use for meniscus tears. Hauser et al give a very comprehensive review of the anatomy and pathophysiology of meniscus tears, with five case reports of MRI-documented meniscus tears successfully treated with PRPP. While further study under more controlled circumstances is needed, the logic of the authorsdiscussion and the results reported clearly validate the use of platelet rich plasma prolotherapy as a first-line treatment for meniscus tears…

The short-term results of meniscal repair have varied significantly, with a range of both promising and disappointing outcomes. Another concern associated with meniscal repair is, not surprisingly, long-term degenerative osteoarthritis. And as the ability to track long-term results has become possible, repair failures and associated symptoms have been observed in large numbers, proving that the effectiveness of this treatment is questionable at best.

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