Meniscus repair with Stem Cell Therapy – an update part 1
In research published by the Journal of Bone and Joint Surgery, doctors have found that a single stem cell injection following meniscus knee surgery may provide Knee Pain relief and aid in meniscus regrowth. In this study, patients received a single injection of adult stem cells following the surgical removal of all or part of a torn meniscus. These patients reported a significant reduction in pain. Further, some meniscal tissue regrew! Up to 15 percent increase in meniscal volume at one year. There was no additional increase in meniscal volume at year two. (Comment: Maybe they should have given more than one injection.)
Wait, that was answered in the American Academy of Orthopaedic Surgeons’ press release. “The results of this study suggest that mesenchymal stem cells have the potential to improve the overall condition of the knee joint,” said Dr. Vangsness (a study author). “I am very excited and encouraged” by the results. With the success of a single injection, “It begs the question: What if we give a series of injections?”1
Meniscus repair with Stem Cell Therapy
Again, we have to ask, if it works so well in rebuilding meniscal tissue, why have the surgery in the first place? It does say multiple injections may benefit the patient more. It seems we have written very often that single injections are not Prolotherapy; single PRP injections are not PRP treatments; and now single Stem Cell injections are probably more effective if given more often? Sounds like Comprehensive Prolotherapy performed at Caring Medical, ie multiple injections of various and supportive elements to fit the individual case of the the patient.
Why have the surgery in the first place?
On December 24, 2013, the New England Journal of Medicine published an article entitled :”Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear.”
This was the work of Finnish researchers who recognized that arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.
So what they did was to conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis.
Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. Then a scoring system was designed to measure pain, symptom severity and knee pain after exercise at 12 months after the procedure.
the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure
What they found was “In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.”2
This is not the first study this year to question the value of meniscal surgery. Earlier in 2013 research published in the American Journal of Sports Medicine showed what little value meniscectomy has. Researchers compared meniscectomy to nonoperative treatment for meniscus tears.2 They specifically studied degenerative horizontal tears of the medial meniscus and hypothesized that surgical treatment would produce better outcomes that nonoperative strengthening exercises.
In other research, doctors hypothesized that surgical treatment would produce better outcomes than nonoperative strengthening exercises. It didn’t.
This study was a randomized controlled trial with the highest level of evidence (level 1). The study had 102 patients with medial meniscus tears – 81 women and 21 men with the average age of 53.8.
Fifty patients underwent arthroscopic menisicectomy while 52 participated in nonoperative strengthening exercises. The results did not match up the to researchers hypothesis. At the two year follow-up there was no difference in pain relief, improved knee function or patient satisfaction. Results also showed that meniscectomy did not provide better functional improvement than the nonoperative group.3
But what was the difference between these two groups? One group of patients underwent invasive surgery, had tissue remove, and will likely experience long-term meniscus degeneration.
In fact, most surgical meniscus treatments have, “all have a high long-term failure rate with the recurrence of symptoms including pain, instability, locking, and re-injury. The most serious of the long-term consequences is an acceleration of joint degeneration.”4
Significant decline in the patients’ knee pain and stiffness
In 2010 we published our findings on Prolotherapy for meniscal tears. We perfromed a retrospective study involving 24 patients, representing 28 knees, whose primary knee complaints were due to meniscal pathology documented by MRI. The average number of Prolotherapy visits was six and the patients were followed on average 18 months after their last Prolotherapy visit. Prolotherapy caused a statistically significant decline in the patients’ knee pain and stiffness. Starting and ending knee pain declined from 7.2 to 1.6, while stiffness went from 6.0 to 1.8.
Prolotherapy caused large improvements in other clinically relevant areas such as range of motion, crepitation, exercise, and walking ability.
Patients stated that the response to Prolotherapy met their expectations in 27 out of the 28 knees (96%). Only one out of the 28 patients ended up getting surgery after Prolotherapy.
Based on the results of this study, Prolotherapy appears to be an effective treatment for meniscal pathology. 4
1. Stem Cell therapy following Meniscal Surgery http://newsroom.aaos.org/media-resources/Press-releases/stem-cell-therapy-following-meniscus-knee-surgery-may-reduce-pain-restore-meniscus.htm
2. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. N Engl J Med 2013; 369:2515-2524December 26, 2013DOI: 10.1056/NEJMoa1305189
3. A Comparative Study of Meniscectomy and Nonoperative Treatment for Degenerative Horizontal Tears of the Medial Meniscus Am J Sports Med May 23, 2013 ; published online before print May 23, 2013.
4. Hauser R, Phillips H, Maddela HS. Hilary J. 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. Journal of Prolotherapy. 2010;(2)3:416-437.