Meniscus Tear Injury
Click here to read Dr. Hauser's article published in the Journal of Prolotherapy, called "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".
The menisci consist of semilunar fibrocartilage, partly filling the space between the femoral and tibial bones. Four principal functions are ascribed to the meniscus:
1. To spread a thin film of synovial fluid, which provides nutrition to the articular cartilage
2. To act as a shock absorber
3. To increase the stability of the knee joint
4. To aid in the complex rotatory mechanics of the knee joint
Meniscus tear injuries occur in most sports, but most commonly occur in contact sports. 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 during meniscus surgery. 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 meniscus 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 torn meniscus. This makes a lot more sense than its removal.
Study Shows Increased Contact Stress Pressure after Meniscectomy
There have been numerous studies showing that the contact stress pressure on the articular cartilage significantly increases after meniscal removal. (Ahmed, A. In vitro measurement of static pressure distribution in synovial joints. Part 1: Tibial surface of the knees. Journal of Biomechanical Engineering. 1983; 105:216-225.; Brown, T. In vitro contact stress distributions on the femoral condyles. Journal of Orthopedic Research. 1984; 2:190-199.)
One such study showed that after partial meniscectomy, the contact stress pressures increased by 110 percent and after total meniscectomy they increased 200 percent. Their conclusion was expected. "The contact stresses increased in proportion to the amount of meniscus removed.(Baratz, M. Meniscal tears: The effect of meniscectomy and of repair on intra-articular contact areas and stress in the human knee. American Journal of Sports Medicine. 1986; 14:270-274.) Other studies have shown even greater increases in pressure, causing from a 450 to 600 percent (six times) increase in pressure on the tibia bone and articular cartilage when the meniscus is removed. (Radin, E. Role of the menisci in the distribution of stress in the knee. Clinical Orthopedics. 1984; 185:290-294.;Seedom, B. Transmission of the load in the knee joint with special reference to the role of the menisci: Part 1. Eng Med. 1979; 8:220-228.)
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 poor blood supply. This is one of the reasons they heal poorly. The best treatment option is to increase the circulation to the damaged meniscus.
Studies Show Meniscus Surgery Actually Increases Injury
Repairing a meniscal tear with arthroscopy makes conceptual sense, however, this just does not occur often enough to warrant the procedure. In an animal study, only 38 percent of the meniscal repairs actually healed. (Cabaud, H. Medial meniscus repairs. American Journal of Sports Medicine. 1981; 9:129-134.)
To add insult to injury, another study showed that surgery to repair the meniscus can actually cause a further spreading of the injury to the non-injured meniscal tissue. The authors noted, "It appears that in radial repairs, progressive spreading at the repair site altered normal meniscal geometry and structure, adversely influencing mechanical function." In common language, attempting to repair the area with arthroscopy makes the normal meniscal tissue weaker and further worsens the injury. The authors went on to say, "Meniscal tissue from repaired radial lesions was significantly lower than controls in yield stress, maximum stress, and elastic modulus. The repaired radial meniscal lesions demonstrated abnormal force transmission and energy dissipation behavior qualitatively similar to a complete meniscectomy." (Newman, A. Mechanics of the healed meniscus in a canine model. American Journal of Sports Medicine. 1989; 17:164-175.) This is unbelievable! Repairing a meniscus tear with surgery makes the meniscal tissue so weak that it is like having no menisci at all.
Incomplete Healing and Further Deterioration Result After Meniscus Repair Surgery
In one large study, where 82 percent of the meniscal injuries were sustained from sporting events, a full 75 percent of the meniscal repairs did not completely heal.(Rubman, M. Arthroscopic repair of meniscal tears that extend into the avascular zone. American Journal of Sports Medicine. 1998; 26:87-95.)
The follow-up arthroscopic examinations were done at a mean of 18 months and clinical examinations at 42 months. This is one and a half and three and a half years later, folks. These are not impressive statistics to encourage athletes to undergo surgery for meniscus tear repair. In this study, in only 18 months, 20 percent of the patients had articular cartilage damage on the tibia and femur that was not present on the initial arthroscopy, but was seen in follow-up arthroscopy. A full 40 percent had deterioration of the articular cartilage under the knee cap. This deterioration occurred over only 18 months! Yet the authors of the paper state that 80 percent of the patients were asymptomatic. But 20 percent of the patients needed further arthroscopic surgery! You see the difference between pain free and healed? Athletes are being coerced into these procedures that do not repair or heal the injured the torn meniscus tissue. Eighty percent were pain-free while their cartilage was rapidly deteriorating. What is being done to stop this arthritic process? Unless the orthopedist plans to refer the athlete for Prolotherapy, nothing is being done.
Click here for more information on Meniscal Injury.
For more on Prolotherapy.