Stem Cell injections for knee meniscus tears and post-meniscectomy

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Ross Hauser, MD and Katherine L. Worsnick, MPAS, PA-C

This article will explore new research of that paints a fascinating picture of natural meniscus healing, surgical and non-surgical meniscus repair, and when Stem Cell Therapy may or may not work for your meniscus tear. We will also discuss the role of comprehensive Stem Cell Prolotherapy in not only treating the meniscus but the articular knee cartilage as well. If you are considering meniscus surgery, or already had meniscus surgery, this article will provide some good information in understanding your injury and what to expect from surgery and what to expect from stem cell Prolotherapy.

The surgical realities of meniscus tear repairs – what the United States Military says:

Army physicians from the William Beaumont Army Medical Center and doctors from Rush University Medical Center have published a new March 2018 study in the Journal of Knee Surgery. It reports on how military surgeons dealt with meniscal injury. The report reveals findings on nearly 30,000 meniscus surgeries.

What are we to make of this? In 4 out of 5 patients, meniscus tissue had to be removed. In 1 out of 5 patients the injury was fixable because of location and size. Meniscus transplant has lost much of its appeal.

The problem is the 4 out of 5 patients not having an option other than tissue removal.

Here is another new 2018 study. This time in the American Journal of Sports Medicine. In this research, doctors compared various treatment methods for Meniscus Root Tears.

This was a detailed 10-year study that looked at the long-term effect of surgical repair and non-surgical repair of meniscal injuries.

The 10-year findings revealed:

For many, the meniscus can heal itself if you do not remove tissue

One of the often overlooked components of meniscus surgery is that it removes healing elements from the knee. Simply, meniscus surgery removes tissue, weakens the structure of the knee, leads to degeneration through instability and knee breakdown. To complete this assault on the knee, surgery removes healing elements within the meniscus tissue that may help the knee naturally rebuild itself. The same can be said for NSAIDs and painkillers which have been shown to inhibit natural healing.

In this study, the researchers found that the meniscus has its own brigade of chondrogenic progenitor cells (Chondrogenic = cartilage, progenitor = creator or originating cells) specifically in the blood-rich red zone of the meniscus. Further, the cells in the blood-rich zone could be called upon to migrate across the meniscus and appear at the site of a white zone (no blood supply portion of the meniscus) injury. (See our discussion red-zone and white-zone meniscal tears.)

In the research above we talked about the 20% of meniscus injuries that are good candidates for surgical repair because that portion of the meniscus had healing elements. In this research, those healing elements were able to cover the whole meniscus.

Research like this reaffirms two things.

The Meniscus does have the capability to repair and regenerate but the articular cartilage of the knee cannot hold the knee together long enough to let this happen

This is a remarkably fascinating study. Japanese researchers wanted to examine the meniscus healing process after an injury or surgical removal of meniscus tissue. In an animal study, the researchers removed a large portion of the meniscus in mice.(4)

What the doctors observed was the meniscus repair and regeneration process after the meniscectomy. After six weeks the doctors observed regenerated tissues resembled those of an intact meniscus forming. The bad news was the articular cartilage of the knee where the removed meniscus use to be, significantly degenerated between two and four weeks after the surgical procedure, and subtle progression in cartilage degeneration was observed between 4 and 6 weeks.

This study requires a deeper look because it also gives us an understanding of what happens in the knee after meniscectomy.

The researchers in this study performed a meniscectomy in the mice

In this study’s summation, the immune system’s rapid response to repair the knee, not only tries to regenerate meniscus tissue damaged by the surgery but also tried to reinforce and prevent damage to the articular cartilage of the knee as if the immune system knew that the meniscectomy would cause articular cartilage.

The Japanese researchers concluded that the remaining meniscus and the articular cartilage of the meniscectomized knee tried, in vain, to work together to regenerate the meniscus and protect the cartilage.

Harvard researchers published in the medical journal Connective Tissue Research, (May 2017)  found similar findings. They isolated and studied the native meniscal tissue in mice and also found an abundance of healing mechanisms.(5)

Stem Cell Prolotherapy – research and validity of treatment

Stem cell Prolotherapy is a non-surgical regenerative treatment that stimulates natural healing repair in the knee. The goal of the treatment is to rebuild tissue and provide stability to the knee. Stem cell Prolotherapy is the combined use of your own harvested stem cells and dextrose Prolotherapy to treat the entire knee environment.

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 donated 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.) (6)

That question was seemingly answered in accompanying press release from the American Academy of Orthopaedic Surgeons press department.

“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?” (7)

Not all meniscus tears and injuries (even that after meniscus surgery) require stem cell therapy to heal. We have documented in numerous studies that simple dextrose Prolotherapy has a 90% success rate in our office. However, for cases of advanced meniscus and related cartilage damage, our team of Prolotherapy practitioners may choose to use stem cell injections in combination with dextrose Prolotherapy to strengthen and stabilize the surrounding support structures of the knee.

Injury to the meniscus is an injury to the entire knee joint. This is why many doctors can provide stem cell treatments, not all get the best results

An international team of researchers writing in the journal Sports Medicine (May 2017) offer a summary of their research that should be of great interest to the patient athlete researching stem cells for meniscus repair.(8)

Stem cells, combined with Platelet Rich Plasma Therapy meniscus injections and Prolotherapy meniscus injections are healing solutions. Caring Medical has conducted research showing the effectiveness of PRP Prolotherapy (PRPP), including case reports of MRI-documented meniscus tears successfully treated with Prolotherapy and Platelet Rich Plasma.(9) 

If you want to discuss your specific case with our staff please contact us

1. Pekari TB, Wang KC, Cotter EJ, Kusnezov N, Waterman BR. Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Service members from 2010 to 2015. The journal of knee surgery. 2018 Mar 7. [Google Scholar]

2. Pekari TB, Wang KC, Cotter EJ, Kusnezov N, Waterman BR. Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Service members from 2010 to 2015. The journal of knee surgery. 2018 Mar 7. [Google Scholar]

3. Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. Journal of Orthopaedic Research. 2016 Nov 1. [Google Scholar]

4. Hiyama K, Muneta T, Koga H, Sekiya I, Tsuji K. Meniscal regeneration after resection of the anterior half of the medial meniscus in mice. Journal of Orthopaedic Research. 2016 Nov 2. [Google Scholar]

5. Vangsness Jr CT, Jack Farr II, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. JBJS. 2014 Jan 15;96(2):90-8. [Google Scholar]

6. 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

7.Gamer LW, Shi RR, Gendelman A, Mathewson D, Gamer J, Rosen V. Identification and characterization of adult mouse meniscus stem/progenitor cells. Connective tissue research. 2017 Feb 4:1-8. [Google Scholar]

8.Andia I, Maffulli N. Biological therapies in regenerative sports medicine. Sports Medicine. 2017 May 1;47(5):807-28. [Google Scholar]

9. Hauser R, Phillips HJ, Maddela HS. 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. [Google Scholar]

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