Stem Cell Prolotherapy injections for knee meniscus tears and post-meniscectomy
With the rise of biologic technologies including stem cell technology and continued research calling arthroscopy surgery for meniscus tear in question, many patients are now exploring non-surgical meniscus regeneration with Stem Cell Prolotherapy.
- If you have questions about meniscus tear stem cell treatment, get help and information from our Caring Medical staff
Stem Cell Prolotherapy – research and validity of treatment
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.
We have published extensively on this subject, please see our research at
- Direct Bone Marrow Aspirate Therapy : Treating Osteoarthritic Joints Using Dextrose Prolotherapy and Direct Bone Marrow Aspirate Injection Therapy
- Regenerative Injection Therapy with Whole Bone Marrow Aspirate for Degenerative Joint Disease: A Case Series
- Rationale for Using Direct Bone Marrow Aspirate as a Proliferant for Regenerative Injection Therapy (Prolotherapy)
Stem Cell Prolotherapy for meniscus damage will be discussed further in this article.
When doctors surgically remove meniscus tissue, they remove native stem cells that coordinate healing and repair.
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 and knee breakdown, and to complete this assault on the knee, removes healing elements within the meniscus tissue that may help the knee naturally rebuild itself.
In September 2017, in the Journal of orthopaedic research, (1) doctors at the University of Iowa, working with researchers from the Harvard Medical School and the National Institutes of Health, looked for the healing elements in the meniscus and identified what they do.
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 essence the injury is calling for help and the chondrogenic progenitor cells respond to begin the rebuilding process. The meniscus has its own damage control mechanism, it sits in the blood rich portion of the meniscus. When red zone meniscus is removed, the meniscus ability to heal itself is removed with it.
The Iowa findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential.
Therefore, the meniscus COULD heal itself.
Research like this reaffirm two things.
- The Meniscus does have the capability to repair and regenerate.
- When we surgically remove meniscus tissue we remove the cells that can naturally repair meniscal damage.
The Meniscus does have the capability to repair and regenerate but the articular cartilage of the knee cannot bear the burden
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.
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.(2)
The suggestion is that the meniscus was trying to heal while the knee environment was collapsing towards degenerative disease. Chronic degenerative knee damage is too many fires for the immune system to deal with simultaneously. Please see our article on knee instability and degenerative knee disease. This article explains why we treat the whole joint degenerating environment.
What your native Meniscus Stem Cells do at the time of injury shows why they should not be removed
Harvard researchers publishing in the medical journal Connective Tissue Research, (May 2017) isolated and studied the native meniscal tissue in mice. What they found was an abundance of healing mechanisms.
- The mouse meniscal stem cells had clonogenicity (the ability to survive in hostile inflammatory environment and reproduce) and multi-potentiality (the ability to change and signal multiple types of healing mechanisms).
- They had the ability to create important extracellular matrix components of adult meniscus. Please see my article on extracellular matrix and joint healing for fascinating new research.
The Harvard team concluded this exciting study by declaring:
- Analysis of (Mouse meniscus stem cells) will allow for a greater understanding of the cell biology of the meniscus, essential information for enhancing therapeutic strategies for treating knee joint injury and disease.(3)
Injury to the meniscus is 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.(4)
- “Regenerative medicine (stem cells, Prolotherapy and blood platelet solutions) seeks to harness the potential of cell biology for tissue replacement therapies, which will restore lost tissue functionality. Controlling and enhancing tissue healing is not just a matter of cells, but also of molecules and mechanical forces.”
- My note: Stem cell treatments are much more than simply injecting stem cells into the knee – while there are no guarantees that any treatment will work 100% – we, as doctors, have to make sure we are doing the most we can to guarantee success. This includes understanding that an athlete may have had a long history of painkiller and cortisone use – this is explained in my article How stem cells heal degenerative joint disease after years of cortisone and painkillers
- This is also covered in my article Why didn’t stem cell therapy work for my knee pain? Where I describe stem cell failure because the entire knee, not just the meniscus, or cartilage, or ligaments are treated.
- Continuing the research cited above from the journal Sports Medicine: The researchers acknowledge the following problems in consistency in treatment. First they “describe the main biological technologies to boost musculoskeletal healing, including bone marrow and subcutaneous fat-derived regenerative products, as well as platelet-rich plasma and conditioned media (meniscus scaffolds).”
- Then they examined a total of 54 studies investigated the effects of mesenchymal stem-cell products for joint conditions including anterior cruciate ligament, meniscus, and chondral lesions as well as osteoarthritis. In 22 studies, cellular products were injected intra-articularly, whereas in 32 studies mesenchymal stem-cell products were implanted during surgical/arthroscopic procedures. The heterogeneity of clinical conditions, cellular products, and approaches for delivery/implantation make comparability difficult.
- Mesenchymal stem-cell products products appear safe in the short- and mid-term, but studies with a long follow-up are scarce. Although the current number of randomized clinical studies is low, stem-cell products may have therapeutic potential. However, these regenerative technologies still need to be optimized.”
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.(7)
What happens in the knee after meniscectomy?
As we have seen above, when meniscus tissue is removed in a meniscectomy, the meniscus tries to recover. However, because the knee is left without the protective padding necessary to prevent osteoarthritis and the future need of knee replacement, recovery is often not fulfilled.
Doctors in Japan writing in the Journal of orthopaedic research examined the phenomena of reduced meniscal function significantly accelerating articular-cartilage degeneration. They did this by studying mice who had a meniscectomy.
- The left anterior halves of the medial menisci in mice were removed. Then the mice were observed to see how their knee dealt with this injury.
- At day three: Extensive macrophagic infiltration into the synovial membrane around the meniscectomized area was observed.
- Explanation: macrophages are immune cells that clean up and remove debris left behind by injury. The body is removing hindrances to healing. In other words the knee is getting ready to heal.
- At day three: Extensive macrophagic infiltration into the synovial membrane around the meniscectomized area was observed.
- Synovial hyperplasia was detected 2 weeks after the operation.
- Explanation: Synovial hyperplasia is inflammation. Healing inflammation. The synovial tissue of the knee was filled with many fibroblastic cells (collagen producers to rebuild cartilage).
- The articular cartilage at the interface of the resected meniscus significantly degenerated between 2 and 4 weeks after the surgical procedure, subtle progression in cartilage degeneration was observed between 4 and 6 weeks. The degeneration slowed by continued.
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.(5)
What happens when you inject stem cells into a knee following meniscus surgery?
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)
This is the concept behind Stem Cell Prolotherapy. Healing is usually not a one treatment proposition. Great care needs to be taken by the health care professional that a customized regenerative program is discussed with the patient so realistic expectations could be met.
If you have questions about meniscus tear stem cell prolotherapy treatment, get help and information from our Caring Medical staff
1 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]
2 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]
3 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]
4 Andia I, Maffulli N. Biological therapies in regenerative sports medicine. Sports Medicine. 2017 May 1;47(5):807-28. [Google Scholar]
5 Hiyama K, Muneta T, Koga H, Sekiya I, Tsuji K. Meniscal regeneration after resection of the anterior half of the medial meniscus in mice. J Orthop Res. 2016 Nov 2. doi: 10.1002/jor.23470. [Google Scholar]
6 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]
7 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 [Google Scholar]
8 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]