If Platelet Rich Plasma Prolotherapy (PRP) can enhance the healing of meniscus following meniscal surgery, why have the surgery? Here is recent research on the use of PRP Therapy and meniscal tears.
“The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal…research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.”1
Meniscal Surgery: Poor Option for Damaged Cartilage
There is no question that cartilage heals slowly and poorly. This difficulty in healing is why the surgical option for meniscal injury is seemingly the only answer to those unfamiliar with the repairing techniques of Prolotherapy, Stem Cell Therapy, and Platelet Rich Plasma therapy.
Recommendations for surgeries involving shaving or removing the torn portion of the tear using arthroscopic surgery, or sewing the tear together is flawed because it does not repair the deteriorated cartilage. By failing to heal the damaged meniscal cartilage, surgery does not alleviate the chronic pain that people with this condition experience. In fact, with this approach the demise of the cartilage is inevitable because the meniscus provides nutrition to the articular cartilage. If the cartilage is damaged, pressure on the bone will be too great and arthritis will develop. Although the individual may feel better for a while after surgery, the fact is that the injured tissue remains injured. If the torn meniscus is completely removed, too much pressure is put on the articular cartilage and shock absorption is dramatically affected.
In the above study, researchers sought to improve the surgical outcomes in meniscal surgery by applying a PRP solution to the torn meniscus that is “white”. In other words there is no blood flow to bring the cells necessary for repair to enhance surgical outcome. The question of course is why have the surgery if there is confidence the PRP treatment will repair the meniscus non-surgically?
Platelet Rich Plasma Prolotherapy for Meniscal Tears
We have been asking that question for years as we have found Prolotherapy to be an effective surgery alternative for meniscal injury. Our published research in the Journal of Prolotherapy stated:
“Prolotherapy solutions can include dextrose, human growth hormone (HGH), platelet rich plasma, and others, all of which stimulate connective tissue cells to proliferate. A retrospective study was done 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. While this is only a pilot study, the results are so overwhelmingly positive that it warrants using Prolotherapy as first-line therapy for meniscal pathology including meniscal tears and degeneration.”2
Do you have questions about this article or any other conditions that Prolotherapy can treat? Please contact us.
1. Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH. A novel hypothesis: The application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears. Med Sci Monit. 2012 Aug 1; 18(8): HY47-50.
2. Hauser RA, 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.