MENISCUS BLOG

Can Prolotherapy repair a small meniscal tear?
I have been told that the torn portion may interfere with the knee movement unless it is removed?

A. Prolotherapy generally has good success at helping meniscal tears/injuries heal since it 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 area. In our opinion this makes more sense than its removal.

Realize though MRI scans typically look the same when meniscal injuries are healed. It doesn't matter whether they heal by themselves, with Prolotherapy or are sewn up by a surgeon, they menisci will still look abnormal on MRI.

So whether a meniscal injury/tear is healed goes more on clinical grounds. Do you not have pain? Can you squat, run and jump without discomfort? Can you cut quickly or sprint without any instability, catching or pain? Is there swelling in the joint? These are the type of questions that determine whether the meniscus is fine or not.

Answer by Ross Hauser, M.D.
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I have a torn meniscus and my doctors suggested I have arthroscopy. I wanted to know how Prolotherapy works and what is the recovery time and is Prolotherapy a permanent cure?

A. For people with meniscal and cartilage issues, generally more than the average three to six visits will be needed for complete healing of the knee, but it IS possible to achieve some significant healing and relief. At each session, you would receive from 20-30 injections to strengthen the meniscus and cartilage, as well as the surrounding ligaments. Treatments are generally spaced four weeks apart. But if you are in a hurry, treatments can be given every one to two weeks. The wonderful part of Prolotherapy is that you can exercise while you are undergoing the treatment. For meniscal injuries this would typically involve Bosu Ball, cycling and swimming. No running generally.

The results we see with Prolotherapy are usually curative (although not everyone will get these desired results.) Once an individual has completed the treatments as recommended by the physician, the area does not need further treatment unless there is a reinjury. Also, after each session there are usually no limitations. You can return to work as usual. Of course, one would not want to continue any activity that causes excessive pain.

Answer by Ross Hauser, M.D.
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Q. Can Prolotherapy help coronary ligaments
A. The coronary ligaments hold the meniscus to the tibial plateau around the outside edge of the meniscus. Prolotherapy can strengthen these small but important ligaments and tack the cartilage back down and stimulate the regeneration of a peripheral tear. This allows the athlete to retain this very important piece of the knee! If they are cut away, it will have an effect on the stability of the knee.

Answer by Ross Hauser, M.D.
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Q. What are the characteristics of a sports-related Meniscal Injury?
A. The athlete is especially prone to meniscus injuries. This is particularly true if the sport involves running and pivoting, such as in tennis and basketball. The meniscus is quite vulnerable to rotational stresses. The medial meniscus on the inner side of the knee is injured much more frequently, than the lateral meniscus on the outside of the knee, due to its stronger attachment to the medial collateral ligament and joint capsule. Men sustain three times as many meniscus injuries as women. This most likely relates to the fact that men participate in more violent sports, such as football, rugby, and hockey, where many of these injuries occur.

The history of a torn meniscus is characteristic: a locking with the knee bent followed by unlocking by shaking the leg. These injuries almost always occur between the ages of 16 to 30. The knee hurts when fully bending it. Athletes can tell which side of the knee is hurt indicating medial or lateral meniscus injury.

Answer by Ross Hauser, M.D.
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Q. Can Prolotherapy improve a medial inner tear of the meniscus
A. Would I get Prolotherapy if I had a meniscal tear? Most definitely I would. Unfortunately there have not been long term studies to prove or disprove that Prolotherapy helps heal meniscal tears. Anecdotal evidence is there that meniscal tears typically do very well with Prolotherapy. We have many patients, who over the years healed completely and did not need any further care.

Typically it takes 4-6 visits of Prolotherapy to heal a meniscal tear. Meniscal tears typically cause very discrete pain on the medial or lateral knee joint line and it increases with running, squatting, and cutting. Sometimes there is a 'catching' sensation. These symptoms usually decrease with each Prolotherapy session.
 
Answer by Ross Hauser, M.D.
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Incomplete Healing and Further Deterioration

Result After Meniscal 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. 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 meniscal repairs. 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 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.

Newman, A. Mechanics of the healed meniscus in a canine model. American Journal of Sports Medicine. 1989; 17:164-175.
Rubman, M. Arthroscopic repair of meniscal tears that extend into the avascular zone. American Journal of Sports Medicine. 1998; 26:87-95.

Article by Ross Hauser, M.D.
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PROLOTHERAPY AFTER KNEE SURGERY
Often after knee surgery, the patient is left with less meniscal and cartilage tissue and a much weaker knee.

The menisci and cartilage cushion the knee every time we bend at the knee, jump or walk. The remaining cartilage and meniscal tissue, and for that matter, ligament, tendon and muscle tissue around the knee, will now have to take more of the brunt of these pounding forces.

The end result will be quicker degenerative changes. Prolotherapy can help strengthen the structures that are left and hopefully cause some regrowth of the tissue that is missing.

For people with meniscal and cartilage issues generally more than the three to six visits will be needed.

Article by Ross Hauser, M.D.
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Lateral meniscus tear
Q. I have a lateral meniscus tear. It happened during routine stretching (I am not an athlete). Although the physical therapy I've been doing has helped, I still have minor sensation of 'catching' and general weakness in the knee. The surgeon I was seeing is very eager to scope my knee, even though he says there is only a 50/50 chance of success. I am very reluctant to have the surgery and want to explore Prolotherapy. I am a 49 years old woman, fit and healthy. Would my condition be something Prolotherapy might treat successfully?

A. If it happened to me I would definitely try Prolotherapy. I would get treated once every one to two weeks for 3 visits and see how it feels…generally takes 3 to 6 visits. You can also talk about what training you can do while it is healing.

Answer by Ross Hauser, M.D.
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I had meniscal surgery on my knee and I have now reinjured it, can Prolotherapy still help?

We have treated many patients who experience re injury even after surgery because the surgery helps repair the tear but does not help heal the weak ligaments and tendons that allowed the tear to occur in the first place. If you did reinjury the meniscus give Prolotherapy a try. In our experience at least 4 out of 5 of patients with meniscal tears get pain free with Prolotherapy (or almost pain free).

So, the likelihood of Prolotherapy being able to help you now that you have re injured is very good. However, to know for sure if you are a good Prolotherapy candidate, you would need to be examined.

Article by Ross Hauser, M.D.
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LATERAL MENISCUS: CASE HISTORY
The patient is a male, age 37. While snowboarding, he put his foot down and twisted his left knee. He had episodes of locking and painful popping associated with swelling and pain. His worst episode happened the day prior to his first visit to me. He could barely walk. I withdrew over one quarter cup of fluid from his knee and injected Prolotherapy solution into the joint. After drawing the fluid out two more times, I treated his lateral meniscus six times with Prolotherapy. After this he returned to both winter and summer sports and unrestricted work duties.

Swelling in a joint typically means that a structure inside the joint is injured, usually in the knee this is a cruciate ligament or meniscus. Either way, the best treatment in my opinion is Prolotherapy.

Prolotherapy can effectively treat many meniscus injuries, especially those in the outer rim. The blood supply to the meniscus nourishes this outer rim and allows for easier healing. Unfortunately, only 15 to 20 percent of meniscus injuries occur in this outer third.

Studies have shown that the central two-thirds of the meniscus is capable of repair using the blood vessels from the joint lining (synovium) and the meniscus itself. It has been demonstrated that the cells of the meniscus can and do heal when exposed to certain growth stimulating factors.

Prolotherapy provides this stimulation to heal. This is why many athletes suffering from the pain and disability of a torn meniscus are sucessfully treated by Prolotherapy instead of the much riskier surgeries.

Article by Ross Hauser, M.D.
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Disclaimer: The information on this website is presented as information only and not a self-help guide NOR AS SPECIFIC HEALTH RECOMMENDATIONS. The physician you are visiting has had the benefit of performing medical examinations and laboratory tests to determine the degree of your symptoms. Important tools in not only prescribing a treatment plan but also in determining your response. If you have concerns about your treatment, please direct your questions to your physician because that is the proper course to take. Prolotherapy may not be effective for every individual and there are risks involved, these risks should be discussed with your physician. Results achieved with some may not be typical of all. Please consult a physician.