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MENISCUS BLOG |
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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. |
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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. |
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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. |
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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. |
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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.
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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.
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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. |
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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. |
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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. |
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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
successfully treated by Prolotherapy instead of the much riskier
surgeries.
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I just got what my doctor is calling Prolotherapy for a torn
meniscus, one shot of glucosamine. I am to return in a month. This does not
sound like Prolotherapy to me, not from what I've read on this web site.
He told me prolotherapy is a made-up word that means proliferate
and it's anything an orthopedist can do for you short of surgery. Does this
sound right? My knee is not better and it has been two weeks.
Read more |
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Read articles on
Meniscal Injury,
Meniscus injury and Other Knee
Pain
Articles by
Ross Hauser, M.D.
Add To Meniscus Pain Blog |
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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. |
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