 | ANATOMY The meniscus is a fibrocartilage structure that sits between the tibia and femur in the knee. There is a lateral and a medial meniscus. The menisci provide cushioning, joint stabilization, joint lubrication, and proprioception. Image: BruceBlaus, via wikimedia |
| INJURY The menisci are often injured resulting in tears. People with absent anterior cruciate ligaments (ACL) are at a higher risk for injury. Tears to the meniscus often occur with excessive twisting movements seen in sports when an athlete plants a leg and pivots. The meniscus is often injured in combination with the ACL and the medial collateral ligament. |  Mikael Haggstrom, via wikimedia. (CC0 1.0) |
TREATMENT
These injuries are often treated conservatively with rest, NSAIDs, and physical therapy. If symptoms don’t improve with conservative treatment or if they are severe enough, surgery is the next option. For symptomatic degenerative meniscal tears that are non-surgical, corticosteroid injections are standard of care.
These injuries are often treated conservatively with rest, NSAIDs, and physical therapy. If symptoms don’t improve with conservative treatment or if they are severe enough, surgery is the next option. For symptomatic degenerative meniscal tears that are non-surgical, corticosteroid injections are standard of care.
 R. Alex Durbin, via jble.af.mil | SURGICAL MANAGEMENT If the tear is in the outer third of the meniscus, blood flow is good and healing can occur. These will often be repaired surgically and with good results. If the tear is in the inner two thirds of the meniscus, then a partial meniscectomy is often pursued. Recently, partial meniscectomy has been shown to be no greater than conservative management for degenerative tears. Partial meniscectomy is the most common orthopedic procedure, with more than 700,000 cases per year. |
ORTHOBIOLOGICS
With surgical options being limited, there has been a lot of interest in regenerative medicine treatments for meniscal tears. Platelet rich plasma (PRP) research in meniscal injuries is limited but encouraging. PRP is known to release growth factors, cytokines, and chemokines which can facilitate the healing process. There have been animal studies investigating the role of bone marrow derived mesenchymal stem cells (BM-MSCs) in the treatment of the avascular zone of the meniscus. There is early high-level evidence for the use of BM-MSCs after partial meniscectomy that show improvement in meniscal volume at 1 year. There have also been numerous studies involving regenerative medicine during surgical intervention.
With surgical options being limited, there has been a lot of interest in regenerative medicine treatments for meniscal tears. Platelet rich plasma (PRP) research in meniscal injuries is limited but encouraging. PRP is known to release growth factors, cytokines, and chemokines which can facilitate the healing process. There have been animal studies investigating the role of bone marrow derived mesenchymal stem cells (BM-MSCs) in the treatment of the avascular zone of the meniscus. There is early high-level evidence for the use of BM-MSCs after partial meniscectomy that show improvement in meniscal volume at 1 year. There have also been numerous studies involving regenerative medicine during surgical intervention.
Alice Pien MD, via wikimedia. (CC BY-SA 4.0)
FURTHER INFORMATION
If you suffer from a meniscus injury, schedule a consultation with Black Stone Physical Medicine to discuss what your best treatment options for you condition. We serve the surrounding area including Albany, Newport, Salem, and Eugene.
If you suffer from a meniscus injury, schedule a consultation with Black Stone Physical Medicine to discuss what your best treatment options for you condition. We serve the surrounding area including Albany, Newport, Salem, and Eugene.
References
Vangsness CT Jr, Farr J 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. J Bone Joint Surg Am 2014;96:90-98.
Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 2009;11:1-25.
Betancourt JP, Murrell WD. Leukocyte-poor platelet-rich plasma to treat degenerative meniscal tear: A case report. J Clin Orthop Trauma. 2016;7(Suppl 1):106-109.
Vangsness CT Jr, Farr J 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. J Bone Joint Surg Am 2014;96:90-98.
Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 2009;11:1-25.
Betancourt JP, Murrell WD. Leukocyte-poor platelet-rich plasma to treat degenerative meniscal tear: A case report. J Clin Orthop Trauma. 2016;7(Suppl 1):106-109.
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