What Are the Alternatives to Knee Surgery?

Knee injuries are very common in the United States and result in over 1 million surgeries per year. Out of those surgeries, there are an estimated 650,000 arthroscopic meniscal procedures performed every year.

That's a lot of cutting!

The problem with knee surgery, especially on the meniscus, is that it can leave the knee incredibly unstable. In fact, re-operation rates for post-meniscectomy can be as high as 29%. This may lead you to question the validity behind this type of knee surgery in the first place.

At The Darrow Sports and Wellness Institute we feel the same way. We try other procedures long before we send a patient to surgery. We believe in more natural modes of healing and therefore make sure we have exhausted all other avenues first. Before we get into that, though, it's valuable, if not essential, to understand what causes knee pain and failure in the first place. To do that, you must understand the anatomy of the knee, specifically that of the meniscus.

What is the Meniscus?

The meniscus is a crescent-shaped fibrocartilaginous structure that usually refers to either of two specific parts of cartilage of the knee: The lateral and medial menisci. Together the menisci provide structural integrity to the knee when it's under pressure, nutrition and lubrication to articular cartilage, and shock absorption during movement. Several ligaments also work in tandem with the menisci to prevent overextension of motion.

Meniscal damage can be caused by acute injury or gradual overuse. Tears are the most common injury. The problem with the meniscus is that it's a poorly vascularized tissue, meaning blood flow to the area is very limited. In fact, only a small percentage (10 to 25%) of the meniscus receives a direct blood supply. If the injury is to this area, there is a moderate chance of natural, internal repair, whereas the other areas of the meniscus, if injured, cannot heal from injury whatsoever.

How Do You Know You Have Suffered a Meniscus Tear?

If the tear is caused by sudden injury or trauma, often the pain is immediate and accompanied by a pop. If it's from ongoing stress and overuse, the pain is less obtrusive and simply increases over time. In both instances, there is usually a bit of swelling and a decrease in mobility and mechanical function. Also, a common characteristic of a meniscal tear is a constant clicking, popping, or locking of the knee joint.

Although these overt symptoms lead many patients to seek help, surprisingly many patients have tears and have no idea. A study in the New England Journal of Medicine showed that out of 991 knees scanned with an MRI, 60% of the patients had a meniscal tear without the hallmark symptoms associated with it. This study illustrates a two-fold importance. One: Meniscal injuries are more common than once thought. Two: If your doctor gets an MRI when you have pain, and finds a meniscus tear, his answer is most likely surgery. However, no one knows if that tear had been there silently for 20 years. According to the study, there is a 60% chance that the meniscus tear is not causing the pain. So why have surgery in the first place.

Thus Surgical Intervention

Surgery for the meniscus consists of several different methods of attack: meniscectomy, meniscal repair, and meniscal allograft transplantation. Although they may offer short-term relief for pain, more often than not, these surgeries result in further degeneration and future pain and instability in the knee. Why? Because no surgery is going to change the inherent lackluster blood supply to the meniscus! Therefore a new method needs to be employed.

A New Mode of Attack

Since it's more a matter of healing, Platelet-Rich Plasma (PRP) therapy seems like the most common sense and obvious mode of attack. PRP works on the meniscus in an entirely different way than surgery. This non-invasive procedure essentially allows your body to heal itself, by using your own platelets re-injected back into the area of injury.

By delivering to the damaged meniscus an extra dose of what it needs the most: your platelets, the meniscus is able to begin healing on its own. How it does this is nothing short of amazing. Platelets stimulate growth factors, which are a necessary part in the healing and regeneration process. By inciting an inflammatory response, PRP boosts an immediate immune response-the growth factors. After this stage, fibroblasts enter the picture and begin depositing collagen, the framework of regeneration. The collagen cells than mature into healthy, robust tissue. So instead of removing the injured meniscus, like in surgery, PRP heals the injured tissue, while also creating new, structurally sound tissue.

Since the meniscus is biologically unable to do it itself, PRP Prolotherapy is imperative!