alternatives to arthroscopic knee surgery for torn meniscus

I'm a parent, so I know that having a sick kid is no fun. 2012 Sep;40(3):66-76. doi: 10.3810/psm.2012.09.1983. I have blogged extensively about pursuing a meniscus surgery alternative since research years ago began showing that this surgery was not helping patients and may be harming them. Because we believe in facing the problem head on instead of ignoring the consequences that will pop up later on down the road. Alternatives to Arthroscopic Knee Surgery for a Meniscus Tear. 2010 Nov 16;43(15):2948-53. doi: 10.1016/j.jbiomech.2010.07.013. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. I’ve performed about 5,000 knee arthroscopies during my career, and the vast majority of my patients see improvement afterward. The patient moves suddenly to avoid a rock, hears a pop in his knee, and his knee begins to swell. *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Let’s stop our story again here and recall that the surgery to “repair” the meniscus has been shown in multiple studies to be no better than a fake or placebo surgery . These are determined by the blood supply. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. An MRI shows some swelling and a meniscus tear and our guy is referred to an orthopedic surgeon. Let’s dig in. While the likeliness of knee arthritis after a meniscus surgery seems to be due to less cushioning in the joint for protecting the cartilage, another reason may be that removing the damaged cells is the last thing the degenerating meniscus needs. This site disclaims any liability for damages or negative consequences from treatments provided by the physicians listed herein to any person referencing GetRegenerative.com. Arthroscopic surgery is a procedure that involves inserting a small camera inside the joint. N Engl J Med. Can a Meniscus Tear Heal on its Own Without Surgery? Through other small incisions, instruments can be inserted to repair or … We do this every day around the Regenexx Network with one of our patented Regenexx procedures, which uses precise ultrasound guidance to inject the knee meniscus with the patient’s own stem cells. Here’s what that procedure looks like: The upshot? Arthroscopic surgery to treat a torn meniscus when the rest of the knee is normal can help to reduce the pain induced by the meniscus tear. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist. Knee arthroscopic surgery is one of the most common orthopaedic procedures, with more than 2 million performed around the world each year. Then we have the research that shows that the surgery may be harmful to the knee. Join Chris Centeno, M.D., founder of Regenexx, to learn about how Regenexx stem cell and platelet procedures can treat your knee injury. For ideal arthroscopic candidates – like those who suffer a traumatic or sports-related meniscal tear, who have no arthritis – arthroscopic surgery can provide a permanent fix. Degenerative meniscus tears should be looked upon as wrinkles with age—and should be treated accordingly. We do not sell, or share your information to third party vendors. To understand why the science now supports that our whole surgical approach to treating meniscus tears is ill-advised, let’s follow a 45- year-old patient who develops knee pain when hiking or running. Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. (4) Sihvonen R, Englund M, Turkiewicz A, Järvinen TL; Finnish Degenerative Meniscal Lesion Study Group. Knee Arthritis, Heal Thyself? Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. The second option is a partial meniscectomy where a portion of the torn meniscus is cut out. Surgical meniscus repair was not superior to sham surgery in a randomized, controlled trial. Watch later. The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. ‘Arthroscopic’ describes the type of key-hole surgery used for this procedure which minimises the impact of the operation itself. Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries. Regenexx is a world-wide network of specially trained physicians providing the world's most advanced, research-driven, regenerative-medicine treatments in North America, Europe, the Middle East, Asia and Australia. DISCLAIMER: The procedures and claims made about particular procedures on or through this site have not been evaluated or approved by the FDA. The New York Times puts this procedure into the “useless” category. In other cases, suture anchors are used to repair a torn meniscus, functioning like staples or pins that hold the padding together. Arthroscopic surgery for treatment of degenerative meniscus tears is less predictable.. Do all meniscus tears need surgery? Reported rates of total knee replacement: One year: 10.1%. Still, a series of studies a few years ago showed that arthroscopic repair of meniscus tears dramatically increased the risk of developing severe osteoarthritis within the next decade that required a total knee replacement. Info. ____________________________________________________, (1) Risberg MA. If your injury doesn’t improve with RICE, NSAIDs and physical therapy, your healthcare provider may recommend arthroscopic surgery. Get fresh updates and insights from Regenexx delivered straight to your inbox. Patients with arthritis, thinning of the cartilage, will often experience degenerative meniscal tears. Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures. It’s easy to conceptualize the knee meniscus as just an inanimate object, like a gasket or rubber piece in the mechanical engine that is your knee. Non-surgical care of meniscus-injury related pain, such as exercise, was equally or more effective than surgical interventions. If you have questions or comments about this blog post, please email us at [email protected]. Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive. Hence, injecting cells into the wrinkle would also do the trick! Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Doctors examine the incidence of total knee arthroplasty ( total knee replacement) in patients who have undergone knee arthroscopy for partial meniscectomy, chondroplasty, or arthroscopic debridement of the knee. 2013 Dec 26;369(26):2515-24. doi: 10.1056/NEJMoa1305189. The researchers found that there were fewer functional cells in the degenerated meniscus tissue that show tears on an MRI. NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. 70 ended up with the actual surgery. His knee locking was very extreme and injecting orthobiologics didn’t work. Get fresh updates and insights from Regenexx delivered straight to your inbox. British Journal of Sports Medicine 2014;48:741. http://dx.doi.org/10.1136/bjsports-2014-093568, (2) Katz JN, Brophy RH, Chaisson CE, et al. Those in the next deeper zone, the red-white, may or may not heal and the innermost white zone tears generally don’t heal on their own. Hence, we have no scientific evidence that this procedure will help this patient’s knee. By submitting the form, you are agreeing that you read and consent to our Privacy Policy. Phys Sportsmed. The New England Journal of Medicine published an eye-opening study looking at arthroscopic partial meniscectomy versus sham surgery for degenerative meniscus tears. Now, the meniscus tear can be repaired with the arthroscope through two tiny (less than a half-inch) incisions. Arthroscopic meniscal resection is the surgical procedure to remove all or part of a torn meniscus. Let’s stop our story right here for a moment. This means that the doctor removes the torn part of the meniscus. We may also contact you via email, phone, and other electronic means to communicate information about our products and services. If meniscus surgery shouldn’t be your first option, what is the alternative? I'm a parent, so I know that having a sick kid is no fun. By submitting the form, you are agreeing that you read and consent to our Privacy Policy. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you. This finding is important for the patient mentioned in the sequence of events described above and anyone else suffering from knee pain due to meniscus tears. New Research Says Yes! The meniscus has three zones, the red, red-white, and white. 2019 Aug 20. doi: 10.1002/art.41082. This site disclaims any liability for damages or negative consequences from treatments provided by the physicians listed herein to any person referencing GetRegenerative.com. This structure can get normal tears as we age, much like your face naturally wrinkles over time. If playback doesn't begin shortly, try … Partial medial meniscectomy and rotational differences at the knee during walking. This is also done in orthopedic clinics when hyaluronic acid gel shots are injected for knee arthritis. Tears don't always cause pain. They can even be used to reduce pain and delay knee replacement for more severe arthritis. And epidural steroid injections are problematic due to their long-term negative impact on bone density. DISCLAIMER: The procedures and claims made about particular procedures on or through this site have not been evaluated or approved by the FDA. (8) Katz JN, Shrestha S, Losina E, Jones MH, Marx RG, Mandl LA, Levy BA, MacFarlane LA, Spindler KP, Silva GS; MeTeOR Investigators, Collins JE. Arthroscopic surgery to treat a torn meniscus when the rest of the knee is normal can help to reduce the pain induced by the meniscus tear. 2016 Apr 5;164(7):449-55. doi: 10.7326/M15-0899. (6) Cohen SB, Short CP, O’Hagan T, Wu HT, Morrison WB, Zoga AC. Your Meniscus … All statements, opinions and references provided by GetRegenerative.com are for informational purposes only. Since the goal of surgery is to preserve healthy meniscus, meniscus repair is attempted when the tear is repairable. If the tear is too big to repair, your surgeon may remove all or part of the meniscus. Tap to unmute. This is a legitimate meniscus surgery alternative. Getting a knee replacement is one approach, but you may not need surgery, at least not right away. Surgery for Torn Meniscus in the Knee is Often Unnecessary, Ineffective, Misdirected. Copy link. A torn meniscus is usually found on an MRI, but there’s one problem about an MRI that shows a torn meniscus in someone who is 35 or older. For this, a surgeon uses special instruments to make the torn edges rougher and then sews the edges of it together. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures. In the past, a torn meniscus required a three- to four-inch incision and an overnight stay (or two) in the hospital. We have a slew of high-quality research studies that show that meniscus surgery has been shown to be ineffective and likely leads to a more rapid progression of arthritis. Knees are the target of many common sports injuries. A 2013 study demonstrated that meniscus surgery results couldn’t beat physical therapy (2). The meniscus is a spacer that helps to cushion the knee cartilage. Arthroscopic knee surgery is discussed in detail below, but the goal of surgery is to “trim” the torn portion of the meniscus that may be generating their symptoms. Get Regenerative does not diagnose or treat medical conditions via this website or via telephone. NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. Individually, each cushion is called a "meniscus." Hence, one reason to pursue a meniscus surgery alternative is obvious, having a meniscus tear is about as common and meaningful as wrinkles on your face. A recent study makes a fine point of this by using sophisticated immunostaining to observe the number of living cells in the meniscus. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Early…, Does getting a neck injury in a car crash, even if it heals, cause long-term…, Regenexx has always had an active research program with our goal being to try and…, One of the hardest things to watch in the stem cell wild west has been…. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else. Join us for a free Regenexx Knee Meniscus Webinar, The New York Times puts this procedure into the “useless” category, http://dx.doi.org/10.1136/bjsports-2014-093568, Stemell: Another Umbilical Cord “Stem Cell” Therapy Bites the Dust, Other Degenerative Conditions & Overuse Injuries, Other Knee Ligaments / Tendons & Overuse Injuries, Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb), Ulnar collateral ligament wear (common in baseball pitchers). This is not only because the meniscus is an important cushion protecting the knee, but also because we should be adding cells to the knee, not removing them! So how can we add cells to a knee meniscus? Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Arthroscopy has revolutionized how knee surgery is performed. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures. However, it’s actually living tissue that’s made up of cells. We do not sell, or share your information to third party vendors. All of a sudden, an otherwise active middle-aged guy can’t hike or run without pain. Learn about Regenexx procedures for knee conditions. (7) Longo UG, Ciuffreda M, Candela V, Rizzello G, D’Andrea V, Mannering N, Berton A, Salvatore G, Denaro V. Knee Osteoarthritis after Arthroscopic Partial Meniscectomy: Prevalence and Progression of Radiographic Changes after 5 to 12 Years Compared with Contralateral Knee. Learn About the #1 Stem Cell & Platelet Procedures for Treating Knee Meniscus Tears - Regenexx. While a huge industry has emerged around removing parts of the meniscus when tears are seen on an MRI, there’s little hard scientific evidence that this is a good idea. August 31, 2020. Get a Regenexx® Second Opinion and avoid unnecessary surgery. In fact, other studies show that in all likelihood, removing some of the knee meniscus will only cause more knee arthritis. Overall, knee surgery was no better than these alternatives for improving physical function, and resulted in only a small reduction in pain. We may also contact you via email, phone, and other electronic means to communicate information about our products and services. Torn meniscus surgery takes one of two forms. 6 Alternatives to Arthroscopic Knee Surgery More Researchers today pitched strike two to arthroscopic surgery for osteoarthritis, a popular choice for many boomers struggling with knee … After 5 years, the meniscus surgery group was about 2 1/2 times more likely to get a knee replacement when compared to those patients who had physical therapy! They do not constitute an endorsement of any medical provider nor guarantee the efficacy of the treatments provided. We know from research that meniscus tears are very common in patients without knee pain, so simply seeing a meniscus tear on an MRI when someone has knee pain is not a valid way to diagnose that the meniscus tear is causing that pain (1). The two cushions in each knee are called the "menisci." And some patients cannot undergo knee replacement surgery for various reasons. However, as revealed above, for most patients, the fact that a meniscus tear was found on MRI shouldn’t be important. Some of the reasons to perform an arthroscopic knee surgery include: 1. In this analogy we can clearly see that it would be far better to inject something to plump up the skin and get rid of the wrinkle for a time, which is what’s done with collagen shots in cosmetic clinics. While there’s little doubt that meniscus degeneration is at play in the cascade of knee arthritis, how all of this works is not so well understood. Learn about Regenexx procedures for knee conditions. A study of patients with osteoarthritis who underwent arthroscopic partial meniscectomy showed that the risk of total knee replacement was 400% greater than those who received non-surgical therapies. The effect of meniscal tears on cartilage loss of the knee: findings on serial MRIs. The meniscus is a shock absorber that lives in the knee and protects the cartilage and bones. Arthroscopic knee surgery for a torn meniscus is a minimally invasive surgical technique that’s performed by inserting a small camera and specialized surgical tools into the knee joint via small incisions. Three years: 15.6%. Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries. The first is repair by suturing the two edges of the torn meniscus together. Early…, Does getting a neck injury in a car crash, even if it heals, cause long-term…, Regenexx has always had an active research program with our goal being to try and…, One of the hardest things to watch in the stem cell wild west has been…. Five-year outcome of operative and non-operative management of meniscal tear in persons greater than 45 years old. Copyright © Regenexx 2021. Knee Arthroscopy. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. It has a figure-8 configuration and can be torn through wear and tear or trauma. More serious meniscus tears may not heal on their own. So regrettably, the meniscus tear is a “red herring”, not a diagnosis. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. The surgery requires a few small incisions and takes about an hour. Hence, we have no scientific evidence that this procedure will help this patient’s knee. They were then randomized in the operating room. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. The resulting recommendation is that patients should seriously consider non-surgical interventions first, such as physical therapy, to treat a meniscus tear's discomfort. Now new research also shows just how poorly this procedure works and how it’s likely pushing patients toward an earlier knee replacement. 2013 Aug 15;369(7):683]. Copyright © Regenexx 2021. The majority of meniscus surgeries are partial meniscectomies. Now, a new study continues to point in the direction that meniscus surgery is likely the exact opposite of what we should be doing to help middle-aged patients with knee pain. And meniscus repair is one of them. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. As a physician who has seen hundreds of patients with meniscus tears over the last decade, I have referred only one for surgery. https://arthritisco.com/arthroscopy-of-the-knee-joint-for-meniscus-injury To understand what that’s about, see below. The title of the above-referenced article, which reviewed the research on middle-aged meniscus tears said it all: “Degenerative meniscus tears should be looked upon as wrinkles with age–and should be treated accordingly”. Acute traumatic meniscus tears Athletes, particularly those that play contact sports, are susceptible to acute and traumatic meniscus injury. Then a study later that year demonstrated that meniscus surgery couldn’t beat a fake or sham surgery (3). Dr. Ramakant Kumar, Best Doctor for Knee Surgery Patna believes that – Arthroscopic knee surgery is still a valid procedure today for lakhs of patients in the country with a multitude of knee pain issues. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you. Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. While the likeliness of knee arthritis after a meniscus surgery seems to be due to less cushioning in the joint for protecting the cartilage, another reason may be that removing the damaged cells is the last thing the degenerating meniscus needs. If meniscus tears are about as clinically meaningful as face wrinkles, what if our solution to the latter problem was to surgically remove each wrinkle? Ann Intern Med. 2019 May;32(5):407-413. doi: 10.1055/s-0038-1646926. Regenexx is a world-wide network of specially trained physicians providing the world's most advanced, research-driven, regenerative-medicine treatments in North America, Europe, the Middle East, Asia and Australia. If that’s not a reason to seek out meniscus surgery alternatives, I’m not sure what is…. Other people with knee pain are too young for a knee replacement — the artificial knee is only likely to last 15 or 20 years, after which the person may need revision surgery. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. (3) Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. At first the patient tries to ignore it, but after a week of no improvement, he visits the family doctor. But if they don’t work, you may need surgery. Most of the time, rest, ice, and pain meds are enough to help you feel better. In addition, like our meniscus tissue, the research shows that the wrinkles are caused by a decrease in the number of living cells, which leads to fewer extra-cellular matrices being produced. Outside of that, all of our patients I have seen have been treated through injection without surgery. All rights reserved. They do not constitute an endorsement of any medical provider nor guarantee the efficacy of the treatments provided. Torn Meniscus Repair (Arthroscopic Meniscectomy) Each of your knee joints is cushioned by two c-shaped wedges of cartilage. Hip injuries and degenerative conditions become more common with age. Torn Cartilage/Meniscus Surgery: Meniscectomy is the official name of the surgery that involves the removal of a portion of the meniscus cartilage from the knee joint. Since there are no Alternatives to Arthroscopic Knee Surgery for Torn Meniscus, surgeons have to perform this surgery. For example, we know that meniscus surgery alters the normal way a knee is built to move (5). Hence, one reason to pursue a meniscus surgery alternative is obvious, having a meniscus tear is about as common and meaningful as wrinkles on your face. Arthroscopic Knee Surgery may be a treatment option for certain types of knee pain. 2013;368(18):1675–1684. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. So shouldn’t we be adding cells instead of removing them? The procedure can reduce pain, improve mobility and stability, and get you back to life’s activities. There are newer injection-based techniques to help promote healing in the meniscus without surgery. J Knee Surg. N Engl J Med. A meniscus tear is among the most common knee injuries, but you might be surprised to learn that your doctor may treat your injury differently, depending on how old you are. We have been treating meniscus tear patients with precise ultrasound-guided orthobiologics like their own platelets and stem cells for more than a decade. Alternatives to knee surgery emerge Physicians used to urge immediate surgery for everyone who had suffered a meniscus tear no matter how mild. And epidural steroid injections are problematic due to their long-term negative impact on bone density. (5) Netravali NA, Giori NJ, Andriacchi TP. and an injection will be ineffective. The upshot? Patients with arthritis, thinning of the cartilage, will often experience degenerative meniscal tears. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. The surgery can be performed on an outpatient basis in less than an hour. Regenexx Alternative to Knee Meniscus Surgery / Meniscectomy. The suture anchors used in meniscus surgery are surgical fasteners that the body eventually absorbs. Meniscus tears on the outer part of the tissue in the red zone which has a blood supply can heal. In fact, other studies show that in all likelihood, removing some of the knee meniscus will only cause more knee arthritis. Hip injuries and degenerative conditions become more common with age. Meniscus tears can be treated by meniscus removal (meniscectomy), meniscus repair, or in unusual circumstances, meniscus replacement. Knee arthroscopy can be very effective for some patients who fail to improve with a conservative course of treatment. J Biomech. Arthritis Rheumatol. Additionally, if we performed an MRI on our patient’s 10 best buddies, all of whom have no knee pain, about half would show a meniscus tear that looked just like our patient’s. Knees are the target of many common sports injuries. All rights reserved. The most common meniscus surgery is a partial meniscectomy. Much like interventional cardiology has gained a foothold over cardiac surgery over the past few decades, interventional orthopedics is providing nonsurgical alternatives to many orthopedic surgeries available today. Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures. In a 60-month study in persons over 45 years of age, the authors looked at how many patients went on to get a knee replacement (8). If you have questions or comments about this blog post, please email us at [email protected]. Why? Why? A meniscus tear is a common knee injury. Removing parts of a meniscus is not a smart idea, despite the fact that a multi-billion dollar medical industry has thrived on the outdated concept.

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