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Clinics in London and Bedford
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Meniscus Repair Clinic

Non-surgical treatment to repair meniscus tears

Have you been told by your doctor that your only option for repairing your meniscus tear is surgery?

We offer non-surgical meniscus repair treatment which harnesses the latest science in natural meniscus regeneration.

Meniscus Tear Treatment

Prolozone Therapy

To understand how Prolozone Therapy works, it is important to first understand why a meniscus tear struggles to heal on its own. As mention above, the meniscus has a limited blood supply. This means it doesn’t receive the same level of oxygen and nutrients that other structures with a good blood supply receive. Oxygen and nutrients help to stimulate the healing compounds required to heal a damaged part of the body.   

Prolozone Therapy involves the injection of an activated form for oxygen combined with nutrients. This activated form of oxygen is called medical ozone. Medical ozone has been shown to stimulate fibroblasts and chondrocytes, which are the small cells that the menisci are made up of.

Alongside helping to repair the meniscus tear, it also helps to strengthen the neighbouring soft tissue structures such as the ligaments of the knee. This helps to enhance the effects of the meniscal repair, prevent a reoccurrence of the tear, and improve the range of motion in the knee joint.

At our clinic, we combine Prolozone Therapy with the prescription of specific physical therapy exercises to improve both the strength and coordination of the muscles around the knee. Improving the health of these muscles is a key part of helping both a medial meniscus tear and lateral meniscus tear to repair.

Prolozone Therapy is also effective for many other common knee injuries.

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What is a meniscus?

A meniscus is a crescent-shaped fibrocartilaginous structure. There are two of them in each knee joint: the medial meniscus, and the lateral meniscus.

As a form of knee cartilage, they help to acts as a shock absorber and spread our body weight across the joint, helping to provide structural integrity during movement.

Working together with articular cartilage, the menisci help to prevent friction between the lower leg (tibia) and thigh (femur) bones.

The blood flow is limited to only the outside portion of the structure, which decreases with age. This is one of the main reasons why a meniscal tear will struggle to heal on its own and has very limited treatment options.

Symptoms of a medial meniscus or lateral meniscus tear

  • Knee pain – usually along the joint line. Pain is felt on the inside joint line for a medial meniscus tear, and on the outside joint line for a lateral meniscus tear.
  • Stiffness or swelling.
  • A popping sensation.
  • Limited range of motion – problems with flexing and extending the knee joint.
  • The sensation of the knee giving way.
  • Locking – a feeling of the knee getting stuck.

A man with a medial meniscus tear holding his knee

Types of meniscus tears

  1. Bucket handle tear: A bucket-handle tear is a horizontal meniscal tear which tends to be quite large. It is common for someone to experiencing a locking sensation with these types of tear. The torn part of the meniscus can get stuck and effect the movement of the knee.
  2. Radial tear: It is regarded as the most common form of meniscus tear. The location of the tear is within the inner portion of the structure that has a poor blood supply.
  3. Horizontal tear: a horizontal tear runs along the circumferential fibres of the meniscus.
  4. Complex tear: This form of meniscal tear involves several tears present at the same time, with a combination of both radial and horizontal.
  5. Flap tear: A meniscus tear can often lead to a flap of tissue becoming loose, which can cause pain as it catches within the joint during certain movements.
  6. Intrasubstance/Incomplete tear: These types of tears aren’t serious, and often indicate the early signs of the meniscus degenerating. They don’t tend to cause too many symptoms.
  7. Degenerative meniscus tear: Meniscal tears that occur as a result of wear and tear. They are more common in older people.

Causes of a meniscus tear

A torn meniscus usually results from the following movements:

  • Sudden pivoting and turning at speed.
  • Movement involving a twist or rotation of the knee.
  • Kneeling down in an awkward position.
  • The pressure from a deep squat.

Meniscal tear risk factors

Contact sports

Activities such as rugby and football involve a lot of contact and unpredictable movements. If an individual hasn’t warmed up properly then this can increase their risk of getting a meniscus injury.

A man holding a medial meniscus injury

Poor muscle strength

Muscles around the knee help to absorb shock during weight-bearing movements. If they are weak, then the joint and the meniscus have to withstand more force than they were designed to withstand, leaving it vulnerable to injury.

Lack of coordination

If the structures around your knee aren’t communicating very well, then they aren’t in a position to protect the knee from over twisting during a sudden movement.

Previous knee injuries

Scar tissue and weakness left in the knee from previous injuries can cause the meniscus to overwork and eventually lead to small tears. Previous anterior cruciate ligament injuries and sprains of the MCL or LCL can increase the risk of a meniscal tear.

Age

As mentioned earlier, the efficiency of the blood supply to the meniscus declines with age. As a result, its structure starts to become brittle, reducing its ability to absorb shock very well.

Osteoarthritis

Once articular cartilage starts to wear down, it increases the pressure on the meniscus during weight-bearing activities.

Complications of a meniscal tear

If left untreated, a meniscus tear can lead to instability in the knee and leave other structures vulnerable to injury. It can also lead to osteoarthritis.

Diagnosis of a meniscus tear

Before sending you for a scan, a doctor or physiotherapist will perform a physical exam that involves an orthopaedic test called the Mcmurray test. The result will provide an indication of the likelihood of a tear and whether a scan will be beneficial.

The scan used to diagnose a torn meniscus is an MRI scan (magnetic resonance imaging). It uses a magnetic field to take multiple images of your knee. It will also look at the health of the cartilage and ligaments to see if there are any other injuries that may also be present. X-rays can’t show a meniscal tear.

An MRI of knee

Meniscus repair surgery

Partial Meniscectomy A partial meniscectomy is a type of knee surgery that involves removing only the damaged part of the meniscus.

Total meniscectomy – a procedure that involves the whole meniscus being removed. This is only advised if the damage is severe.

Arthroscopic repair – a form of knee arthroscopy, it is a surgical procedure that is only suitable if the tear is small enough. It involves an orthopedic surgeon making small incisions to insert an arthroscope into the knee to stitch up the tear using a suturing technique.

If a meniscus tear is associated with an anterior cruciate ligament tear, then the ACL reconstruction and meniscal repair will take place within the same surgical procedure.

What are the negative effects of meniscus surgery?

As with all types of open and arthroscopic surgery, there are short term risks involved. There are studies that have been performed comparing the effects of surgical repair treatment with non-surgical repair treatments.

Research published in the American Journal of Sports Medicine showed that meniscectomy surgery didn’t provide a better success rate compared to non-surgical treatment.

The randomized controlled trial involved 102 patients. Fifty underwent arthroscopic surgery and the other 52 participated in rehab exercises.

After a two-year follow-up after the meniscal repair surgery, patients reported no difference in knee function, pain relief, or patient satisfaction.

The following link is to the study: https://pubmed.ncbi.nlm.nih.gov/23703915/

Short term negative effects –

  • Damage to local blood vessels.
  • Risk of a blood clot.

Long term negative effects –

  • Acceleration of knee osteoarthritis, causing someone to need a knee replacement in the future.
  • Increased risk of degenerative tears in other parts of the joint.

The success rate of a meniscal repair decreases when there is an ACL tear.

Knee arthroscopy surgery for a meniscus repair

Tips to prevent meniscus tears

  • Improve muscle strength.
  • Improve coordination.
  • Warm-up and stretch before physical activity, particularly if it involves sudden twists and turns.
  • Periodically book in to see a physical therapist or a sports medicine practitioner to have your walking or running gait assessed. They will also be able to prescribe strengthening exercises for the supporting leg muscles of the knee, such as the quadriceps.
  • Depending on your activity level and if you are a keen sportsman it is good to have a monthly leg massage at a physical therapy clinic. The massage should focus on leg muscles such as the quadriceps and hamstring muscles of the thigh bone. A massage will also help to improve the range of motion and prevent other knee pain conditions.
  • Wear a knee brace to keep your knee stable if you perform any contact sports or activities that involve a lot of twisting and turning, such as tennis or squash. This is important if you have had previous sports injuries. An orthopaedic surgeon may advise a patient to wear a knee brace after any type of knee surgery.

Frequently asked questions about meniscus repair

Can a meniscus tear heal on its own?

It is hard for a meniscus repair to heal on its own due to its poor blood supply.

Can you walk around with a torn meniscus?

It is okay to walk around on a knee meniscus that has been torn but only if it isn’t causing the individual to limp or to use crutches. Limping can cause other problems such as pain in the shin bone, hip, or lower back. It is advised to seek medical advice when the pain is causing an individual to limp.

How long does it take for a torn meniscus to heal without surgery?

This all depends on the type and severity of the meniscus tear and how much physical therapy you have. Meniscus injuries in older people tend to heal much slower.

What should I avoid with a torn meniscus?

Avoid any physical activity that involves twisting of the injured knee.

Can I take anti-inflammatory medications for a meniscus tear?

Anti-inflammatory medications such as ibuprofen may be able to reduce some of the inflammation but it won’t help to repair a knee injury. Long-term use can cause side effects.

What is the recovery time after an arthroscopy? 

The recovery time after an arthroscopy can range from between 4-6 weeks to 6 months. This will depend on how complex the meniscal repair was during knee surgery and how much physical therapy is performed afterwards. An orthopaedic surgeon will be able to provide a rough estimate after they have seen the MRI scan.

 

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