To understand how Prolotherapy works, it is important to first understand why a meniscus tear struggles to heal on its own. 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.
Prolotherapy involves the injection of a regenerative solution into the tendon to provide a direct supply of what is needed to heal the meniscus and provide pain relief. The treatment has been shown to stimulate fibroblasts and chondrocytes, which are the small cells that a meniscus is made up of.
Alongside helping to repair a 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 a meniscus repair, preventing a reoccurrence of the tear, and improving the range of motion in the knee joint.
At our clinic, we combine Prolotherapy 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 a lateral meniscus tear to repair.
Prolotherapy is also effective for many other common knee injuries. It is important to note that the treatment is naturally anti-bacterial, so it is deemed one of the safest injections on offer within medicine.
A meniscus is a crescent-shaped fibrocartilaginous structure. There are two of them in each knee joint: the medial meniscus, and the lateral meniscus.
It is a form of rubbery cartilage that helps 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.
Additionally, it does not contain a significant blood supply. 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 meniscus tear will struggle to heal on its own and has very limited treatment options.
Most meniscal tears will show symptoms of:
Menisci are the shock absorbers, they help in the distribution of weight and protect the joint. Sometimes they become damaged or weaken over time due to different causes. Additionally, they are common in people who play sports. A meniscus tear usually results from the following movements:
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 tear.
Poor muscle strength
Muscles around the knee help to absorb shock during the activities in which weight is placed on the knees such as standing, walking running. If the muscles are weak, then the joint and the meniscal tissue have to withstand more force than they were designed to withstand, leaving them 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. For example, previous anterior cruciate ligament injuries can increase the risk of meniscal injuries. Other knee injuries that can cause tears include sprains of the MCL or LCL.
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.
Once articular cartilage starts to wear down, it increases the pressure on the meniscus during weight-bearing activities as a result meniscus weakens and eventually breaks down.
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.
Before sending you for a scan, a doctor or physiotherapist will perform a physical exam that involves an orthopedic 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 meniscal damage is a magnetic resonance imaging MRI scan. It uses a magnetic field to take multiple images of the soft tissues of your knee including ligaments, menisci, cartilage, and tendons. 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 rupture. Additionally, a patient will complain about pain and swelling around the joint. The present complaint about symptoms of a meniscus tear, MRI scans, X-rays, and physical examination will help the physician in making the proper diagnosis.
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 meniscal damage is severe.
Arthroscopic repair – a form of knee arthroscopy, also called keyhole surgery. It is a surgical procedure that is only suitable if the tear is small enough. It involves an orthopedic surgeon making a small incision to insert an arthroscope (camera) into the knee to stitch up the torn meniscus using a suturing technique or to remove the tear using surgical instruments through other incision.
If a meniscus tear is associated with an anterior cruciate ligament injury, then the ACL reconstruction and meniscal repair will take place within the same surgical procedure.
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 meniscus repair surgery, patients reported no difference in knee function, knee pain relief, or patient satisfaction.
The following link is to the study: https://pubmed.ncbi.nlm.nih.gov/23703915/
Short term negative effects –
Long term negative effects –
The success rate of a meniscus repair decreases when there is an ACL tear.
Many meniscus tears will not require surgery immediately. If your symptoms subside and your knee does not lock or swell, your doctor may consider pain management and recovery via nonsurgical treatment.
The initial treatment will include anti-inflammatory drugs such as Ibuprofen and RICE to prevent pain and swelling
RICE. RICE is beneficial for the majority of sports-related injuries. RICE is an acronym that stands for Rest, Ice, Compression, and Elevation.
Rest. withdraw yourself from the activity that caused your injury. Your physician may advise you to use crutches to prevent placing weight on your leg.
Ice. Several times a day, apply cold packs for 20 minutes at a time. Do not apply directly ice to the skin. Ice will help in reduce pain.
Compression bandage. Wearing an elastic bandage will prevent further edema and blood loss.
Elevation. Recline while you rest and elevate your leg higher than your heart to minimize swelling.
As soon as the initial healing process is complete, your physician will recommend rehabilitation exercises. Regular exercise is required to restore your knee strength and mobility. You will begin by performing exercises to increase your range of motion. Gradually, strengthening activities will be incorporated into your recovery plan.
In many instances, rehabilitation can be performed at home; however, your physician may suggest working with a physical therapist. The recovery time for a meniscus repair is approximately three to six months.
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. Orthopaedic surgeons advise that if the injury is located in the inner two-thirds, which lacks blood flow, it cannot be healed and may require surgical treatment.
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 meniscus 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.