The Evidence behind Knee Meniscus Surgery

By Chris Centeno, MD /

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For the past several years and moving forward into the future, we will see many new research studies trying to ascertain if a medical procedure has solid evidence for efficacy. This is often done through a meta-analysis where researchers look at many different published studies. The findings of these studies are often that what is being performed commonly by physicians and surgeons doesn’t have the highest level of evidence (level I). A recent study came to that conclusion regarding arthroscopic surgery of the knee to repair or trim a meniscus tear, concluding that there was no high level evidence showing that it helped patients. The fact that knee surgery didn’t meet this research based criteria for efficacy is not surprising, in that many things physicians do don’t have that level of support. In fact the only surprising thing is that the vast majority of the patients we talk to everyday don’t know that there’s no high level evidence showing that knee surgery to fix a torn meniscus works. While my posts have discussed many reasons why menisectomy likely doesn’t help, including the fact that less knee meniscus tissue (after some has been trimmed out during arthroscopic knee surgery) likely means that arthritis will follow, there are other concerns. One of these is that the meniscus is mostly without blood vessels (avascular) and as a result, won’t heal when sutured. Even when areas of the meniscus with blood vessels are found to be torn and sutured, these areas of the torn knee meniscus that are surgically repaired often fail to heal as well. The diagram above shows the blood vessels in the outer meniscus and the fact that the majority of the meniscus has no blood supply. In experiemental studies, CD34+ stem cells have been able to establish new blood supply in areas without good supply and this may be why we often see good success with many of our patients who recieve injections of their own stem cells into a torn knee meniscus.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
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Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

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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. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

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Hip injuries and degenerative conditions become more common with age. 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. 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.

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Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
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