The Case for Utilizing Prolotherapy as First-Line Treatment
for Meniscal Pathology:
A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented
Meniscal Tears and Degeneration
By Ross A. Hauser, MD, Hilary J. Phillips,
and Havil S. Maddela
abstract
Meniscus injuries are a common cause of knee pain, accounting for
one sixth of knee surgeries. Tears are the most common form of meniscal
injuries, and have poor healing ability primarily because less than
25% of the menisci receive a direct blood supply. While surgical
treatments have ranged from total to partial meniscectomy, meniscal
repair and even meniscus transplantation, all have a high long-term
failure rate with the recurrence of symptoms including pain, instability,
locking, and re-injury. The most serious of the long-term consequences
is an acceleration of joint degeneration. This poor healing potential
of meniscus tears and degeneration has led to the investigation
of methods to stimulate biological meniscal repair. Research has
shown that damaged menisci lack the growth factors to heal. In vitro
studies have found that growth factors, including platelet derived
growth factor (PDGF), transforming growth factor (TGF), and others,
augment menisci cell proliferation and collagen growth manifold.
Animal studies with these same growth factors have confirmed that
meniscal tears and degeneration can be stimulated to repair with
various growth factors or solutions that stimulate growth factor
production. The injection technique whereby the proliferation of
cells is stimulated via growth factor production is called Prolotherapy.
Prolotherapy solutions can include dextrose, human growth hormone,
platelet rich plasma, and others, all of which stimulate connective
tissue cells to proliferate.
A retrospective study was done involving 24 patients, representing
28 knees, whose primary knee complaints were due to meniscal pathology
documented by MRI. The average number of Prolotherapy visits was
six and the patients were followed on average 18 months after their
last Prolotherapy visit. Prolotherapy caused a statistically significant
decline in the patients’ knee pain and stiffness. Starting and ending
knee pain declined from 7.2 to 1.6, while stiffness went from 6.0
to 1.8. Prolotherapy caused large improvements in other clinically
relevant areas such as range of motion, crepitation, exercise, and
walking ability. Patients stated that the response to Prolotherapy
met their expectations in 27 out of the 28 knees (96%). Only one
out of the 28 patients ended up getting surgery after Prolotherapy.
Based on the results of this study, Prolotherapy appears to be an
effective treatment for meniscal pathology. While this is only a
pilot study, the results are so overwhelmingly positive that it
warrants using Prolotherapy as first-line therapy for meniscal pathology
including meniscal tears and degeneration.
Journal of Prolotherapy. 2010;2(3):416-437.
KEYWORDS: human growth hormone, meniscal degeneration, meniscal tear, meniscus,
platelet rich plasma, Prolotherapy.
Epidemiology of Meniscal Injuries
Knee injuries are a common concern resulting in over 1 million
surgeries performed to the knee in the United States every year.1-3 According
to the National Athletic Trainers’ Association, knee injuries account
for 10% to 19% of high school sports injuries and 60.3% of all high
school athletic-related surgeries.4 Similar
studies of collegiate sports have shown that knee injuries make
up 7% to 54% of athletic injuries, varying by the nature of the
sport.5-9 The leading injuries
to the knee, in both adults and children alike, are primarily patellofemoral
derangements or ligament strains and tears.10-12 Secondary
to these injuries are meniscal tears, which have generated particular
interest in both the young and elderly population as studies over
the past several decades have revealed a rise in both degenerative
and traumatic meniscal injuries. Meniscal tears occur as early as
childhood, where they serve as the leading cause of pediatric arthroscopy,
and increase with age and activity.13,
14 An estimated one sixth of knee surgeries are performed
for lesions of the meniscus, and it is likely that many more remain
untreated every year.15, 16 In
one study of cadaver knees, untreated meniscal lesions were found
in 34% of the autopsied subjects.17
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