SPORTS INJURIES
Meniscal Injury
The menisci consist of semilunar fibrocartilage, partly filling the
space between the femoral and tibial bones. Four principal
functions are ascribed to the menisci:
1. To spread a thin film of synovial fluid which provides nutrition
to the articular cartilage
2. To act as shock absorbers
3. To increase the stability of the knee joint
4. To aid in the complex rotatory mechanics of the knee joint
Meniscus injuries occur in most sports, but most commonly occur in contact
sports. They often occur in combination with ligament injuries, particularly
when the medial meniscus is involved. This is partly because the medial
meniscus is attached to the medial collateral ligament and partly because
tackles are often directed towards the lateral side of the knee, causing
external rotation of the tibia. Injury to the medial meniscus is about
five times more common than injury to the lateral meniscus.
By knowing the function of the meniscus, it is possible to predict what will
happen when meniscal tissue is shaved or removed. Since it provides some of
the nutrition to the articular cartilage, its removal will aid in the demise
of the cartilage. If the cartilage is damaged, then the pressures on the bone
will be too great and arthritis will soon follow. This is not the only reason
why articular cartilage damage is sure to follow after meniscectomy. The removal
of the menisci allows too much pressure to be put on the articular cartilage,
thus lessening the shock absorption. This is why cartilage damage and proliferative
arthritis must be the end result of meniscal removal. No other option is available.
If the surgeon removes the meniscus, arthritis is the end result. If that were
not enough, the menisci aid in the stability of the knee. If they are removed,
the knee is left with too much motion and becomes unstable. This also increases
the likelihood of articular cartilage damage and subsequent arthritis.
Arthroscopic shaving and removal of the meniscus would therefore be expected
to result in the progression of arthritis in the knee. Prolotherapy, on the
other hand, would be expected to heal the meniscus, since Prolotherapy stimulates
the body to repair the injured tissue. Prolotherapy given to the injured menisci
stimulates fibroblastic growth of new stronger meniscal tissue, thereby repairing
the area. This makes a lot more sense than its removal.
Study Shows Increased Contact Stress Pressure after Meniscectomy
There have been numerous studies showing that the contact stress pressure on
the articular cartilage significantly increases after meniscal removal. (Ahmed,
A. In vitro measurement of static pressure distribution in synovial joints.
Part 1: Tibial surface of the knees. Journal of Biomechanical Engineering.
1983; 105:216-225.; Brown, T. In vitro contact stress distributions on the
femoral condyles. Journal of Orthopedic Research. 1984; 2:190-199.)
One such study showed that after partial meniscectomy, the contact stress
pressures increased by 110 percent and after total meniscectomy they
increased 200 percent. Their conclusion was expected. "The contact stresses increased in proportion
to the amount of meniscus removed.(Baratz, M. Meniscal tears: The effect of meniscectomy
and of repair on intra-articular contact areas and stress in the human knee.
American Journal of Sports Medicine. 1986; 14:270-274.) Other studies
have shown even greater increases in pressure, causing from a 450 to
600 percent (six times) increase in pressure on the tibia bone and articular
cartilage when the meniscus is removed. (Radin, E. Role of the menisci
in the distribution of stress in the knee. Clinical Orthopedics. 1984;
185:290-294.;Seedom, B. Transmission of the load in the knee joint with
special reference to the role of the menisci: Part 1. Eng Med. 1979;
8:220-228.)
Menisci are normally shaved or removed because they are believed to repair
so poorly. Menisci, like many of the soft tissues treated with Prolotherapy,
have poor blood supply. This is one of the reasons they heal poorly. The best
treatment option is to increase the circulation to the damaged menisci.
Studies Show Meniscal Surgery Actually Increases Injury
Repairing a meniscal tear with arthroscopy makes conceptual sense, however,
this just does not occur often enough to warrant the procedure. In an animal
study, only 38 percent of the meniscal repairs actually healed. (Cabaud, H.
Medial meniscus repairs. American Journal of Sports Medicine. 1981; 9:129-134.)
To add insult to injury, another study showed that meniscal repair can
actually cause a further spreading of the injury to the non-injured meniscal
tissue. The authors noted, "It appears that in radial repairs, progressive spreading at the
repair site altered normal meniscal geometry and structure, adversely influencing
mechanical function." In common language, attempting to repair the area with
arthroscopy makes the normal meniscal tissue weaker and further worsens the injury.
The authors went on to say, "Meniscal tissue from repaired radial lesions was
significantly lower than controls in yield stress, maximum stress, and elastic
modulus. The repaired radial meniscal lesions demonstrated abnormal force transmission
and energy dissipation behavior qualitatively similar to a complete meniscectomy." (Newman,
A. Mechanics of the healed meniscus in a canine model. American Journal
of Sports Medicine. 1989; 17:164-175.) This is unbelievable! Repairing
a meniscal tear makes the meniscal tissue so weak that it is like having
no menisci at all.
Incomplete Healing and Further Deterioration Result After Meniscal Repair Surgery
In one large study, where 82 percent of the meniscal injuries were sustained
from sporting events, a full 75 percent of the meniscal repairs did not completely
heal.(Rubman, M. Arthroscopic repair of meniscal tears that extend into the
avascular zone. American Journal of Sports Medicine. 1998; 26:87-95.)
The follow-up arthroscopic examinations were done at a mean of 18 months and
clinical examinations at 42 months. This is one and a half and three and a
half years later, folks. These are not impressive statistics to encourage athletes
to undergo meniscal repairs. In this study, in only 18 months, 20 percent of
the patients had articular cartilage damage on the tibia and femur that was
not present on the initial arthroscopy, but was seen in follow-up arthroscopy.
A full 40 percent had deterioration of the articular cartilage under the knee
cap. This deterioration occurred over only 18 months! Yet the authors of the
paper state that 80 percent of the patients were asymptomatic. But 20 percent
of the patients needed further arthroscopic surgery! You see the difference
between pain-free and healed? Athletes are being coerced into these procedures
that do not repair or heal the injured the tissue. Eighty percent were pain-free
while their cartilage was rapidly deteriorating. What is being done to stop
this arthritic process? Unless the orthopedist plans to refer the athlete for
Prolotherapy, nothing is being done.
Click
here for more information on Meniscal Injury.
For more on Prolotherapy.
Would you like information of how to be our patient? Click Here
Want to talk to us first? Click
Here
< Back to Sports Injuries
|
