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

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 longterm 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, E p i D E M i o l o g y o F M E n i s c a l i n j u r i E s K nee 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 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.