The majority of patients I see with knee pain either tell me “my doctor told me I have bone on bone” or “I have a torn meniscus”. They usually have already seen a physician and come in with the MRI. In a day and age when almost everyone over age 55 has MRI changes consistent with meniscal disease or has some joint space narrowing on the X-ray, I am still amazed as to how quickly a patient is willing to sign the informed consent for either arthroscopic meniscal surgery or a total knee replacement. “Referring patients to other physicians is one of the most fundamental and frequently performed tasks in clinical practice” according to an opinion in VIEWPOINT, an opinion section in The Journal of The American Medical Association appearing in the November 12, 2014 edition. The article concludes that the single most important factor for making the referral should be based on scientific evidence; not the usual and customary.
So what is the evidence supporting cellular orthopedics and not invasive surgery for meniscal pathology? The very essence of the response is to be found in the scientific evidence; you need the meniscus now so as to avoid degenerative joint disease later. It is one thing to have a “clunking” meniscus causing giving way and knee buckling; that’s the positive MacMurray sign. That’s a mechanical problem and not a pain problem usually resulting from trauma. The issue I am referring to is the almost every day patient presenting with knee pain The scientific evidence clearly documents worsening of a condition wherein surgical meniscectomy, be it open or arthroscopic, will worsen the symptoms and hasten the need for the knee replacement. Even in the younger population presenting with knee pain and devoid of mechanical symptoms, evidence based scientific orthopedics emphasizes saving the meniscus. For a better understanding check out http://www.regenexx.com/
By chance, while I was writing this Blog, the Radiologic Society was meeting in Chicago and here is an excerpt of a scientific presentation. “A popular surgery to repair meniscal tears may increase the risk of osteoarthritis and cartilage loss in some patients The findings show that the decision for surgery requires careful consideration in order to avoid accelerated disease onset, researchers said.”
“Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function,” said Frank W. Roemer, M.D., from Boston University School of Medicine in Boston and the University of Erlangen-Nuremberg in Erlangen, Germany. “However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”
“We found that patients without knee osteoarthritis who underwent meniscal surgery had a highly increased risk for developing osteoarthritis and cartilage loss in the following year compared to those that did not have surgery, regardless of presence or absence of a meniscal tear in the year before,” Dr. Roemer said.
All 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59 percent) of the knees with meniscal damage that didn’t have surgery. In addition, cartilage loss was much more common among knees that had undergone surgery: 80.8 percent of knees with surgery showed cartilage loss, compared with 39.5 percent of knees with meniscal damage and no surgery.
Cellular Orthopedics offers the alternative to surgery, preserving the critical meniscus with Bone Marrow Aspirate Concentrate and Mesenchymal Stem Cells