Non-Operative Treatment of Meniscal Tears

Casey Wagner, MDNon-Operative Sports Medicine

Emory Sports MedicineAtlanta Wildcats Team Physician

Disclosures

• I have nothing to disclose

Meniscus Anatomy

• Medial• C-shaped

• Lateral• Circular

Meniscus Vascularity

• Red – Red• Peripheral 1/3

• Red – White• Middle 1/3

• White – White• Medial 1/3

Function

Function

• Shock absorption• Stability• Nutrition• Lubrication• Proprioception

Types of Tears

• Degenerative • Traumatic

• Mechanical block?

https://www.sportsinjuryclinic.net%2Fsport-injuries%2Fknee-pain%2Flateral-knee-pain%2Flateral-meniscus-tear&psig=AOvVaw0ZwNieU5w8cCcmkERvwoTV&ust=1589592429523000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCKDitrjbtOkCFQAAAAAdAAAAABAD

Non-operative treatment

• Clinical J Sports Med. May 2020• Systemic review and meta-analysis • Degenerative meniscus tears• Mild to no underlying OA• Outcomes based on function and pain• Measures at 6 mo, 1 y, 2 y, 5 y• Arthroscopic partial meniscectomy not superior to non-op tx

• Lower extremity strengthening exercises

Non-operative Treatment Options

G. Malanga et al. Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics. PMR. March 2019• Physical therapy – first line in acute and chronic tears• Physical therapy if underlying OA• Orthobiologics

• PRP and Mesenchymal cells • Research limit• IA or intrameniscal?

Non-operative Treatment• Kaminski Int J Mol. Sci. Feb 2019

• Prospective, Double Blinded, RCT• Percutaneous Trephination v Percutaneous Trephination + PRP• Chronic horizontal meniscus tears

Trephination????

https://upload.wikimedia.org/wikipedia/commons/5/55/Hieronymus_Bosch_053_detail.jpg www.livescience.com%2F62591-trepanation explained.html&psig=AOvVaw2b_UnsTHihUoFh3lyHJOl8&ust=1589765493700000& source=images&cd=vfe&ved=0CAIQjRxqFwoTCKDi5ZbguekCFQAAAAAdAAAAABAO

Meniscal Trephination under USPMR 2017

Non-operative Treatment

• Kaminski Int J Mol. Sci. Feb 2019• Failure rate determined by tear on MRI at about week 33

• No significant difference between groups• PRP + trep 11 full heal and 4 partial out of 25 vs trep 7 f and 4 p out of 26

• PRP meniscus significant rate of meniscus healing and survival• 8/11 treph. arthroscopy • 2/15 PRP + treph arthroscopy

• PRP statistically significantly (P=0.032) better in cumulative outcome• No complications

Thank you

Citations1. Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and

function. Sports Health. 2012;4(4):340-351. doi:10.1177/1941738111429419

2. Lee SH, Lee OS, Kim ST, Lee YS. Revisiting Arthroscopic Partial Meniscectomy for Degenerative Tears in Knees With Mild or No Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin J Sport Med. 2020 May;30(3):195-202. doi: 10.1097/JSM.0000000000000585

3. G. Malanga et al. Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics. PMR. 2019 Mar;11(3):292-308. doi: 10.1016/j.pmrj.2018.08.384. Epub 2019 Feb 27

4. R Kaminski et al. Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Int J Mol Sci. 2019 Feb 16;20(4). pii: E856. doi: 10.3390/ijms20040856.

5. Baria MR et al. Sonographically Guided Knee Meniscus Injections: Feasibility, Techniques, and Validation. PMR. 2017 Oct;9(10):998-1005. doi: 10.1016/j.pmrj.2016.12.012.