Dear Dr Hacker:
In 2011 I suffered a complete ACL tear and a Meniscus tear. Dr. XXXXXX did surgery on my knee and during surgery he was unable to repair the Meniscus. As a result he removed 50% of the Meniscus in my right knee. I have since had another surgery to clean out the right knee and to sew another meniscus tear in the same knee.
As a result of my injury I was retired from the police force. I now teach and was referred to you from a co-worker. My question is, is it possible to repair my meniscus and possibly regrow my meniscus that was removed?
Thanks – C. V., San Diego.
The most interesting part of this question is about meniscus regrowth, or meniscus regeneration. Can a meniscus be regenerated ?
There are several ways to treat this problem and answer this question. First, the meniscus plays an important part in normal knee function and its absence leads to increased progression of cartilage wear in the knee, or osteoarthritis. You can learn a little more about the meniscus here:
Meniscus Transplant
A meniscus that has been removed can be completely replaced by a meniscal transplant. This is taken from a donor and placed into the knee. This is a significant surgery to the knee and should be done when there is no good alternative, the patient is young, and the remaining cartilage surfaces are in good shape. there is concern regarding long term benefit, with one study showing a 30% failure rate at 10 years after surgery.
Collagen Meniscal Implant
The Collagen Meniscus Implant (CMI®) is a biological and completely absorbable implant made from highly purified collagen with a porous structure. It is attached arthroscopically to fill the void resulting from damaged and lost meniscal tissue and makes use of the body’s own ability to repopulate the structure with its own cells over time to regenerate the normal structure of the meniscus. Over time this results in meniscus regeneration. There is data showing benefit from this surgery for chronic meniscal injuries and is something to consider in the right patient.
Stem Cell Treatments
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I was able to find one randomized double blinded clinical trial that showed benefit from stem cell injections for meniscal tears at two years out following treatment. While these patients did see improvement in symptoms, only a small percentage (about 15%) showed increased meniscal tissue at one year following treatment on MRI. There may be some benefit as a pain mediator as these cells can tend to have anti-inflammatory properties.
Bottom Line: Meniscus Tissue is Hard to Grow
In general current research shows it is hard to grow a new meniscus. The important question to ask is why does my knee really hurt, and what can be done to help? This is not the same answer for everyone. The absent meniscus itself does not cause pain. The concern is what happens to the cartilage protected by the meniscus, and is there something that can be done to protect it, or help it heal? New research is also addressing this concern, and newer treatment methods, including FDA trials, mqy help answer this question.
To this specific patient, while these ideas here are informative, I would not really be able to give a personalized answer without seeing your knee, your xrays, perhaps an MRI, and the most recent scope pictures taken during the last surgery. It all goes together to come up with the right treatment plan. As always, I love trying to help people solve these problems and look forward to seeing you in my office soon to discuss it all in detail.
IF you have a meniscus tear, had meniscus surgery, have a cartilage injury, are wondering about meniscus regeneration, and are worried about your knee and its future, please don’t hesitate to contact me and set up a consultation.
References:
C. Thomas Vangsness Jr., MD, et al.: “Adult Human Mesenchymal Stem Cells Delivered via Intra-Articular Injection to the Knee Following Partial Medial Meniscectomy: A Randomized, Double-Blind, Controlled Study”, J Bone Joint Surg Am, 2014 Jan 15; 96 (2)
Gustavo Vinagre, MD: Are Collagen Meniscus Implants a Reality? Orthopedics, September 2014 – Volume 37 · Issue 9: 581-582
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