The meniscus is a commonly injured structure within the knee joint. As a shock absorber and stabilizer, it is crucial to knee health and longevity in terms of performance and activity. Traditionally, tearing it meant meniscus removal, which leads to rapid destruction of the joint surface cartilage and development of arthritis, and the end of play, sport, or activity as you know it. But there is hope! At Mayo Clinic, we offer treatment options you can’t get elsewhere, performed by experts who have developed them.
Whether your injury is acute, degenerative, or mechanical, whether you are a professional athlete or weekend warrior, all treatment options are based on one goal: to repair and restore, not remove, your meniscus. Aaron Krych, M.D., orthopedic surgeon, Mayo Clinic Orthopedics and Sports Medicine says, “We are repairing tears that even five years ago were beyond hope,” and we continue to be at the forefront of researching and pioneering techniques to preserve the meniscus.
Treatment options depend on your diagnosis, type of injury, and specific situation. Non-operative treatment generally starts with rest, avoiding activities that aggravate pain, ice, bracing, compression, elevation, and physical therapy to help strengthen the muscles around the knee joint. The next level of non-operative treatments are ultrasound-guided injections; those can be corticosteroid or hyaluronic acid, or orthobiologics.
How we differ: regenerative medicine treatment options
“In many cases, standard treatment options can be very effective,” says Jacob Sellon, M.D., sports medicine physician and Co-Chair of Mayo Clinic Orthopedics and Sports Medicine. Yet, if more is needed, orthobiologics may be recommended. “Orthobiologics are a group of treatments made from substances or tissue in the human body processed in such a way that they can be delivered to help heal or improve pain in a specific area,” explains Dr. Sellon. Right now, Mayo is at the forefront of researching and using such regenerative medicine, which includes platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and microfragmented adipose tissue (MFAT). “Our bodies can do amazing things in terms of an injury, and what we’re trying to do [with regenerative medicine] is harness that capability in our own body trying to heal,” says Jeffrey Payne, M.D., sports medicine physician, Mayo Clinic Orthopedics and Sports Medicine.
Platelet-rich-plasma (PRP):
PRP is currently the most utilized orthobiologics injection for meniscus injuries at Mayo, especially for meniscus injury in the setting of knee arthritis.
- Multiple ongoing studies show PRP may help with pain and functioning
- For some people, use of PRP has increased quality of life to such an extent that they are able to repeat it as necessary and avoid knee replacement surgery
- Offers the potential to delay joint replacement
- Can be used synergistically with standard treatments such as physical therapy or ultrasound-guided meniscus trephination (the use of needling to promote healing) to lead to better outcomes
How PRP works
Dr. Sellon explains, “Platelets are the part of the blood that stimulate the healing process.” To get them, we draw a sample of blood from the patient, concentrate the parts of the blood that we want, and then use ultrasound guidance to inject that platelet rich plasma into the area of the body to be treated. The whole process takes place in the office, in less than an hour or so.
How we differ: operative treatment options
If non-operative treatment is not effective, or the knee is locked, surgery may then be considered.
Repair, Don’t Remove
The techniques of meniscus repair we have developed at Mayo include repairing the torn edges of the meniscus, with the short- and long-term goal being to preserve the meniscus tissue and help prevent knee osteoarthritis. “We’ve developed different surgical techniques that are specific to each tear type,” Dr. Krych explains, “so we approach meniscus repair like bringing a toolbox and we have six or seven different options that help us repair more complex tears and save more meniscus than we have in the past.”
- Minimally invasive
- Outpatient
- Can even be used for root tears, with mid- and long-term results showing decreased rates of arthritis and need for joint replacement
- Published studies of prospective young competitive wrestlers show that after meniscus repair, 89% returned to sport
Recovery can take four to eight months and includes up to six weeks on crutches, with rehabilitation and physical therapy – all under the care of Mayo Clinic’s team of sports medicine experts. Your treatment doesn’t end after the surgery; we are with you on every stage of the journey.
Arthroscopic meniscus transplant:
In some situations, meniscus transplant may be an option for patients with severe injuries and who do not have advanced arthritis. At Mayo, we can do this arthroscopically. During this procedure, explains Kelechi Okoroha, M.D., orthopedic surgeon, Mayo Clinic Orthopedics and Sports Medicine, team physician for the Minnesota Timberwolves, “We transplant the meniscus from a cadaver (allograft) and restore the biomechanic function.” The recovery from a meniscus transplant can be extensive, with the use of crutches for up to 4-6 weeks, and six to nine months of physical therapy. As with all treatment at Mayo, this rehabilitation plan is part of the comprehensive and world-class care you receive from us.
If you’re curious about what meniscus repair or treatment options might be right for you, contact one of our Knee Meniscus Specialty Clinics in Minneapolis, MN or Rochester, MN to find out more.
For more information, or to make an appointment, please visit sportsmedicine.mayoclinic.org.
