Often I will hear remarkable statements in emails. Here is an example of one shared about knee pain.
This person contacted me because they were interested in a stem cell program to help them avoid a knee replacement. He reported that he had an arthroscopic surgery to remove part of his meniscus recently. The doctor who performed the surgery told his patient to make sure he called him when they were ready for knee replacement.The doctor said that he was already familiar with this patient’s knee anatomy and he could be counted on to do a good job when it was time for the replacement.
- The doctor was so sure that the arthroscopic procedure he performed on this person’s knee, specifically the meniscus, would cause sufficient accelerated knee damage that knee replacement would be needed sooner rather than later. The doctor did not want to lose out on being able to perform the replacement surgery.
As the predicted knee degeneration occurred, the patient instead reached out to us and stem cell therapy. Hindsight and foresight, the person had wished they would have reached out before the surgery so we could have helped with his meniscus repair.
It you have been diagnosed with:
- partial posterior root medial meniscus tear,
- had a meniscus injury with ACL tear,
- bucket handle meniscus,
- Meniscus degeneration with osteoarthritis,
Stem cell therapy may be an option for you. Let’s examine some research.
Can a meniscus regenerate itself?
New research into the healing world of the knee meniscus is fascinating. Despite decades of traditional medical beliefs that because of its poor or even absent network of blood vessels and blood supply, parts of the knee meniscus cannot heal. Researchers are discovering the meniscus is in fact, always trying to heal itself.
Can a meniscus really regenerate itself? This is a question I am often asked. The answer is yes, in some circumstance.
A strange and fascinating case leads to awareness that a meniscus can regenerate itself
In 2011, three doctors from the North Middlesex University Hospital in the United Kingdom published a strange case history in the medical journal Case Reports in Medicine. What was odd about this case was that a 70 year old man who had recently undergone total knee replacement was suffering from terrible knee pain. It wasn’t the knee pain that was odd, patients frequently report knee pain after knee replacement. What was strange to the doctors was what was causing the knee pain. Here is their case:
Report: The patient’s surgery had taken place at another hospital, and he had made an initially uneventful recovery with a good clinical range of motion and satisfactory postoperative radiographs. At 9 months, however, he began to develop medial and lateral retinacular (middle and side tendon related pain) and deep knee pain, without associated knee swelling, warmth, or wound disturbance. (No infection or apparent injury) His symptoms steadily worsened, particularly with load-bearing activity and bending his knee past 80 degrees.
Meniscus tissue was growing inside the knee replacement
“Our patient was found to have soft-tissue entrapment between the femoral component and the polyethylene tray . . . suggestive of meniscus-like tissue. Meniscal regeneration has been previously described in experimental and clinical studies following meniscectomy and has also been previously reported following TKA (total knee replacement).”(1)
Studies suggest that this is possible because the meniscus is always trying to heal itself. How did this patient story end? Another surgery, arthroscopic debridement to remove the new meniscus tissue because it was trapped in the hardware.
What was the moral of the story? Make sure you do not leave any meniscus behind in total knee replacement, it may regrow itself, and a 70 year old man was not too old to grow new meniscus tissue and his own stem cells had something to do with it.
A study in the Journal of orthopaedic research lead by the Department of Orthopaedics and Rehabilitation, University of Iowa discusses how a meniscus regenerates and heals.
The researchers hypothesized that the meniscus contains a population of regenerative cells, (cells that stimulate stem cell activity) and that they migrate to the site of meniscal injury. In the above study that is what the doctors speculated happened to their patient.
However, studies revealed that migrating cells were mainly confined to the red zone in normal menisci: (This is the area where the meniscus has good blood flow and healing elements are abundant). However, these cells were capable of repopulating defects made in the white zone, (the area without circulation). When the meniscus was injured, migrating cell numbers increased dramatically. Stem cells in the knee increased in number to combat the injury.These findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential, even into the white zone area.(2)
The short of it? The meniscus figures out how to heal itself if it can. Even in the areas that are typically believed unhealable because of lack of blood flow to that area.
Stem cell numbers? What is even more fascinating is that the meniscus signals for more stem cells from the knee capsule to come to the injured area. For those people asking about stem cell numbers that are harvested for treatment, you won’t get an answer from the meniscus because it is mobilizing the stem cells already in the knee. Sometimes the meniscus only needs little spark, an injection of own stem cells to facilitate an abundant healing.
The meniscus is always trying to heal itself
If you had a meniscus tear you are familiar with “White Zone,” and “Red Zone,” meniscus tears. The “Red Zone,” part of the meniscus, the outer edges, receives a steady stream of healing cells from its well organized blood vessel network. For those of you with a meniscus injury that is being recommended to surgery, you may have had your doctor explain to you that you have a “White Zone,” tear. The “White Zone,” lies in the center of the meniscus. It does not have a well organized blood network. It is these meniscal injuries that send patients to surgery. Unfortunately because of the lack of blood supply the damaged tissue needs to be removed.
The meniscus and cartilage are trying to heal each other
In the Journal of orthopaedic research doctors examined the process of meniscal regeneration and cartilage degeneration following meniscus surgical removal in mice. They found that there is a healing environment that the meniscus and cartilage create independently of each other spurred on by native stem cells, that later melds together, suggestive of a balance between meniscal regeneration and cartilage homeostasis.(3) The meniscus and cartilage are trying to regenerate each other.
This special relationship between cartilage, meniscus and stem cells is discussed in new research from the University of Iowa. The Iowa findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor (stem cell) population with strong reparative potential.(4) The problem for patients is that despite the desire to heal and regenerate, as pointed out by the Iowa researchers, “Serious meniscus injuries seldom heal and increase the risk for knee osteoarthritis; thus, there is a need to develop new reparative therapies. In that regard, stimulating tissue regeneration by autologous stem/progenitor cells has emerged as a promising new strategy.”
In past articles I have written extensively about how stem cells change the environment of diseased joints to healing. Research like that above confirms that when one part of the knee is repairing, the entire knee is repairing. This change of environment is something a surgery cannot offer.
Doctors at the University of Southern Denmark confirm this:
“Patients undergoing arthroscopic partial meniscectomy are at increased risk of knee osteoarthritis. Meniscal damage and/or Meniscal surgery may alter knee-joint loading (the distribution of weight across the knee) to increase osteoarthritis risk.”(5)
As noted, research has suggested poor long-term outcomes for patients with meniscectomies with increased incidence of osteoarthritis, leaving a need to develop technology to regenerate meniscal tissue following meniscectomy. The answer is stem cells.(6)
What are realistic expectations that stem cell therapy can help your meniscus related knee problems?
As you have seen in this article, the meniscus has a remarkable ability to heal itself. When someone comes into our office with knee problems we start with a conversation so we can learn about the patient’s lifestyle and what are his/her goals of the treatment. Is it to get back to marathon training or is it to get up and down a staircase without his/her knee locking up? Then we will do a detailed physical examination looking for those signs that will tell us how helpful stem cell therapy may be.
Do you want to talk about your meniscus injury with Dr. Darrow?
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
1 Matar HE, Dala-Ali B, Atkinson HD. Meniscal regeneration: a cause of persisting pain following total knee arthroplasty. Case reports in medicine. 2011;2011.
2 Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. Journal of Orthopaedic Research. 2016 Nov 1.
3 Hiyama K, Muneta T, Koga H, Sekiya I, Tsuji K. Meniscal regeneration after resection of the anterior half of the medial meniscus in mice. J Orthop Res. 2016 Nov 2. doi: 10.1002/jor.23470. [Epub ahead of print]
4 Seol D et al. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
5 Thorlund JB, Holsgaard-Larsen A, Creaby MW, et al. Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy: a prospective cohort study. Osteoarthritis Cartilage. 2016 Jul;24(7):1153-9. doi: 10.1016/j.joca.2016.01.987. Epub 2016 Feb 2.
6. McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42. doi: 10.1097/JSA.0000000000000073.
There is controversy in the medical community about umbilical cord blood stem cells. Some insist that the injectable solution contains abundant live umbilical cord blood stem cells. Some suggest that the stem cells are not alive. I have seen the flow cytometry showing live stem cells. The research shows that these stem cells release cytokines and growth factors that awaken native stem cells. I have tried this treatment on myself for both shoulders and knees. After great success, I started using this treatment on patients. I still use PRP and bone marrow depending on the patient’s pathology and requirements. To date the results are excellent for all of these treatments. We are in the process of doing a study on cord blood stem cells (we have done others on bone marrow and PRP) to see which treatments are the most successful. We are awaiting more long term results.