Stem cell therapy and healing meniscus damage – Dr. Marc …

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about stem cells and meniscus injury using the contact form below.

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 patients knee anatomy and he could be counted on to do a good job when it was time for the replacement.

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.

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.

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 wasnt 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 patients 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 a70 year old man was not too old to grow new meniscus tissue and his own stem cells had something to do with it.

A new 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 wont 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.

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.

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 ahealing 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.(4)

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 Denmarkconfirm 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)

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 patients 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.

STEM CELL INSTITUTEA leading provider of bone marrow derived stem cell therapy, Platelet Rich Plasma and Prolotherapy in Los Angeles and the world!11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025PHONE: (800) 300-9300

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.

5Thorlund 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.

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Stem cell therapy and healing meniscus damage - Dr. Marc ...