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- Meniscal Injuries and Their Treatments
- (1) Articular cavity puncture and irrigation
- (2) Non-steroidal anti-inflammatory drugs
- (3) Injection of Sodium Hyaluronate
- (4) Glucosamine Hydrochloride Treatment
- (5) Injection of Platelet-Rich Plasma
- (6) Intra-articular injection of Ozone
- (7) Intra-articular injection of stem cells
- Conclusion
The menisci of the knee are two pads of fibrocartilaginous tissue which serve to disperse friction in the knee joint between the Tibia and the Femur.
The meniscus plays an important role in the knee joint for weight bearing and shock absorption, it also helps stabilize the knee joint and helps lubricate the articular cartilage. Once the meniscus is damaged, the stability of the knee joint will change, which will induce changes in the internal environment of the knee joint and promote the formation and development of knee osteoarthritis.
The greatest displacement of the meniscus is caused by external rotation, while internal rotation relaxes the meniscus. Injury is mainly caused by rapid deceleration, jumping, landing, squatting, and spinning. This injury is particularly common in competitive athletes, such as soccer, basketball, and sometimes tennis players.
More and more clinical studies believe that conservative treatment should be adopted for early meniscal injuries without obvious surgical indications.
Meniscal Injuries and Their Treatments
Meniscus injuries can occur at any age, common in young people and the elderly, and can be divided into two types: traumatic and degenerative. Acute or traumatic injuries are caused by the strong motion of the knee joint. However, meniscus injuries can also occur in the absence of any history of knee trauma; these are the result of degenerative or chronic tears. The two types of tears can be distinguished morphologically: Traumatic meniscus injuries are usually vertical and longitudinal, while degenerative tears usually originate in a horizontal direction.
The meniscus has a certain self-healing ability. Generally, conservative treatment of mild to moderate injuries and some severe injuries can promote the relief of symptoms and achieve the purpose of treatment.
(1) Articular cavity puncture and irrigation
If there is a lot of effusion in the affected knee and the tension in the joint cavity is high, it is necessary to puncture the knee joint to clean up the blood and fluid in it and then lavage the joint cavity.
(2) Non-steroidal anti-inflammatory drugs
At present, non-steroidal anti-inflammatory drugs commonly used in the clinical treatment of meniscus injury include diacerein, diclofenac sodium, ibuprofen, etc. Non-steroidal anti-inflammatory drugs work through COX (cyclooxygenase), which is an enzyme that converts arachidonic acid into prostaglandins, prostacyclins, and thromboxanes. Inhibiting these products can reduce inflammation and also have antipyretic and antithrombotic effects and analgesic effects.
(3) Injection of Sodium Hyaluronate
Sodium hyaluronate is an important component of synovial fluid, which can reduce joint friction, help repair cartilage damage in joints, and improve joint mobility. Sodium hyaluronate also has strong anti-infection effects and can reduce intra-articular pressure. Research on meniscus cells removed from patients found that hyaluronic acid promotes the migration and proliferation of inner and outer meniscus cells in a concentration-dependent manner and can inhibit the apoptosis induced by prostaglandin E2.
In addition, hyaluronic acid was found to promote meniscus regeneration by activating the CD44 receptor and the P13K and MAPK signaling pathways.
(4) Glucosamine Hydrochloride Treatment
Glucosamine hydrochloride has a positive effect on meniscus repair. The drug can promote the content of polyglucosamine in synovial fluid and cartilage matrix, and at the same time, it can promote the synthesis of hyaluronic acid and chondroitin sulfate. In the knee cartilage matrix, bone elasticity and strength are closely related to the number of proteoglycan components, and glucosamine can promote the production of proteoglycans, effectively enhance bone elasticity and strength, improve meniscus regeneration, and enhance the function of affected knees to relieve the pain.
(5) Injection of Platelet-Rich Plasma
Platelet-rich plasma (PRP) is a product of platelets, which can induce the migration and adhesion of cartilage precursor cells and vascular endothelial cells, and can also promote the synthesis of cartilage matrix and form the original meniscus scaffold. PRP contains a variety of growth factors, including transforming growth factor-β1 (TGF-β1), fibroblast growth factor (FGF-2), (platelet-derived growth factor (PDGF), and vascular endothelial growth factor (VEGF), all the which are involved in cell differentiation, chemotaxis, angiogenesis, and extracellular matrix production to varying degrees. Many clinical experiments have also shown that the use of arthroscopic surgery combined with intra-articular injection of PRP in the treatment of meniscus injuries has better improvement in knee joint function and pain than surgery alone.
(6) Intra-articular injection of Ozone
Ozone is a strong oxidant which has the functions of anti-oxidation, analgesia, anti-infection, and alleviating hypoxia in locally damaged tissues. It has a short half-life, diffuses easily, and is readily absorbed by tissues.
Studies have confirmed that when ozone is used to treat aseptic joint inflammation and joint injury, it can not only relieve joint pain, but also accelerate the disappearance of tissue edema, reduce bleeding, and improve joint function. Medical ozone has the characteristics of low cost, multi-functional, simple and safe, etc., making it widely used in clinical practice..
(7) Intra-articular injection of stem cells
In recent years, tissue engineering meniscus technology has been studied more in meniscus repair, and the key seed cells include meniscus fibro chondrocytes and mesenchymal stem cells. Meniscus stem cells not only have the characteristics of mesenchymal stem cells but also easily differentiate into fibro chondrocytes.
Patients with partial medial meniscectomy were divided into 3 groups, experimental groups A and B received 50 million and 150 million mesenchymal stem cells combined with human serum albumin, hyaluronic acid, and plasma joint cavity injection, and the control group received an intraarticular injection. Hyaluronic acid was injected into the joint cavity and analyzed by semi-quantitative MRI. It was considered that the meniscus increased by more than 15% as positive growth. The results showed that 24% of patients in group A and 6% of patients in group B showed positive growth of meniscus volume one year after the operation, while there was no such growth in group C, suggesting that intra-articular injection of mesenchymal stem cells can promote meniscus regeneration.
Conclusion
A knee meniscus injury is a relatively common orthopedic disease in clinical practice. The treatment approach has evolved from early conservative treatment to surgical interventions such as complete meniscus resection, partial resection of the damaged part, suture repair, arthroscopic treatment, and later tissue engineering technical repair of the meniscus. In recent years, there has been a shift back towards conservative treatment. This change is the gradual realization of the significance of the existence of the meniscus by scientific researchers and clinical workers. The purpose of conservative treatment is to minimize the secondary damage to the knee meniscus during surgery damage.
Based on the research on the conservative treatment of meniscus injury mentioned above, it can be seen that conservative treatment has a good curative effect on most patients with meniscus injury and avoids long-term and short-term complications such as trauma, cartilage damage, and knee osteoarthritis caused by surgical treatment. However, for patients with knee meniscus injury presenting with snapping and locking symptoms, conservative treatment is not as effective, and surgery should be performed as soon as possible.