New treatments offer hope for a common knee injury
Article Published by: nj.com
Chances are, if you experience a tear to the meniscus in your knee, you’ll know it. About 700,000 Americans undergo meniscus surgery (“meniscectomy”) annually, according to the American Physical Therapy Association. Many others suffer silently with this potentially debilitating condition, enduring symptoms that range from pain, swelling and stiffness to a complete inability to bend the knee or walk.
The good news is that a variety of new and minimally invasive treatments for meniscal tears are offering better long-term outcomes. Described as the knee’s “shock absorbers,” the menisci (two surround each knee) are rubbery strands shaped like the letter C that fit between a round and a flat bone. They help to equally distribute the body’s weight, protecting and extending the life of surrounding cartilage.
“The meniscus acts like a wedge, increasing the contact area between two bones and decreasing the stress on them at any time,” says sports medicine specialist Charles Gatt, chairman and associate professor of orthopaedic surgery at Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital in New Brunswick.
“Meniscal tears are one of the most common orthopaedic injuries we see,” says Alan Reznik, a spokesman for the American Academy of Orthopaedic Surgeons and chief medical officer at Connecticut Orthopaedic Specialists in New Haven, Connecticut.
Reznik says that tears can result from rapid twisting, such as getting up from a chair or running and pivoting while playing basketball, tennis, soccer, football or any sport involving cleats.
“Injuries are often in proportion to an individual’s age, hours of play and the intensity of their activity, so we’re seeing more meniscal tears among younger people, because kids are more active in sports than ever,” he says.
Gatt agrees, adding that orthopaedists also are seeing more meniscal tears in older populations. “This is especially true among ‘weekend warriors,’ because older individuals are more active today and the arthritis that often plagues older knees makes the meniscus more susceptible to being torn,” says Gatt. He adds that about 50 percent of males older than 70 are likely living with a meniscal tear.
Decades ago, “the philosophy was to remove the entire meniscus via a total meniscectomy based on the belief that it would grow back,” Gatt says. “The problem was that it didn’t, and all of those patients probably had to have a knee replacement at some point.”
Today, however, the standard approach is a partial meniscectomy, removing only the torn section and retaining what’s healthy, using arthroscopic surgery done through two small incisions.
Depending on the severity of the tear, from smaller “clean” tears to more serious”radial” and “root” tears, which cause the meniscus to become detached from the bone, Reznik says, advances in technology and process often can avoid the second incision. This speeds up the procedure and recovery time, and causes less scarring.
Reznik says that because of advances such as the fiber optic telescope, smaller cutting and shaving instruments that self-suction and newer anesthetic agents that work faster and wear off more quickly, most surgeries can be done on an out-patient basis using local anesthesia, with minimal risk of complications. Other cutting-edge options, Reznik says, include meniscal grafts and transplants, as well as the use of platelet-rich plasma that can be clotted with growth factors and reinserted into the knee to stimulate the natural healing process.
Despite the success of these less-invasive approaches to meniscal tears, Gatt says that even a high-tech repair of a partial tear is a temporary solution.
“The symptoms will go away and the patient will do okay for five to 10 years, but the loss of even part of the meniscus can accelerate the onset of arthritis,” he says.
Because of this, Gatt says he is excited about the development of tissue-engineered meniscus replacement technology, which he is spearheading with research partner Michael Dunn, professor of orthopaedic surgery at Rutgers Robert Wood Johnson Medical School and director of the university’s Orthopaedic Research Laboratory.
“Essentially, we’re building a scaffold out of a biodegradable polymer, developed at Rutgers, that’s been submerged in collagen and hyaluronic acid, and weaved into the shape of a meniscus,” says Gatt.
The spongelike device is inserted into the knee and fully dissolves, stimulating the body to rebuild new meniscal tissue naturally.
“There have been a couple of attempts at this technology by researchers over the years,” says Gatt, but either the implants didn’t dissolve or they released particles internally that caused inflammation.
“By contrast, our dissolvable polymer is strong enough to bear the pressure between the two bones while stimulating the body to grow a new meniscus in its place — one that’s not comprised of scar tissue, but of neo-meniscal tissue.”
Initially funded by grants from the National Institutes of Health and the U.S. Department of Defense, and recently by a nonprofit venture capital group, the team’s newly created venture, NovoPedics, Inc., is hoping to develop one of the industry’s first sustainable implantable medical devices that restores mobility to patients suffering from severe meniscal knee injuries. “Up until now, there’s been no great option for patients dealing with post-meniscectomy pain and many would ultimately need a knee replacement,” Gatt says. The product, to be marketed under the trade name MeniscoFix, is scheduled for clinical trials in the next two years, with a target of becoming commercially available within five to seven years.
“Our product can potentially return people to a good quality of life and eliminate the long-term consequences of meniscus removal, avoiding the need for a knee replacement later on,” Gatt says.
For Reznik, an orthopaedic surgeon for more than 25 years, there’s never been a broader array of options for patients or a more exciting time to practice in the field.
“The transformation we’ve seen in the industry in the last 40 years has been significant, and I marvel at and am in awe of the way we can now see and work in a space as small as the meniscal area with such perfect detail and precision,” Reznik says.
“Today, we can truly tailor treatments to the patient’s specific type of tear and employ the least-invasive method to get the best outcome.”
ABOUT IFFIE OKORONKWO, M.D.
Iffie Okoronkwo, M.D. is a Spine and Sports Rehabilitation Medicine and Pain Management physician at Manhattan Spine and Sports Medicine (http://www.manhattanmd.com/), a private practice based in New York City with 40 years of experience providing the finest expert medical care and services to patients around the world.
Dr. Iffie is board certified in Physical Medicine and Rehabilitation and, as a physiatrist, utilizes ultrasound guided injections, fluoroscopy guided injections, PRP, regenerative medicine, and more to evaluate and treat a variety of conditions affecting muscles, joints, ligaments, and nerves.