The last few days were used to discuss meniscus tears and the lacking evidence that surgical interventions provide. See the most recent evidence at Am J Sports Med. 2010 Sep;38(9):1907-16. Epub 2010 Jun 29. Turning to regenerative orthopedic medicine and meniscus tears, let’s consider other options.
Today I’ll discuss attempting to reverse meniscus displacement outside the weight bearing aspect of the joint. In the image to the left, on the left side of the joint, notice that the triangular dark colored tissue is no longer cushioning between the femur and tibia bones. Though this can happen naturally through degeneration, the most common scenario we see this occur is after trimming or debridement of the meniscus with arthroscopic surgery.
As early as 1997, researchers were using fat extracted from around the joint to try to repair meniscus injuries (Int Orthop. 1997;21(4):232-8). This was a sheep study, where a meniscus was removed and the space left was filled with fat from near the joint. The fat–or, rather—the stem cells contained in the fat transformed into a meniscus like structure! Unfortunately, the researches noticed that the structure degenerated over time and may not provide long term protection. However, plastic surgeons have known this for years—when fat is transferred to another location, in this case for cosmentic purposes, it has no natural blood supply to maintain the tissue, and it eventually wastes away. Researchers and clinical physicians at our clinic and others are now using the growth factors derived from platelets to assist the body in establishing a blood supply to the fat to aid the body in maintaining the tissue for longer periods. We have begun using this fat in cases of meniscus extrusion as seen above. To the right is an ultrasound image of a fat graft holding a meniscus in place and helping to restore the natural cushion for the joint.
Regenerative Orthopedic Medicine – Corpus Mederi Ipsum
A simple, yet elegant, concept is emerging that I believe will transform not only orthopedic medicine, but the care of all human conditions: Corpus mederi ipsum—the body will heal itself