Meniscus Injury: Choosing Between Arthroscopy and PRP Treatment Options

Meniscus injury: choosing between arthroscopic surgery or PRP therapy?

On March 23, I was involved in a car accident.
After undergoing an MRI this week, the doctor diagnosed me with an outer meniscus tear and injuries to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL).
Additionally, there is still significant hemarthrosis in my knee.
Currently, my knee swells considerably if I do not wear a knee brace, but it functions relatively normally on flat surfaces when I do wear the brace.
The doctor mentioned that the current MRI cannot determine if the meniscus has the potential for self-repair and suggested that I rest for another three weeks to observe the recovery of my knee.
However, I mentioned that I am an amateur cyclist and would like to recover quickly to resume training.
The doctor then suggested that if I want to expedite the process, I could opt for arthroscopy and repair, but he noted that very few people decide to proceed with arthroscopy immediately and recommended that I observe my condition first (or I could choose PRP treatment, but he indicated that its effectiveness is limited).

I have several questions:
1.
Is it true that whether the meniscus can heal on its own can only be determined at the time of arthroscopy? (I thought an MRI could provide that information.)
2.
If the arthroscopy determines that the meniscus can heal on its own, would that mean no repair surgery would be necessary? (Would it be simply sutured?) If it is just a diagnostic procedure, how long would the wound take to heal?
3.
If a meniscus repair is performed, what is the typical recovery time before I can resume sports training? The doctor mentioned that surgery would require hospitalization and that I would need to wear a special brace postoperatively, which would significantly limit my mobility.
This is why he suggested not to rush into arthroscopy.
4.
What does the current literature say about the effectiveness of PRP for treating meniscus injuries? I've seen conflicting information online, with some sources claiming it is effective and others stating the results are not significant, showing a wide discrepancy.
5.
Generally speaking, how long should I wait after resting before the knee swelling indicates that arthroscopy is necessary?
I apologize for having many questions that I did not think of during the consultation; I only realized them upon reflecting afterward.

JYC, 30~39 year old female. Ask Date: 2023/04/20

Dr. Chen Yongxue reply Orthopedics

1.
Is it only during the arthroscopic examination that we can determine whether the meniscus can heal on its own?
2.
If the arthroscopic examination indicates that it can heal on its own, will no repair surgery be performed? (Is it just sutured?) If it is merely an examination, how long will the wound recovery take? The regenerative capacity of meniscal cartilage is quite poor; it only has a chance to regenerate in the outer one-third where there is vascular nourishment, while other areas are difficult to heal.
MRI is merely an imaging examination and is not as direct as arthroscopy, which can also provide treatment (the outer part can be sutured, and the inner part can be trimmed).
Regardless of whether it is an examination or combined surgery, the skin wound can typically have stitches removed in about seven to ten days.

3.
If a meniscus repair is performed, how long does it generally take to recover to the point of being able to engage in sports training? The doctor mentioned that surgery would require hospitalization and that a special brace would need to be worn postoperatively, which would be quite inconvenient.
Because of this, he suggested that I should not proceed directly with arthroscopic surgery.
The brace is actually quite convenient, easy to put on and take off, and recovery takes about three months.

4.
What does the current literature say about the effectiveness of PRP in treating meniscal injuries? Some online sources claim it is effective, while others say the results are not significant, showing a considerable discrepancy.
PRP utilizes platelets to form a clot that gradually turns into fibrous scar tissue.
Firstly, the effects are not significant, and secondly, the evaluation period needs to be two months, which could delay the treatment of meniscal cartilage and the anterior cruciate ligament (ACL).
Personally, I find this approach inappropriate.

5.
Generally speaking, how long should one wait after rest before knee swelling indicates the need for arthroscopic intervention? If treated properly, significant reduction in swelling should be achievable in about two weeks.
It is recommended that since you have a concurrent ACL injury, this greatly affects the stability of the knee joint.
In cases of knee instability, I believe it is quite challenging for the meniscal cartilage to heal.
If your activity is cycling, where there is no need for sudden changes in direction, you might consider muscle training to compensate for the function of the ACL, but whether the meniscal cartilage can recover remains uncertain.
Thank you.

Reply Date: 2023/04/20

More Info

When considering treatment options for a meniscus injury, particularly in the context of your recent car accident, it’s essential to weigh the benefits and risks of both arthroscopy and PRP (Platelet-Rich Plasma) therapy. Here’s a detailed breakdown of your questions and the relevant medical insights.

1. Can the meniscus heal on its own?
The ability of the meniscus to heal spontaneously largely depends on the location and type of the tear. The meniscus has a limited blood supply, particularly in its inner two-thirds, which makes healing more challenging. An MRI can provide valuable information about the meniscus, but it may not definitively determine whether a tear can heal on its own. Arthroscopy allows for direct visualization and assessment of the meniscus, which can provide a clearer picture of the injury and its healing potential.

2. What happens during an arthroscopy?
If an arthroscopy is performed and the surgeon determines that the meniscus can heal on its own, they may opt not to perform any repair. Instead, they might simply clean up any loose fragments or debris. The recovery time from a diagnostic arthroscopy is typically shorter than from a repair procedure, often ranging from a few days to a couple of weeks, depending on the extent of the procedure and individual healing rates.

3. Recovery time for meniscus repair:
If a meniscus repair is necessary, the recovery timeline can vary significantly. Generally, athletes can expect a rehabilitation period of about 4 to 6 months before returning to high-impact activities like cycling or running. Post-surgery, you will likely need to wear a brace and follow a structured rehabilitation program to regain strength and mobility.

4. Effectiveness of PRP therapy:
PRP therapy has gained popularity for treating various musculoskeletal injuries, including meniscus tears. The literature presents mixed results; some studies indicate that PRP may help reduce pain and inflammation and promote healing in minor tears, while others suggest limited effectiveness. The variability in outcomes can depend on factors such as the severity of the injury, the specific PRP preparation method, and individual patient characteristics.

5. When to consider arthroscopy due to persistent swelling:
If your knee remains swollen despite rest and conservative treatment, it may be time to consider arthroscopy. Typically, if swelling persists for several weeks (often around 4-6 weeks) without improvement, further evaluation may be warranted. Persistent swelling can indicate ongoing inflammation or mechanical issues within the joint that may require surgical intervention.

In summary, while both PRP and arthroscopy have their roles in treating meniscus injuries, the choice between them should be guided by the specifics of your injury, your activity level, and the advice of your orthopedic specialist. Given your status as an amateur cyclist eager to return to training, discussing these options in detail with your physician is crucial. They can help you weigh the potential benefits of immediate surgery against the risks and recovery time involved. Always remember that each case is unique, and personalized medical advice is essential for optimal outcomes.

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