WASHINGTON, DC (Ivanhoe Newswire) — A misstep on the sports field or an awkward move while twisting or turning at home or work. Sometimes it doesn’t take much to tear the meniscus, the rubbery piece of cartilage protecting the knee. When there’s a tear that won’t heal, is it better for doctors to repair or replace?
Seventeen-year-old, Owen Joyce, loves to practice soccer with his brother Reilly. Owen is a three sport varsity athlete. During tryouts last spring, he made a sudden move and another player fell onto his leg.
Owen explained, “When I went to lift it up it caved in, and this part of my knee went straight to the ground and it kinda noodled out. And, it just felt like a huge release of pressure.”
Owen had an ACL injury and a torn meniscus. Both required surgery.
“Many, many years ago, meniscus tears were thought to be best dealt with by just taking the whole meniscus out. Unfortunately, that led to a lot of arthritis,” said John-Paul H. Rue, MD, Orthopedic Sports Medicine Surgeon at Mercy Medical Center in Baltimore.
Over the past ten years, studies show a growing number of patients are opting to have the meniscus repaired.
Dr. Rue continued, “As we’ve gotten better with technology and the surgical tools and our ability to fix these or repair these, we’ve become more skilled at preserving the meniscus.”
Dr. Rue said surgeons weigh a patient’s age and the extent of the injury. If the tear is in what they call the “red zone”, an area where there’s good blood supply that helps with healing. One drawback, recovery after repair is slow, six to eight weeks.
It’s been several months since doctors repaired Owen’s ACL and meniscus. He’s almost full strength.
Owen’s advice to others, “Your time will come soon enough when you are gonna be able to get back on that field and play the way you used to.”
As we age, the meniscus becomes more brittle, making it more susceptible to tears. Minor tears can go away in two or three weeks. Moderate to severe tears often require treatment. The good news is that Owen has just been fully cleared to play soccer again.
Contributors to this news report include: Cyndy McGrath, Producer; Roque Correa, Editor and Videographer.
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MENISCUS: REPAIR OR REPLACE?
BACKGROUND: About 30 million children and teens participate in some form of organized sports in the United States. And, more than 3.5 million injuries occur each year. By far, the most common are sprains and strains. Contact sports, such as football, are more dangerous and can be expected to result in a higher number of injuries than a non-contact sport, such as swimming. However, all types of sports have a potential for injury, whether from the trauma of contact with other players or from overuse or misuse of a body part. According to the National SAFE KIDS Campaign and the American Academy of Pediatrics, the leading cause of death from a sports-related injury is a brain injury. Sports and recreational activities contribute to approximately 21 percent of all traumatic brain injuries among American children. More than 775,000 children, ages 14 and younger, are treated in hospital emergency rooms for sports-related injuries each year that occurred as a result of falls, being struck by an object, collisions, and overexertion during unorganized or informal sports activities.
MOST COMMON ATHLETE INJURY: A meniscal tear is one of the most frequently occurring cartilage injuries of the knee. It’s the piece of cartilage that cushions and stabilizes the joint, and protects the bones from wear and tear. All it takes is a good twist of the knee to tear the meniscus. Meniscus tears are a special risk for older athletes since the meniscus weakens with age. More than 40% of people 65 or older have them. Symptoms can include pain in the knee, swelling, popping sensation during the injury, difficulty bending and straightening the leg, or tendency for your knee to lock up. Treatment for meniscal tears depends on the size and location of the tear. Other factors which influence treatment include age, activity level and related injuries. The outer portion of the meniscus, often referred to as the “red zone,” has a good blood supply and can sometimes heal on its own if the tear is small. In contrast, the inner two thirds of the meniscus, known as the “white zone,” does not have a good blood supply. Tears in this region will not heal on their own as this area lacks blood vessels to bring in healing nutrients, therefore, requiring surgery.
TREATMENT BREAKTHROUGHS: Stem cell therapy is part of a treatment that falls under the broad umbrella of “tissue engineering” or “regenerative therapy.” Doctors say that the future of meniscus repair is not in surgery, but tissue engineering. More research should be given towards maximizing the healing/regenerative properties of stem cells. Doctors in China say, “The repair of meniscus tissue in the avascular zone (without blood vessels to bring healing components) remains a great challenge, largely owing to their limited healing capacity. Stem cell based tissue engineering provides a promising treatment option for damaged meniscus because of their multiple differentiation potential, or ability to change into meniscal and cartilage cells.” Scientists are looking at rabbits with massive meniscal defects with hopes of seeing if a single stem cell injection would improve the defect. Doctors at Harvard University found unique characteristics in the stem cells of mice meniscus that could be reawakened by stem cell augmentation. The Harvard team reports that studying the mouse meniscal stem cells would provide essential information for enhancing therapeutic strategies for treating knee joint injury and disease.
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