From the Guidelines
Platelet-rich plasma (PRP) therapy is not recommended for a radial meniscus tear due to the lack of standardization in available preparations and techniques, as well as concerns regarding its effectiveness and safety, as stated in the 2020 American College of Rheumatology guideline 1. The management of radial meniscus tears is a complex issue, and treatment options should be carefully considered based on the individual patient's needs and circumstances.
Key Considerations
- The American Academy of Orthopaedic Surgeons recommends against the routine use of hyaluronic acid in patients with knee osteoarthritis, and also notes that meniscus tears in patients with knee osteoarthritis are a challenging clinical complication, often resulting from the degenerative process rather than an independent cause of clinical symptoms 1.
- The 2020 American College of Rheumatology guideline strongly recommends against the use of platelet-rich plasma treatment in patients with knee and/or hip OA due to concerns regarding the heterogeneity and lack of standardization in available preparations, as well as techniques used 1.
- The typical protocol for PRP treatment involves drawing 30-60 mL of the patient's blood, processing it in a centrifuge to concentrate platelets, and injecting 3-5 mL of PRP directly into the knee joint under ultrasound guidance, but this treatment may not be effective for all patients, particularly those with larger tears or poor tissue quality.
Treatment Options
- Arthroscopic partial meniscectomy may be an option for patients with mild-to-moderate knee osteoarthritis and meniscal tears that do not respond to nonsurgical treatment, such as physical therapy, corticosteroid or other intra-articular injections, or other modalities 1.
- Patients with radial meniscus tears should be carefully evaluated and treated on a case-by-case basis, taking into account the size and location of the tear, as well as the patient's overall health and activity level.
- A rehabilitation program including gentle range of motion exercises and progressive strengthening should accompany any treatment for a radial meniscus tear, to promote healing and improve function.
From the Research
Preparation for Radial Meniscus Tear Repair
To prepare for a radial meniscus tear repair, it is essential to understand the current concepts and techniques used in management and repair.
- The diagnosis of meniscal tears requires detailed history-taking, physical examinations, special diagnostic tests, and most likely magnetic resonance imaging (MRI) to confirm the lesion 2.
- A good understanding of the meniscal structure, including vascularity, zones, function, and affected movements with associated symptoms, plays a crucial role in establishing an optimal management plan 2, 3.
- Meniscal repair has been shown to have better long-term outcomes and is therefore recommended for all tears, especially for young patients with acute traumatic lesions 2, 3, 4.
Repair Techniques
Various methods of repairing radial tears can be employed, including:
- All-inside double vertical sutures
- The addition of vertical "rip-stop" mattress sutures
- Transtibial pullout augmentation 4
- A technique using a traction suture to aid in maintaining reduction throughout repair, followed by the use of a combination of techniques to form a "super-hashtag" configuration of both vertical and horizontal mattress sutures 5
Rehabilitation
To ensure proper healing before undergoing physical therapy, it is crucial to abstain from weight-bearing and deep knee flexion for the first 6 weeks after surgery 4.
- Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair 6.
- There is a lack of consensus regarding the optimal postoperative protocol following meniscal repair, and additional studies are needed to better clarify the interplay between tear type, repair method, and optimal rehabilitation protocol 6.