Do All Meniscus Tears Need Surgery?
Research by Horga, et al (1) suggests the answer is no! Using the latest (and most powerful) MRI scanners Horga’s team found abnormalies in 97% of the non-painful knees. Thirty percent (30%) had meniscus tears, cartilage and bone marrow lesions at the knee cap area (patellofemoral). About 1/3 of the knees had severe cartilage lesions. Tendon damage was detected in about 1 in 5 patients.
Remember, these were patients who had NO knee pain. Hence if so many patients have big problems on their knee MRI’s and have no pain, why are we so many people getting knee meniscus surgery for tears?
One answer is that they have not tried alternative therapies like Shockwave Therapy.
Extracorporeal Shock Wave Therapy (ESWT) stimulates newblood vessel growth.
ESWT faster return to competition and athletic activity.
ESWT is a safe and effective non-invasive outpatient procedure.
(1) Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, D’Silva A, Sharma S, Moon JC, Hart AJ. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Feb 14. doi: 10.1007/s00256-020-03394-z.
The goal of epidural injections and surgery is to provide pain relief. The goal of shockwave therapy (Zimmer, Storz, Piezowave), Magnet therapy (Magnawave), and laser therapy (TheraLase, LightForce) is to provide a healing environment inside the body leading to pain relief. Epidural injections do not heal a bad back. Shockwave, laser, magnet therapy, exercise and hands-on therapy will help heal a bad back.
Some patients do get epidural steroid injections and find short-term pain relief. Often times this sense of immediate pain relief prevents people from getting the proper treatment for his/her long term back pain care.
A study from Vanderbilt University discusses the use of epidural injection treatments and spinal surgery:
…surgery is superior to epidural steroid injections for improving quality of life and pain, however after a year neither the surgery or the epidural steroid injections significantly helped improve the patient’s disability.(1)
Johns Hopkins School of Medicine, Walter Reed National Military Medical Center, University of Toronto researchers describe:
Epidural steroid injections provide modest pain relief up to 3 months in patients with lumbosacral radicular pain caused by herniated disks, but they have no impact on physical disability or incidence of surgery.(2)
The Chinese University and Prince of Wales Hospital in Hong Kong: …transforaminal epidural steroid injection cannot alter the need for surgery in the long term.(3)
Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute:
For some patients epidural steroid injections did not work at all. “Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection.” (4)
THE PROBLEM you as a patient face: Epidural steroid injections are still one of the most frequently performed low back pain procedures. BUT, epidural steroid injections really should be questioned for lack of effectiveness, and may be dangerous.
Patients need to know that they have alternatives. Rather than exposing patients to risks from injections and dangerous complications, I start low back treatment with non-invasive shockwave, laser, or magnet therapy, combined with skilled hands-on therapy and ELDOA exercise training. (5) Doesn’t this make sense?
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1 Sivaganesan A, Chotai S, Parker SL, McGirt MJ, Devin CJ. 161?Patient-Reported Outcomes After Epidural Steroid Injections vs Surgery for Degenerative Lumbar Disease: A Prospective, Matched Cohort Study. Neurosurgery. 2016 Aug;63 Suppl 1:164-5. doi: 10.1227/01.neu.0000489730.99853.c3.
2. Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg. 2016 Mar;122(3):857-70. doi: 10.1213/ANE.0000000000001155.
3. Leung SM, et al. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Med J. 2015 Aug 14. doi: 10.12809/hkmj144310. [Epub ahead of print]
4. Radcliff K, Hilibrand A, Lurie JD, Tosteson TD, Delasotta L, Rihn J, Zhao W, Vaccaro A, Albert TJ, Weinstein JN. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation: A Subgroup Analysis of the SPORT Trial J Bone Joint Surg Am. 2012 Jun 27. doi: 10.2106/JBJS.K.00341. [Epub ahead of print]
5. Epstein NE The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature Spine: 2013;3:74-93 6. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am. 2010 Nov;21(4):825-34.
A new study published by Dedes V et al. called Effectiveness and Safety of Shockwave Therapy in Tendinopathies (Mater Sociomed. 2018 Jun;30(2):131-146. doi: 10.5455/msm.2018.30.141-146) concluded:
“Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice (for treating tendinopathies) because of its effectiveness and safety.”
People suffering from tendinopathies exhibit reduced mobility due to the pain caused by the movement of the tendons involved. Shockwave therapy is non-invasive, simple, fast and safe for tendon injuries.
Shockwave therapy is especially helpful in the treatment of elbow tendinopathy, Achilles tendinopathy, plantar fasciitis and rotator cuff tendinopathy.
It can help reduce pain, improve function and quality of life.
Call 310-444-9393 for an appointment
If the thought of a potential flare up of chronic pain has you worried, a new service now offered at Dr. Jeffrey Tucker’s office in West Los Angeles might be able to help.
Dr. Tucker notes “As patients have become more educated and empowered, they’ve started to realize a pill isn’t always the solution, and likewise, many physicians realize alternative therapies like magnet therapy can be of great benefit to patients”
In addition to the proven benefits of magnet therapy, including relief from chronic pain, sports injuries, elevated mood and better sleep, magnet therapy is a natural remedy that allows the body to heal itself.
Dr. Tucker has embraced alternative treatment options for sports injuries such as laser therapy, shockwave, SCENAR and deep muscle stimulation. “My mission is to help people live the healthiest lives possible, and that means offering a number of services and treatment options that can help reduce the need for expensive medical care”.
Osteitis pubis is a painful overuse injury of the pubic symphysis and the surrounding bone area. This is typically found in athletes whose sports involve kicking, rapid accelerations, decelerations, and abrupt directional changes. This is often seen in soccer, rugby, football players, and distance runners with complaints of groin pain.1
Specific complaints include anterior and/or medial groin pain. Some patients also point to the lower abdominal area, adductor muscles, inguinal region, perineal area, and/or scrotal area and describe “pain”. Symptoms can be severe and can limit participation in sports until proper treatment is instituted.
TREATMENT FOR GROIN, HIP, AND PELVIC PAIN
Get a good evaluation by a doctor who understands sports injuries. I treat a lot of persistent groin pain due to chronic repetitive trauma and overuse stress. If it involves the pelvic joints, the muscles, and/or tendons a Chiropractor is a good first choice.
I usually find insertional tendinopathy accompanied with pubic symphysis irritation, so Shockwave is a good first line of therapy. I am the only practitioner we know of who has 3 different types of shockwave machines.
Prolotherapy and Platelet Rich Plasma Therapy may be a useful treatment for this diagnosis as well.2,3 In some cases of advanced deterioration I am hearing players using Stem Cells. We have many patients combining treatments like laser, shockwave, and injections to accelerate healing.
- Scholten PM, Massimi S, Dahmen N, Diamond J, Wyss J. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R. 2015 Jan;7(1):79-83. doi: 10.1016/j.pmrj.2014.08.943. Epub 2014 Aug 16.
- Beatty T. Groin Pain Osteitis pubis in athletes. Curr Sports Med Rep. 2012 Mar-Apr;11(2):96-8. Groin Pain Osteitis pubis citations
- Topol GA, Reeves KD: Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series. Am J Phys Med Rehabil 2008;87
Serious athletes come in to my office with complaints of back pain and/or hip pain. Their medical doctors have recommended steroids and/or cortisone injections, but these patients want to try something else before risky shots or pills. These patients are savvy, they think long term recovery. They want what the pro-athletes get! They usually already had the MRI, and they have tried to work it through on their own. They want my advice because they heard I take the time to help them figure out the cause of the pain. The question I need to figure out “Is your movement pattern irritating a disc problem, ligaments, or the muscle system?” Then we figure out the best treatment plan together.
Patients are hearing about Platelet-Rich Plasma Therapy (PRP), stem-cell regeneration therapy, shockwave therapy, laser, Deep Muscle Stimulator, and other “locker room” treatments for the pro’s. I organized my office so the average person can get what the pro’s get. I use 3 types of shockwave or pulse therapy, and 2 types of laser that create effective treatments for disc injuries, muscle pain, and spinal ligament instability.
Shockwave therapy, laser therapy and the proper movement therapy stimulates the regeneration of the discs. ligaments and muscles directly. Yes, decreased disc height can be changed and scar tissue can be broken up. As with any treatment, the earlier and sooner the treatment intervention begins the better the outcome.
I constantly look for research that helps recovery in sports injuries and therapies that offer effective therapeutic results.
If you want to try therapies that the top pro athletes are getting to alleviate back pain and hip pain call my office at 310-444-9393.
Many patients come in to see me for knee pain. These are patients looking for non-surgical options for meniscus injuries, patellofemoral syndrome pain, knee osteoarthritis and ligament injuries. Most people are familiar with arthroscopic surgical procedures and they are hearing about stem cell therapy for joints. But most people have not yet heard about extracorporal pulse attenuating therapy (EPAT), acoustic pulse therapy, radial pulse therapy or shockwave therapy. These are alternative non-invasive regenerative therapies for knee damage.
Most doctors still believe that the inner knee meniscus cannot heal because it has a poor network of blood vessels and blood supply. But newer research is discovering the meniscus is always trying to heal itself.
How does acoustic shockwave therapy help a meniscus regenerate?
1. Re-establish the normal outer soft-tissue textures. If you are swollen shockwave helps get it resolved.
2. It can aid in bone and joint alignment (ankle, femoral, tibial and hips). This may require a skilled Chiropractor.
3. Restore normal range of motion.
4. Shockwave therapies such as the Zimmer EnPuls, PiezoWave Acoustic therapy and the Storz EPAT are used to stimulate the growth of new meniscus tissue and help your own stem cells to do the job of repair. A shockwave sales rep was in my office two weeks ago and commented that I may be the only doctor in the Country who has all 3 top shockwave deices.
Please call 310-444-9393 for an appointment
- Arthroscopy Journal, doctors concluded that PRP injections are a viable treatment for knee osteoarthritis and should be considered in patients with knee osteoarthritis.6 Studies like these add to the accumulating evidence that PRP can halt and reverse meniscus degeneration.7,8
- J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472 they confirm that stem cell therapy stimulates the regeneration of meniscal tissue. Specifically with regard to post-meniscectomy meniscus growth (with stem cells).9 This means we can use the PIEZOWAVE and EnPuls to stimulate regeneration even after surgery.
- Doctors at the University of Iowa found that stem cells and cartilage cells could be influenced to migrate to the site of “white-zone” where the most difficult meniscus tears are. I use Laser and PiezoWave and EnPuls to do just that!
- I do think stimulating the tissues with PiezoWave and EnPuls shockwave can promote regeneration and is a promising new strategy in meniscus repair.10
- Stimulating stem cell based strategies for meniscus tissue is a fundamental role in meniscal regeneration. 11
- Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
- Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, Shieh YH, Wu CH, Deng WP. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011 Sep;32(25):5847-54. Epub 2011 May 25.
- van Buul GM, et al. Platelet-Rich Plasma Releasate Inhibits Inflammatory Processes in Osteoarthritic Chondrocytes. Am J Sports Med. 2011 Nov;39(11):2362-70. Epub 2011 Aug 19.
- Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
- McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42. PUBMED Meniscus Growth With Stem Cells
Dr. Jeffrey Tucker, a sports medicine chiropractor and patent holder on a cannabis cream process says, “Cannabis creams help achy joints and sore muscles be less painful. Getting old doesn’t have to be the end of high quality performances.”
Dr. Tucker says “Continue to train at a level of intensity where you feel pushed every now and then and, stay motivated to be consistent with your workouts. Don’t overdo it each and every workout, we want you to remain injury-free.” Tucker finds that when an older person gets an injury it could take longer to recover and they lose ground in their training. Tucker recommends cannabis creams to his patients for sore joints and muscles.
By the time we are forty Tucker feels we should know our exercise capacity, in other words, the mileage you can walk or run without an injury, or the amount of weight you can lift without needing extra recovery days. Tucker also suggests men get there testosterone checked at age 30 so they have a base line for later in life. We can offer men natural supplements to help boost testosterone if they need it later in life. Estrogen dips dramatically after menopause but estrogen has a number of positive effects on workout performance, including boosting of cardiac output (amount of blood pumped from the heart per minute) and a preservation of bone density. Tucker notes that he has patients that use testosterone and estrogen with cannabis creams. Female athletes who don’t opt for postmenopausal estrogen-replacement therapy might suffer from weaker cardiac action, a higher incidence of stress fractures and greater overall rates of injury, all of which could downgrade performance and aerobic capacity by making consistent training more difficult. Estrogen-replacement therapy should be considered and women can determine how estrogen influences their performances over time.
Tucker encourages exercise intensity and says it is a greater producer of fitness than mileage. Therefore increasing the intensity and recovery and cutting back on the miles is the way to go! It’s easy to do! Here’s an example:
* Running six times a week for a total of 30 miles with 3 miles at a fast pace, can be changed to,
* Running five days a week for 25 miles with 4 miles at a fast pace.
The extra day recovery and less miles will decrease the risk of injury but increasing pace for an extra mile improves V02max, running economy, and competitive performances.
The idea of adding in more recovery seems to fit well with older athletes’ training needs. Tucker is a big advocate of cross training (swimming, walking, running, cycling, step machines, and weight training) and says his favorite exercises these days is isometrics and the Turkish Get Up. Everyone agrees that strength training is important for people over the age of 50 – when atrophy (wasting) of muscle and skeletal tissue begins to become a problem.
Final note: ALWAYS consult your doctor before embarking on a program of cannabis and strenuous exercise.
In the Journal of Knee Surgery doctors from the Department of Orthopaedic Surgery, University of Pittsburgh had this to say about regenerative medicine:
- Biologic agents (stem cells and blood platelets or PRP therapy) are gaining popularity in the management of bony and soft tissue conditions about the knee. However, what they don’t say is that these therapies have risks! I encourage patient’s to start with non-invasive, non-operative therapy in the athletic and aging population.
I agree that Platelet-rich plasma (PRP) and stem cells have shown promise in the treatment of various conditions. I see improved outcomes following shockwave therapy and or laser therapy in early osteoarthritis of the knee, as well as in chronic patellar tendinopathy conditions. My feeling is to start with non-invasive regenerative therapies such as laser and shockwave and then go with injections on an as-needed basis.
- There is evidence that supports PRP in the augmentation of anterior cruciate ligament (ACL) reconstruction. But there is research for shockwave too. Shockwave therapy research exists for collateral ligament and meniscal injuries as well. I’m especially excited about the results we see with knee osteoarthritis using the laser and shockwave devices.
- …As the volume and quality of evidence continue to grow, biologic agents are poised to become an integral component of comprehensive patient care throughout all orthopedic specialties. (2) I completely agree with this statement.
- The use of stem cells as a biological approach to treat cartilage lesions and osteoarthritis has widely increased. The same is true for Laser and Shockwave therapy.
- Different sources have been investigated for clinical application, especially targeting knee or ankle cartilage disease.(3) I continue to be especially excited about the results we are seeing with the shockwave therapy and laser combination treatment.
I think athletes or high activity people with joint pain need to learn about the choices between stem cell injections and non-invasive laser and shockwave treatments to restore damaged cartilage, and also to act as a protector against future deterioration of the knee joint.
1 Kopka M, Bradley JP. The Use of Biologic Agents in Athletes with Knee Injuries. J Knee Surg. 2016 May 20. [Epub ahead of print]
2 Filardo G, Perdisa F, Roffi A, Marcacci M, Kon E. Stem cells in articular cartilage regeneration. Journal of Orthopaedic Surgery and Research. 2016;11:42. doi:10.1186/s13018-016-0378-x.
3 Yang X, Zhu TY, Wen LC, Cao YP1, Liu C, Cui YP, Meng ZC, Liu H. Intraarticular Injection of Allogenic Mesenchymal Stem Cells has a Protective Role for the Osteoarthritis. Chin Med J (Engl). 2015 20th Sep;128(18):2516-2523. doi: 10.4103/0366-6999.164981.
- Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update.Open Access Journal of Sports Medicine. 2016;7:21-32. doi:10.2147/OAJSM.S72332.