Meniscus tears are very common and come in a variety of types and occur in different zones of the knee. The peripheral part of the meniscus is known as the red-red zone because it has the best blood supply. The central portion is known as the red-white zone becuase of its moderate blood supply and the white-white zone has a poor blood supply. Typically, tears in this white-white zone are surgical resected because of their poor healing capacity. Newer mechanical techniques are being developed to suture these tears together. And, now biologic enhancement with platelet-rich plasma has been formally proposed as a way to improve the chances of such a tear healing. Data will need to be developed but it is clear we will need both better devices to suture the meniscus AND biologic stimulation in order for white-white tears to heal.
See video below about meniscus tears and the abstract of an article proposing PRP to help heal meniscus tears.
A novel hypothesis: The application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears.
Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH.
Med Sci Monit. 2012 Aug 1;18(8):HY47-50.
The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal. Basal research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.
SourceDepartment of Orthopaedics, Xiangya Hospital, Central South University, ChangSha, Hunan, China and Department of Orthopaedics, First People's Hospital of ShaoYang City, ShaoYang, Hunan, China.