Despite the predominance of knee arthritis in the US, there are few good options for patients hoping to relieve pain & improve function. Physical therapy can help to increase muscle tone to the quadriceps muscles to reduce excessive workload on the joint. Also inflexible muscles can be stretched to restore the normal kinetic chain to reduce pain & prevent further aggravation of symptoms. Orthotics & braces may decrease the mechanical forces that are adding stress on the joint. However these treatments will not influence the underlying inner cartilage defects and biochemical environment.
Knee arthroscopies are quite popular and certainly have a role in particular cases including severe meniscus and ACL tears. However in a recent study in the New England Journal of Medicine, there was no demonstrable benefit of knee arthroscopies for moderate to severe knee arthritis compared to physcial therapy and medications. 92 surgical patients and 86 controls (Physical therapy & medications) were compared over 2 years.
http://content.nejm.org/cgi/content/short/359/11/1097
The article was reviewed recently in the LA Times.
http://www.latimes.com/news/nationworld/nation/la-sci-knee11-2008sep11,0,1198164.story
This article should raise awareness that we need to develop innovative approaches to maximize healing in an increasingly active population. Over 27 million Americans have osteoarthritis.
We are performing Platelet Rich Plasma Injection Grafts in hip and knee arthritis with encouraging results. The field of orthobiologics is rapidly growing and promises to deliver new approaches to treating tendon and cartilage disorders. In my practice we are treating meniscal tears immediately to accelerate healing. Many patients do not need an arthrocsopy after 2 months of the PRP graft and physical therapy. By potentially avoiding surgical meniscal repairs, we hope to reduce the incidence of subsequent arthritis. We are conducting studies to further refine the treatment to achieve a maximal result.
We are beginning clinical trials of Platelet Rich Plasma (PRP) injections in patients suffering with knee arthritis. There is an increasing “boomer” population with earlier knee arthritis as a result from prior trauma including meniscal tears & arthroscopies with scarring and cartilage loss etc. This phenomenon is termed “chondropenia.” We are searching for non-invasive alternatives to knee replacements in these active individuals.
A European Study from Oct 07′ by Anitua & Sanchez et al. injected 10 osteoarthritic patients with PRP & studied the cellular effects of PRP. They found an increase in hyaluronic acid concentration, balancing cell proliferation (angiogenesis). However, there was no effect on IL 1-B, which generally plays a role in osteoarthritis. This information gives us insight into how PRP may potentially benefit arthritis.
