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● Curing Chronic Pain
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● Turning to Prolotherapy
● Prolotherapy and Chronic Pain
● The Proof Prolotherapy is Working?
● Prolotherapy: Creating Collagen
● How To Support Treatment

 

The Journal of Prolotherapy

Table of Contents of all issues of The Journal of Prolotherapy

Prolotherapy After Arthroscopy
Ross Hauser, M.D.
I cannot tell you how often I ask my patients why they received an Arthroscopy and what the post surgery report showed, and the answer is so often “I don’t know.” Unfortunately, people agree to procedures, surgeries, or medications without really knowing the reasons for them.

Here we will look at a patients’ actual arthroscopy reports with my opinion regarding what they need to look for and questions they need to find out.

Let’s look at this very short arthroscopy report from a prominent Chicago Hospital (consistently voted among the best hospitals in the country) on our patient Barb.

Surgery Note:
Procedure done: Left knee arthroscopy and partial medial meniscectomy and debridement of chondromalacia findings, severe grade 4 chondromalacia of the medial compartment.

Findings:
Mild patellofemoral changes were seen. Debridement was carried out. Partial meniscectomy ensued. There was a root tear of the posterior horn and grooving of the medial femoral condyle which was debrided. Completion there was improvement of the meniscal instability. ACL, PCL, and lateral compartment were essentially unremarkable. She tolerated the procedure very well and was discharged home.

As you can see from the arthroscopy report, Barb has severe grade 4 chondromalacia and it is clear that the orthopedist removed part of her meniscus. The report does not state how much of the meniscus was removed, so please ask the surgeon how much of the meniscus was removed and exactly where it was removed. Also note Barb’s meniscal instability was improved, yet it is still present? So what do you think is going to happen to Barb long term? I am certain that Barb will experience even more aggressive medial compartment osteoarthritis, resulting in an eventual knee replacement surgery. Fortunately a better solution besides long term chronic medial knee pain leading to a knee replacement and possible disability is available!

Let’s look at each of Barb’s problems present on this short arthroscopy report and see what she can do about it.

Grade 4 Chondromalacia
Before the arthroscopy, Barb had a grade 4 chondromalacia; and after arthroscopy it remained the same!

Nothing has changed except the orthopedist shaved some of the Cartilage underneath her knee cap, so she has even less cartilage than she had before the arthroscopy. Is this a good thing? This is actually a bad thing. While she may feel better for a short while, this procedure probably aged her knee 15 years. She will eventually start experiencing pain. Let’s think about this.

The procedure was done in February 2009. She came to see a Prolotherapist (me) in early 2010, so she had pain relief for less than a year.

In essence, the only thing that the procedure accomplished as it relates to her chondromalacia was accelerate the aging of her knee.

Chondromalacia refers to cartilage deterioration and Chondromalacia Patella (CP) means cartilage deterioration beneath (underside) the knee cap. It can be graded on a scale from 0 to 4, and it generally goes as follows:

Grade 0: healthy cartilage
Grade 1: the cartilage has some soft spots
Grade 2: minor cartilage tears are visible
Grade 3: deep lesions in the cartilage that are more than 50% of the cartilage layer
Grade 4: the cartilage tear goes all the way to the bone

Arthroscopy reports sometimes outline the size of the defect and the measurement will be reported. The arthroscopic treatment of a grade 4 lesion typically involves scraping or removal of the lesion.

The treatment that Barb needs now is Prolotherapy to stimulate cartilage repair. While the scientific data is still accumulating in the case for Prolotherapy stimulating cartilage repair, because we so many success stories with chondromalacia, (pain not only remits, but function, clicking, and grinding improves), we deduce that cartilage repair must be happening. The bottom line with Barb is that she will need Prolotherapy for her condition. We recommend she also perform exercises that stimulate joint fluid production, such as bicycling (range of motion without pounding).

Meniscal Instability
Barb had meniscal instability before the arthroscopy now she has it after the surgery. The surgeon says it improved. Let me ask you this, “how can removing meniscal tissue improve the real stability of the knee?” Do I suspect right after surgery she experienced less noise in her knee? Most likely her answer was “yes.” Will having less meniscal tissue improve or hurt her knee joint stability long term? Absolutely, it will hurt it. The bottom line is Barb needs Hackett-Hemwall Prolotherapy to improve her knee instability. Fortunately for Barb, Prolotherapy is a great alternative treatment for degenerated and torn menisci. Because her meniscus is involved she will most likely receive Prolotherapy with human growth hormone or another strong Prolotherapy solution.

Partial Medial Meniscectomy
Typically a partial meniscectomy means that Barb now has 60-70% of her meniscus remaining. Would having less of her meniscus help or hurt the knee stability? Would this make development of severe degenerative arthritis on the medial side of her knee more or less likely? I think more likely. The bottom line here is Barb should have come to the office to receive Hackett-Hemwall Prolotherapy before the arthroscopy, but she surely needs it after the arthroscopy as well! Because she has had an arthroscopy, she will most likely need more, not less, Prolotherapy visits! If she does not receive Prolotherapy, most likely she will end up with one or even bilateral knee replacements. Barb did not want this and decided to receive Prolotherapy. She was seen once per month for six months. She is following a natural healing regime consisting of taking pro-healing supplements, achieving a good healthy weight, and exercises to help her build muscle and get into an easily doable exercise routine. Hopefully we won’t be hearing from Barb anymore. Shouldn’t that be the goal of every physician? In the end, her knee should be stronger and healthier and so should the rest of her!