Your meniscus is important.
Two pads of cartilage wedged between your shin and thigh bones, the meniscus works to absorb shock, distribute load and provide stabilization in and around the knee. Yet meniscal tears are dubbed "extremely common knee injuries" by the American Academy of Orthopaedic Surgeons, and the most common treatment for these tears involves removing some or all of the meniscus via a procedure known as a meniscectomy. But removing the knee's main shock absorber creates some serious problems, particularly for athletes and active people. Removing just 20% of the meniscus tissue can cause a force concentration increase of 350% on the tibia.
"Over the years, we've learned that when a surgeon takes out a torn meniscus, depending on the location of the tear, the increase in force concentration in the knee goes up dramatically. If you take out a small part of the posterior part of the meniscus cartilage, you've dramatically narrowed the area of contact in the knee, which increases the force. People with meniscectomies go on to develop arthritis over the next period of years," says Dr. Kevin Stone, orthopedic surgeon and founder of The Stone Clinic. "There are about 1.5 million knee arthroscopies in the United Sates each year, and about a million of those involve removal of part or all of the meniscus tissue. And only 10% are ever repaired by the surgeon, and only 0.2% of those are ever replaced with a meniscus allograft. So it's still very uncommonly done, which is really a shame. Because we know it can be done."
Stone is the man we can thank for that. After suffering a knee injury as a college soccer player at Harvard, he had his meniscus removed. As his career in medicine began to take shape, he took interest in finding better ways to replace and repair torn meniscus at the encouragement of his mentor, Dr. Richard Steadman. Stone went on to father innovations like the collagen meniscus implant and the three-tunnel technique of meniscus transplantation, and his clinic specializes in meniscus-related procedures.
Tracy Porter, the 31-year-old cornerback who sealed the New Orleans Saints' Super Bowl XLIV victory with his pick six of Peyton Manning, has long suffered from debilitating knee pain related to the removal of his meniscus. After utilizing various quick fixes over the years which didn't address the root of the problem, Porter visited The Stone Clinic in late 2017. There, he received a meniscus allograft (a procedure where the meniscus of a donor was inserted into his knee) along with articular cartilage paste grafting. Injections of amniotic stem cells and growth factors were used to accelerate the healing process.
"We didn't get to see Tracy until he'd already developed bone-on-bone arthritis. The articular cartilage had worn off so much that the raw ends of the tibia and the femur are exposed," Stone says. Seven months out of surgery, Porter is now nearly fully recovered and itching to continue his NFL career:
"In the past, people were told that their torn meniscus cartilage was not repairable. Either because it had poor blood supply, it was degenerative, etc. But what we're trying to push patients and people to do is to ask their surgeons to try harder to repair it. Because what we found is removing the tissue is devastating to the joint. So it's worth it to adopt some of the newer technologies for making complex tears actually heal. That's either better suturing techniques, stimulating new blood supply, adding growth factors and adding stem cells, using collagen scaffolds to help regenerate areas that are missing, all these little improvements can help take a tissue that was once thought could just be removed with impunity and save it," Stone says. "I would encourage patients to push their physicians to adopt newer techniques or to find doctors who are really interested in saving that cartilage."
Photo Credit: tommaso79/iStock
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