🚨The MSK Playbook: Meniscus Edition 🚨

A thread 🧵 on treatment options:

💉 Injections
🧬OrthoBiologics
🌱 Dietary supplements
🔂 Repair
✂️ Meniscectomy
🦵 Transplants

1/X

@Mykneesurgeon

#MSKPlaybook #MeniscusTear
blogs.bmj.com/bjsm/?p=10968

The usual 💉contenders🕴️‍♂️

💉 Steroid
- Effective in reducing pain / synovitis
- 🗣️ discus dose / frequency - to ⬇️chondrotoxicity

💉 Viscosupplementation
- May improve pain and function
- Consider if patients want to avoid steroid burden

ncbi.nlm.nih.gov/pmc/articles/P…

2/x

Is #PRP beneficial for tissue repair / regeneration ? 💉

Evidence suggests YES ✅

📣 Significant variations in outcome by preparation🩸 & site 🗺️

📣High ⏫ platelet concentration better outcome

✨ Improvement in pain and function

Jeffrey Peng, MD

ncbi.nlm.nih.gov/pmc/articles/P…

3/x

📣Patient commonly about about supplements ?

Small studies (OA), looking at:

🌱 Bowsellia Serrata
🫚 Turmeric

Evidence suggests:
⬇️ knee pain
⬇️ reduce stiffness
⏫ improve joint function

‼️risk of bias
⚖️ Compare 2 known side effects of alternative meds

Jeffrey Peng, MD

4/x

Meniscectomy is generally indicated if repair is likely to fail. Some important factors are:

🕰️ age 50+
🦵 mechanical symptoms
🩸poor vascular supply

Patients should be informed of increased risk of:

🦴 knee OA
🦿functional limitations

oarsijournal.com/article/S1063-…

5/x

🧬 Autologous chondrocyte therapy

Indications:
📏 lesion >2cm
🚫 no previous meniscal surgery
🦴 minimal OA
🦵 stable joint

Has been shown to help patients return to pre-injury sporting levels

Arman Memarzadeh

ncbi.nlm.nih.gov/pmc/articles/P…

6/x

Meniscal transplant may be considered if:

‼️ Post-meniscectomy pain >6mo
🕰️ age 50+
📐 BMI >35
👍 joint alignment and stability
🩻 minimal radiological OA

An emerging therapy, keep an eye out for the current METEOR2 trial 👀

Arman Memarzadeh

warwick.ac.uk/fac/sci/med/re…

A massive thank you to the team for putting this one together.

Ryan on his first Sports medicine project!

and for their support

Arman Memarzadeh Jeffrey Peng, MD RH Imran Lasker

#MSKplaybook British Journal of Sports Medicine (BJSM) BMJ Open Sport & Exercise Medicine basem_uk