Marc Darrow MD,JD

A Baker’s cyst can be a very confusing knee ailment for some patients. First, it has nothing to do with being a baker, but rather it was named for the surgeon who first described it, Dr. William Baker. Secondly, often it is not explained by the attending physician that the Baker’s cyst itself is not the cause of the patient’s knee problems, but rather a symptom of knee instability and developing osteoarthritis.

Typically a patient will call or email our office asking for help for the problems of Baker’s Cyst. Some of these patients have had the cyst drained before and it has returned. Most tell us that the orthopedist who drained the cyst the first or even second time warned them that the cyst will return and that they will need some type of knee surgery to prevent it from coming back.

One of the reasons it keeps coming back is because the person’s knee has a lot of damage. Here is an example of an email I will get:

Hello Dr Darrow. I have been having pain in my knee. I have been to several doctors and have had an MRI. The MRI says I have a torn meniscus. This is causing me a lot of pain when I walk. A few months ago, I had a cortisone injection in my knee. For a while, my knee felt great. But now that pain is back. I have been told to consider a meniscus surgery by one doctor and a  full knee replacement by another. I also has a Baker’s cyst that has now grown much larger and it causing me great discomfort. I have been told I can drain it, but it will just keep coming back.

Read More

Marc Darrow MD,JD

The majority of total knee replacement patients are overweight or obese and physical activity levels and weight do not appear to change in a high proportion of patients after knee replacement

I was reading a study in the journal Disability and rehabilitation.(1) It was led by Northwestern University. It talked about the weight problems people have after they had total knee replacement and the continued problems the patients had in the inability to losing weight despite the new knee.

This study may come as a surprise to many who think that a knee replacement will help them shed pounds put on by the immobilization caused by their long battle with degenerative knee disease and knee pain.

I want to give some of the learning points here directly from the research so you can get the story directly from the people in the study.

Read More

Marc Darrow MD,JD

Knee pain is one of the most common problems we see at our institute. When it comes to a more active individual, there can be many knee pain causes. One possible cause is Iliotibial band syndrome or more often referred to as IT band syndrome. It is also commonly referred to by patients as “pain on the outside of my knee.” The people I see with this problem are usually long distance runners and those who are starting up a very aggressive exercise routine and they overdo it.

The pain of IT band syndrome is very familiar to those who have it and those who treat it. It is usually located not only on the outside of the knee but on the length of the the outer thigh from hip to knee. What causes this pain? As just mentioned, overuse injury especially in distance running and over doing it when you start a new exercise program. As you bend your knee, the IT band at its attachment at the shin bone can impinge or trap soft tissue beneath it causing pain. The friction of rubbing against this soft tissue can also thin out and wear away at the Iliotibial band itself.

Read More

Marc Darrow MD,JD

In this article I will present research on the use of stem cell therapy treatments for knee osteoarthritis. I will discuss published research by the Darrow Stem Cell Institute on the use of bone marrow derived stem cells. I also invite you to ask your questions using the form below about your knee pain.

Stem Cells Instead of Knee Replacement?

Over the years it became clear to many researchers that knee replacement had to be redefined and disputed as the gold standard of knee osteoarthritis, “bone-on-bone,” treatment. Other doctors, however, had already decided to abandon joint replacement and explore growing tissue as the new standard of care. The thinking was simple—why remove bone and tissue when these could be repaired and rejuvenated?
Read More

Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

Understanding the possible complications of corticosteroid injections

Here are some of the most recent papers reminding doctors about the possible side effects of corticosteroids:

A January 2021 (1) study issued this statement:

“The current evidence would suggest that the use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning. These benefits generally last several weeks without long-term effectiveness. In addition to its limited short-term effectiveness, there are multiple potential adverse effects including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections.”

Read More

Marc Darrow MD,JD

In his 2011 paper published in the International journal of general medicine, (1) Christian Schneider, MD, Ph.D., explains Traumeel injections as an alternative to Non-Steroidal Anti-Inflammatory Medicines. He describes the treatment in this way.

“Traumeel is a fixed combination of diluted plant and mineral extracts. It has been available over the counter in Germany for over 60 years and in Austria for over 40 years, and is currently available in approximately 50 countries, including the USA. The combination is currently used to treat acute musculoskeletal injuries, such as sprains and traumatic injuries, and as supportive therapy in pain and inflammation of the musculoskeletal system. It can be used in the form of tablets, drops, injection solution, ointment, and gel.

The ingredients of Traumeel have been used for many years for therapeutic purposes, such as for pain (Atropa belladonna), inflammation (Echinacea), bruising (Arnica montana), wound healing (Matricaria recutita, Calendula officinalis), bleeding (Achillea millefolium), edema (Mercurius solubilis), and infections (Hepar sulfuris). Based on such observations, Traumeel was developed by the German physician, Dr Hans-Heinrich Reckeweg in the 1930s; he combined botanical and mineral substances to produce this natural medicine to treat musculoskeletal injuries and inflammation.”

As described on the website drugs.com, “Traumeel® Injection Solution is an anti-inflammatory, analgesic, anti-edematous, anti-exudative combination formulation of 12 botanical ingredients, 1 mineral substance and 1 animal derived substance. Traumeel® Injection Solution is officially classified as a homeopathic combination drug.”

The purpose of Traumeel injections is to be an alternative to Non-Steroidal Anti-Inflammatory Medications and Cortisone

The goal of Traumeel is to act as an anti-inflammatory and be a safe alternative to NSAIDs and Cortisone

A study published in 2017 in the European Journal of Integrative Medicine (2) showed that Traumeel injections could be beneficial in pain and inflammation reduction in patients with knee osteoarthritis who fail to respond to standard-of-care pain treatments, (anti-inflammatories and cortisone)  who are at risk due to the side-effects these medications cause. However, further research is needed to determine if Traumeel injections can slow and/or prevent progression of knee osteoarthritis.

1 Schneider C. Traumeel – an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. International Journal of General Medicine. 2011;4:225-234. doi:10.2147/IJGM.S16709.

2 Lozada CJ, del Rio E, Reitberg DP, Smith RA, Kahn CB, Moskowitz RW. A double-blind, randomized, saline-controlled study of the efficacy and safety of co-administered intra-articular injections of Tr14 and Ze14 for treatment of painful osteoarthritis of the knee: The MOZArT trial. European Journal of Integrative Medicine. 2017 Aug 1;13:54-63.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References:

1 Garcia JB, Rodrigues DP, Leite DR, do Nascimento Câmara S, da Silva Martins K, de Moraes ÉB. Clinical evaluation of the post-laminectomy syndrome in public hospitals in the city of São Luís, Brazil. BMC research notes. 2015 Dec;8(1):1-7.
2 Bailey JC, Kurklinsky S, Sletten CD, Osborne MD. The effectiveness of an intensive interdisciplinary pain rehabilitation program in the treatment of post-laminectomy syndrome in patients who have failed spinal cord stimulation. Pain medicine. 2018 Feb 1;19(2):385-92.

Marc Darrow MD,JD

Many patients we see, have been researching their options in treating their chronic knee pain. These people come to see us because they are exploring non-surgical alternatives and have investigated various forms of regenerative medicine techniques. This includes the use of their own blood platelets as a healing solution, (more commonly referred to as Platelet Rich Plasma Therapy) or stem cell therapy which we will discuss below in relation to hyaluronic acid injections.

Many of these patients, perhaps including yourself as well, have had prior discussion with doctors about hyaluronic acid injections. These injections can provide a good amount of pain relief, temporarily. But ultimately they do not regenerate tissue and they are only a stop gap measure to delaying inevitable joint replacement.

• Hyaluronic acid is a naturally occurring substance that is a major component of the protective synovial fluid that surrounds the knee. In its natural form it is also a key component of wound healing. In its processed form used for injection purposes, hyaluronic acid is NOT a key healing component as attested to by suggestions and recommendations that these injections are stop gaps until knee replacement can be performed.

Read More

Marc Darrow MD,JD

As we see more patients looking for alternatives to knee surgery who are being pain managed along with anti-inflammatory medications or NSAIDs (non-steroidal anti-inflammatory medications), and painkillers, one question they all seem to have is: “What are these medications doing to my knees.” The simple answer is, they are destroying your knees, and the research to support this goes back a long way. In fact it was in 1993 that Dr. MJ Shield wrote in the European journal of rheumatology and inflammation (1) that “Growing evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs), while able to alleviate inflammation, may damage articular cartilage.” How? By preventing the growth of new cartilage.

Nothing has changed in 27 years. These medications are continually shown to accelerate knee damage.

But, NSAIDS can make knees feel better in the short-term, and in the long-term in greater doses. In the over 20 years that we have treated patients with knee problems, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.

This simple statement, that inflammation is Nature’s way of healing has been the subject of decades long debate in the medical community. Many doctors argue that you have to shut down inflammation to prevent more damage. For decades, cortisone became the weapon of choice. Cortisone as doctors would later find out, would destroy joints and contributed to the great surge in joint replacement surgeries.

Read More

Marc Darrow MD,JD

Research: Realistically 9 to 30% of patients do not return to work after knee replacement

Before I begin, let me state that some people get great benefits from total or partial knee replacement. But not everyone is convinced it will be of great benefit to them or realizes the expectation they had going into knee replacement that they would come out with a pain-free knee with increased mobility. Some people are willing to wait months for their knee replacement, some people try to avoid the knee replacement because they have a lot of concerns about lengthy rehabilitation, down time, ability to return to work or some type of sport and the possibility that something can go wrong. Some people get the knee replacement because they think everything will go right.

“Not what I expected”

In January 2020,(1) doctors in Sweden produced an ambitious study to try to understand why a patient was not happy with their knee replacement when there were no obvious reasons that they should be. Especially when the surgery went without complication and was considered successful.

Here are some of the problems the patient reported and how it hindered them in their daily routine or trying to get back to work. Read More

Marc Darrow MD,JD

Many people today are exploring meniscus surgery alternatives. One reason is that they may be on a waiting list to get the surgery. Another is that they have been doing research and are not absolutely convinced that meniscus surgery will help them anyway.

Meniscus repair surgery, opinion as of 2020: “in the knees without the meniscus, the impact and load are three times higher.”

A 2020 study in The archives of bone and joint surgery (1) offers an updated opinion on meniscus surgery. Here are some points brought up by the surgeon researchers.

The knee needs its meniscus:

• “The menisci (meniscus) perform many essential biomechanical functions. These functions include load transmission, shock absorption, stability, nutrition, joint lubrication, and proprioception (the sense of knee in 3D space). They also serve to decrease contact stress and increase contact area and joint congruency. The knee would be deprived of all these functions if the meniscus removed. Therefore, in the knees without the meniscus, the impact and load are three times higher.”

Surgical repair? Patients should be warned the return to sport should be delayed for up to 6 months

• “Rehabilitation after meniscal repair is slower and different from rehabilitation after meniscectomy. The physiotherapist and surgeon should respect the slow process of biological healing of the meniscus and therefore they need to be careful with the rehabilitation program especially in active flexion. The return to sport should be delayed for up to 6 months; however, 86 to 91% of patients could back to play. It is also crucial for the patient to know there is 8 to 20% risk of failure and re-operation, however, the long term outcome of meniscal repair is better than partial meniscectomy because of chondroprotective action of meniscus.”

Meniscus repair is not a small surgery without complication.

• “Meniscus repair is not a small surgery without complication. It is technically challenging and has a steep learning curve. General complications of arthroscopy such as venous thromboembolism, infection and vascular injury could occur. Specific complication including nerve injuries, ligamentous injury, iatrogenic cartilage lesions, and poor suture techniques can happen during meniscal repair. The surgeon should depict and accept the eventual complications and address them as rapidly as possible. It is also important to form patients about potential complications.”

Failure of meniscal repair occur in up to 25 % of patients

• “Failure of meniscal repair occur in up to 25 % of patients. Failures in the first six months of surgery are usually related to technical issues during repair, while failures between 6 and 24 months are indicating poor healing process. Failure later than 2 years of repair show retear or degenerative processes in the meniscus. . . Secondary meniscectomy is a treatment for failed meniscal repair. The amount of meniscal resection is less in 35% of cases, which shows partial healing of the meniscus. Revision of meniscal repair is another option and two small series reported 25 to 33% failure rate for the procedure.”.

Meniscus transplant surgery – “Meniscal allograft transplantation for symptomatic knees after meniscectomy decreases pain and often improves function, but it does not replicate a normal meniscus”

Sometimes I will get an email or phone call asking me about meniscus transplants. The person who asks me has been told that they have a bone on bone situation in their knee. What I find interesting is that many of these people are active people. They maybe having a little trouble running or jogging but they can ride their bicycles without issue, they are even skiing, and they can walk okay. So this is a knee that is functioning and moving. But, the person who contacts me says that they have be recommended to a meniscus transplant because they have “bone on bone and the meniscus transplant will bring back some cushion.”

Meniscal transplant is a very major surgery as far as I’m concerned. I have personally never seen one work out with the patients who come in to see me. There are a lot of people who had this surgery successfully. The people who are coming to see me are the ones for whom this surgery has failed. That is why I never see the successful surgery patients.

In December 2020, there was an editorial in the medical journal Arthroscopy (2). It gives a good reality of the meniscus transplant outcome.

“Meniscal allograft transplantation for symptomatic knees after meniscectomy decreases pain and often improves function, but it does not replicate a normal meniscus. The ability of to delay arthritic changes is an ongoing area of study, and it is known that outcomes and graft survivorship deteriorate with longer follow-up. Recommended indications are symptomatic patients after meniscectomy with mild (or at most moderate) degenerative changes and absence of (or surgically corrected) associated malalignment or ligament deficiency. When these indications are followed, 80% of patients improve, with survivorship of 83% at 10 years and 56.2% at 20 years.

Can stem cell therapy regenerate meniscus tissue?

For many people, the long rehabilitation, possible need for secondary surgery, and other post-surgical factors weigh heavily in their decision making process as to how to proceed to fix their meniscus tear. For many people, regenerative medicine in the form of stem cell therapy may be something to be explored.

• New research into the healing world of the knee meniscus is fascinating. Despite decades of traditional medical beliefs that because of its poor or even absent network of blood vessels and blood supply, parts of the knee meniscus cannot heal. Researchers are discovering the meniscus is in fact, always trying to heal itself.
• HOWEVER, the expectation that stem cell therapy can regrow a meniscus from nothing or regenerate extensive amounts of meniscus tissue removed in meniscectomy must be tempered with a realistic expectation of what these treatments can and cannot do.
• Stem cell therapy for meniscus tears can help repair deficits in the existing meniscus.
• Stem cell therapy when administered as a multi-injection treatment as opposed to a single one-time shot, can also help support, rebuild, and stabilize the knee capsule and help restore a more normal knee function. A more normal knee function can remove stress from the meniscus and other supportive knee tissue such as ligaments and tendons.
• What your realistic expectation of what stem cell therapy can do for your meniscus tear must be discussed with a doctor knowledgeable and experienced in the treatment.

White Zone,” and “Red Zone,” meniscus tears.

Let’s look at an October 2020 study (3) that made some interesting observations. What the research team wanted to do was assess Bone marrow-derived mesenchymal stem cells’s potential to engineer meniscus-like tissue. The researchers pointed out that “Bone marrow-derived mesenchymal stem cells have the potential to form the mechanically responsive matrices of joint tissues, including the menisci of the knee joint.” So to test how good these stem cells were at re-engineering meniscus tissue, they compared the bone marrow stem cells taken from the iliac crest versus the meniscus fibrochondrocytes cells (cartilage cells) isolated from castoffs of partial meniscectomy from non-osteoarthritic knees.

To simulate conditions that may occur in the human body after cell transplantation, the bone marrow-derived mesenchymal stem cells were cultured in type I collagen (the stuff that cartilage is made of) scaffolds. What they found was that the bone marrow-derived mesenchymal stem cells produced functional replacement meniscus tissue better than meniscus tissue did.

This study is not definitive in the way bone marrow derived stem cells may heal and regenerate meniscus tissue. What it does show however, that it is possible.

The Meniscus is always trying to make more meniscus

A study in the Journal of orthopaedic research (4) lead by the Department of Orthopaedics and Rehabilitation, University of Iowa discusses how a meniscus regenerates and heals.

The researchers of this study hypothesized that the meniscus contains a population of regenerative cells, (cells that stimulate stem cell activity) and that these cells migrate to the site of meniscal injury.

“White Zone,” and “Red Zone,”

If you had a meniscus tear you are familiar with “White Zone,” and “Red Zone,” meniscus tears. The “Red Zone,” part of the meniscus, the outer edges, receives a steady stream of healing cells from its well organized blood vessel network. For those of you with a meniscus injury that is being recommended to surgery, you may have had your doctor explain to you that you have a “White Zone,” tear. The “White Zone,” lies in the center of the meniscus. It does not have a well organized blood network. It is these meniscal injuries that send patients to surgery.

This is what these researchers said: “studies revealed that migrating cells were mainly confined to the red zone in normal menisci: (This is the area where the meniscus has good blood flow and healing elements are abundant). However, these cells were capable of repopulating defects made in the white zone, (the area without circulation). When the meniscus was injured, migrating cell numbers increased dramatically. Stem cells in the knee increased in number to combat the injury.These findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential, even into the white zone area.

The short of it? The meniscus figures out how to heal itself if it can. Even in the areas that are typically believed unhealable because of lack of blood flow to that area.

The meniscus is mobilizing the stem cells already in the knee to the site of the its injury.

Stem cell numbers? What could be considered even more fascinating is that the meniscus signals for more stem cells from the knee capsule to come to the injured area. For those people asking about stem cell numbers that are harvested for treatment, the meniscus is mobilizing the stem cells already in the knee to the site of the its injury.

Research from September 2020: Stem cells live in all the zones of the meniscus

A study published in the journal Arthroscopy (5) wanted to know what type of stem cell populations lived in the meniscus’s red-red (RR), red-white (RW) and white-white (WW) zones and what type of blood flow went into these areas. To find out they performed a study on human cadaver menisci. So, what did they find?

• There were no significant differences in the clonogenicity (the ability to clone itself to start healing repair) of isolated cells between the three zones.
• Progenitors (cells like stem cells that differentiate into different types of cells, chondrocytes for example that make cartilage) from all zones were found to be potent to differentiate to mesenchymal lineages.
• Additionally, results demonstrate the presence of vascularization in the WW zone. The white-white is typically considered unrepairable because it is believed that no blood flow is present.

The meniscus and cartilage are always trying to heal each other

An October 2020 paper titled: “The menisci and articular cartilage: a life-long fascination,” (6) explains that the “menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other.”

Simply, if you have a meniscus tear, eventually this will damage the protective cartilage of the thigh and shin bones which sandwich the meniscus. But Nature is pretty clever. Nature does not rely on surgical outcomes because as noted, meniscus surgeries lead to accelerated osteoarthritis, how? By accelerating stress and damage on the articular cartilage. So Nature designed the meniscus and the cartilage to look out for each other.

In the Journal of orthopaedic research (7) doctors examined the process of meniscal regeneration and cartilage degeneration following meniscus surgical removal in mice. They found that there is a healing environment that the meniscus and cartilage create independently of each other spurred on by native stem cells, that later melds together, suggestive of a balance between meniscal regeneration and cartilage homeostasis. The meniscus and cartilage are trying to regenerate each other.

This special relationship between cartilage, meniscus and stem cells is discussed in research from the University of Iowa. The Iowa findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor (stem cell) population with strong reparative potential.(8) The problem for patients is that despite the desire to heal and regenerate, as pointed out by the Iowa researchers, “Serious meniscus injuries seldom heal and increase the risk for knee osteoarthritis; thus, there is a need to develop new reparative therapies. In that regard, stimulating tissue regeneration by autologous stem/progenitor cells has emerged as a promising new strategy.”

In past articles I have written extensively about how stem cells change the environment of diseased joints to healing. Research like that above confirms that when one part of the knee is repairing, the entire knee is repairing. This change of environment is something a surgery is not expected to offer.

What are realistic expectations that stem cell therapy can help your meniscus related knee problems?

Researchers at the Osaka University Graduate School of Medicine in Japan teamed with the Mayo Clinic to release a January 2020 (9) paper outlining the current research on stem cell therapy for meniscus repair. In this study they wrote:

“Clinical studies evaluating the effects of MSC (stem cell) injections in the knee joint are limited, but early clinical data suggests encouraging results. Currently, there have not been any reported safety concerns or side-effects in the clinical use of MSC injections.

There is only one randomized double-blind controlled study to date studying the effects of MSC injections into the knee post medial meniscectomy [10]. The study contained 55 subjects in 3 groups who underwent a percutaneous injection of allogeneic MSCs with one group receiving 50 × 106 cells another 150 × 106 cells and control receiving only hyaluronic acid. At 12 months follow up, MRI scan findings reported a significant increase in meniscal volume in 24% of patients receiving 50 × 106 cells and 6% receiving 150 × 106 cells. None of the control group patients demonstrated an increase in meniscal volume. The study is limited to MRI scan being the only objective outcome measure, but the study methodology is rigorous in that it has the advantage of being blinded and randomized.”

As you have seen in this article, the meniscus has an ability to heal itself. When someone comes into our office with knee problems we start with a conversation so we can learn about the patient’s lifestyle and what are his/her goals of the treatment. Is it to get back to marathon training or is it to get up and down a staircase without his/her knee locking up? Then we will do a detailed physical examination looking for those signs that will tell us how helpful stem cell therapy may be.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References:

1 Razi M, Mortazavi SMJ. Save the Meniscus, A good Strategy to Preserve the Knee. Arch Bone Jt Surg. 2020 Jan;8(1):1-4. doi: 10.22038/abjs.2019.45438.2242. PMID: 32090138; PMCID: PMC7007719.
2 Carter T. Editorial Commentary: Medial and Lateral Meniscus Allografts Using Bone Plug Fixation in Patients Without Advanced Arthritis Have 80% Positive Outcomes at 10 Years.
3 Elkhenany HA, Szojka ARA, Mulet-Sierra A, Liang Y, Kunze M, Lan X, Sommerfeldt M, Jomha NM, Adesida AB. Bone Marrow Mesenchymal Stem Cell-Derived Tissues are Mechanically Superior to Meniscus Cells. Tissue Eng Part A. 2020 Oct 30..
4 Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. Journal of Orthopaedic Research. 2016 Nov 1.
5 Chahla J, Papalamprou A, Chan V, Arabi Y, Salehi K, Nelson TJ, Limpisvasti O, Mandelbaum BR, Tawackoli W, Metzger MF, Sheyn D. Assessing the Resident Progenitor Cell Population and the Vascularity of the Adult Human Meniscus. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Sep 23.
6 Kopf S, Sava MP, Stärke C, Becker R. The menisci and articular cartilage: a life-long fascination. EFORT Open Reviews. 2020 Oct;5(10):652-62.
7 Hiyama K, Muneta T, Koga H, Sekiya I, Tsuji K. Meniscal regeneration after resection of the anterior half of the medial meniscus in mice. J Orthop Res. 2016 Nov 2. doi: 10.1002/jor.23470. [Epub ahead of print]
8 Seol D et al. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
9 Jacob G, Shimomura K, Krych AJ, Nakamura N. The Meniscus Tear: A Review of Stem Cell Therapies. Cells. 2019 Dec 30;9(1):92. doi: 10.3390/cells9010092. PMID: 31905968; PMCID: PMC7016630.
10 Vangsness Jr CT, Jack Farr II, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. JBJS. 2014 Jan 15;96(2):90-8.