Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Cartilage. 2021 Dec;13(1_suppl):387S-391S. doi: 10.1177/19476035211037390. Epub 2021 Sep 13.
Meniscal degeneration is a common finding even in young patients' knees, and it is regarded as a predictor for the onset of early osteoarthritis (OA). When symptomatic, it represents a challenge since arthroscopic surgery provides unpredictable results: recent evidence has shown that partial meniscectomy is not better than conservative management up to 2 years of follow-up, and the removal of meniscal tissue may accelerate OA progression toward OA. Intra-articular injection of corticosteroids or hyaluronic acid may help in providing temporary symptomatic relief, but no influence should be expected on the quality of the meniscal tissue. Biologic agents have been adopted to treat a variety of degenerative musculoskeletal pathologies, and the use of platelet-derived growth factors (GFs) has become routine. Preclinical studies have documented that platelet-derived GFs may play a beneficial role in stimulating meniscal repair and regeneration by triggering anabolic pathways and stimulating local mesenchymal stem cells from synovium. Furthermore, also mechanical stimulation (e.g., arthroscopic trephination or percutaneous needling) in the red-red or red-white zone may further promote tissue healing. The purpose of the present brief report is to describe the clinical outcomes at 18 months' follow-up in a cohort of patients affected by symptomatic medial meniscus degeneration and treated by percutaneous needling plus intra- and perimeniscal injection of autologous conditioned plasma (ACP). The procedure was shown to be safe and provided significant pain reduction and improvement in subjective scores. This treatment option deserves further investigation in a comparative setting, to establish whether it could offer advantage over isolated intra-articular injections.
半月板退变在年轻患者的膝关节中也很常见，被认为是早期骨关节炎 (OA) 发病的预测因素。当出现症状时，这是一个挑战，因为关节镜手术的结果不可预测：最近的证据表明，半月板部分切除术并不优于保守治疗，在 2 年的随访中，切除半月板组织可能会加速 OA 的进展。关节内注射皮质类固醇或透明质酸可能有助于暂时缓解症状，但不应期望对半月板组织的质量产生影响。生物制剂已被用于治疗各种退行性肌肉骨骼疾病，血小板衍生生长因子 (GFs) 的使用已成为常规。临床前研究已经证明，血小板衍生的 GFs 通过触发合成代谢途径和刺激滑膜来源的局部间充质干细胞，可能在刺激半月板修复和再生方面发挥有益作用。此外，在红白区或红-白区进行机械刺激（例如关节镜磨钻或经皮穿刺）也可以进一步促进组织愈合。本简要报告的目的是描述一组接受经皮穿刺加关节内和半月板内自体条件血浆 (ACP) 注射治疗的症状性内侧半月板退变患者的 18 个月随访的临床结果。该操作被证明是安全的，可显著减轻疼痛并改善主观评分。这种治疗选择值得在对照环境中进一步研究，以确定它是否比单独关节内注射更有优势。
