DEAR DR. ROACH:
I have reached the beginning of osteoarthritis after a meniscus trim from years ago. Can platement-rich plasma (PRP) therapy, or anything else, regenerate cartilage? — E.C.
ANSWER:
Loss of cartilage is an important part of the complex condition called osteoarthritis, along with osteophytes (“bone spurs”) and inflammation of the synovium (connective tissue that lines the joint and makes joint fluid). Unfortunately, despite decades of research, there are still no treatments that are proven to regenerate cartilage or halt the progression of osteoarthritis.
A recent trial of PRP injections in the knee failed to show any benefit to the cartilage or to overall pain levels, compared with a placebo injection of plain salt water. I don’t recommend PRP as a treatment for osteoarthritis of the knee. The main treatment for osteoarthritis of the knee is regular exercise and medications as necessary to reduce pain. Exercise has been shown to improve function, as well as relieve pain and protect the knee.
Many people still think that exercise will wear out the knee faster, but this is proven to be erroneous. The type of exercise that people will best tolerate depends on many things, including the severity of their arthritis, their weight and their degree of pain, and I often will refer my patients with osteoarthritis of the knee to a physical therapist, to help teach the best exercise plan.
Your story shows the importance of avoiding meniscal surgery when possible. We are far less likely to recommend surgery for a torn meniscus, because any cartilage you take out can hasten the progression of osteoarthritis. But, sometimes, it is necessary to relieve pain.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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