Comparative analysis of the use of L-PRP/L-PCP injections, arthroscopic partial resection and non-steroidal anti-inflammatory drugs in the treatment of the meniscus tears

Abstract

Recent studies show that among people with an active lifestyle about 6-10 % of injuries are acute injuries of the knee joints, namely – meniscus tear. The main treatment options for traumatic meniscus tears include surgical arthroscopic partial meniscectomy or meniscus repair, and conservative regenerative injection techniques. Today, the choice of treatment tactics remains controversial. THE PURPOSE of the study was to evaluate the effectiveness of regenerative injection techniques in comparison with partial resection of the menisci and non-steroidal anti-inflammatory drugs (NSAIDs) in combination with the systematic use of kinesiotherapy for traumatic meniscus injuries. MATERIALS AND METHODS. The results of treatment of 154 patients with traumatic meniscus injuries were evaluated. Group 1 (n = 53) received intra-articular injection of plasma rich in growth factors with a high platelet concentration of at least 1 million/μL and a high number of leukocytes (L-PRP/L-PCP) in combination with low molecular weight hyaluronic acid; the number of injections from 3 to 6 with an interval between injections of 2 weeks. Group 2 (n = 49) received NSAIDs therapy (Ibuprofen, 200 mg 2 times/day, 7 days with a break of 1 week) for 2 months and a course of physiotherapy exercises. Patients in group 3 underwent arthroscopic partial meniscectomy, followed by recommendations for physical activity. Evaluations were performed using VAS scale, WOMAC questionnaire and KOOS survey scale at 3, 6, 12, 24, and 36 months after the end of treatment. RESULTS. The obtained results demonstrated the effectiveness of intra-articular use of L-PRP/L-PCP in the treatment of traumatic meniscus tears in the short term (up to 3 months) and in the long term (up to 3 years), represented by the improvement of joint function and a significant reduction in the level of pain, which was observed in patients of group 1 after 36 months: by VAS 1.2 ± 0.5 cm, KOOS 94.5 ± 4.8 points, and WOMAC questionnaire 4.0 ± 1.9 (p < 0.05 compared to primary data). The use of NSAIDs and physiotherapy exercises is not effective in the short term (3-6 months), and over time the condition of patients only worsens: after 36 months VAS 7.6 ± 1.9 cm, KOOS questionnaire 24.9 ± 3.9 points (p < 0.05), and WOMAC 72.2 ± 7.1 (p < 0.01 compared to primary data). Partial arthroscopic meniscal resection can reduce pain and restore functional status to satisfactory within one year, with further progression of pain symptoms and functional limitations in the second and third year of the study, which is showed after 36 months: for VAS 5.7 ± 1.9 cm, KOOS questionnaire 47.1 ± 5.7 points, and WOMAC 64.1 ± 5.9 (p < 0.05 compared to primary data). CONCLUSION. Intra-articular administration of L-PRP/L-PCP with hyaluronic acid can improve functionality and reduce pain in patients with traumatic meniscus injuries for up to 3 years. The use of NSAIDs and kinesiotherapy is not effective at all stages of follow-up. As for the use of arthroscopic partial resection, it provides an opportunity to get rid of pain and improve the capabilities of patients with traumatic meniscus tears for up to 12 months.