How to Fix a Meniscus Tear Without Surgery

Hi Doug,
I have a question about your meniscus tear. How did you treat it without surgery? Was it just by doing your Fusion training? And how long did it take to fully heal?

I’m a professional dancer and yoga teacher with a mild medial meniscus tear on both knees (no clicking or giving way… but definitely reduced ROM in flexion and weight bearing ability), I’ve been off dancing for 2.5 months now, and I’ve had to reduce and modify my yoga practice a great deal since. I’m trying to let my menisci heal on their own with conservative physical therapy, since I am not a good candidate for surgery according to my physio anyway because of the mildness of my symptoms, but I am losing muscle strength especially in my legs from not being able to dance/do yoga and exercise enough without aggravating the injury.

I am really hoping to resume dancing and doing a full yoga practice soon, even though I know it will probably take more time than I want to.

Thank you in advance for your response.
Miriam (not her real name)

What Happened

Thanks Miriam for your question and sharing your situation.

Just to bring everyone else up to speed, back in 2011, I slipped getting up off the floor and my right knee sort of twisted and buckled making a load snapping sound.

I was working with a client at the time and it was loud enough that she stopped and said,”Oh my God, are you alright?”

Well, that snapping sound as my right medial meniscus tearing apart. What followed was a couple of months of limping, my knee giving way, locking up and a generally frustrating period of time.

I did my best to rebuild the strength of my joint and leg but the tear was just too large.

Almost twenty years ago, I tore the left medial mensicus playing basketball and ended up in surgery. I had the same symptoms then as I did in 2011 so in my mind I was thinking, “I do not want to go through surgery”.

What I Did

I had helped people recover and rebuild following platelet rich plasma injections (PRP) and had done some additional research on it. I thought there may be some benefit to giving that a shot (no pun intended 🙂

The PRP process consists of drawing some blood, spinning it in a centrifuge and then injecting the platelets into the injured tissue. Platelets carry certain proteins – growth factors – that help tissue heal. The PRP process concentrates the growth factors by up to ten times the normal amount.

There wasn’t any scientific data to show that this idea – injecting the mensicus with PRP – would work. So, it was an expensive gamble with the injections costing anywhere from $750 to $1000.

But, I’m an “early adopter” and like to test new things. So, PRP was the choice for me.

My knee post-PRP

I had the injection and also had some knee pain from it. My knee swelled up like someone had stuffed a small apple in it. I was on crutches for about three weeks. This was my choice mostly. I felt that the injured tissue might be too fragile to withstand full weightbearing right away. Again, no data to prove it but it made sense to me.

After about seven days, I started a joint strengthening program – this was partial weightbearing – and then proceeded from there into rebuilding the strength and capacity of my leg. My program was very similar to what I present in my book “The Runner’s Knee Bible: The Keys to Running Again”.

I had a great result from this process.

But, it took quite a while for my knee to return to “normal”.

You not only need to be willing to experiment but you also MUST be patient.

After about one year, I had almost 100% return of normal motion, had no symptoms, I could exercise consistently and my knee felt solid.

Progress though is not linear and there’s an interesting, well, maybe bizarre is a better word, response that your body has to PRP.

We call it the “prolocoaster”.

About eight to twelve weeks after the injection, my knee suddenly felt a lot worse. More like it did before I had the injection and I thought, “Did I somehow mess this up? Is the mensicus torn again?”

I knew about this phenomenon having helped a number of people post-PRP injection but knowing about it and living it are different things.

These cycles of feeling good and feeling not so good continued for about a year and then just dissipated.

Not everyone has the same response though to PRP. Some people have less pain; some more. Some go through the “prolocoaster” more often; some less. Some people have a great result and some don’t.

Why?

No one knows…yet.

There’s a lot going on in this general area of “regenerative medicine” and there’s some encouraging research.

I was invited to give a presentation in May 2011 at the American Association of Orthopedic Medicine Annual Conference – “Regenerative Orthopedic Medicine – Applications through the Lifespan” in Las Vegas. While I was there, I met and visited with a number of researchers who were investigating alternative methods of healing using the body’s own natural healing processes. PRP was one the methods and there were a number of stem cell papers as well.

For a small meniscus tear, we’ve had fairly good success using the principles I outlined in my book “The Runner’s Knee Bible” but if you can add PRP to the equation, I think you “stack the deck” in your favor. Sometimes surgery is the only option but I would do my best to avoid it.

Why Choose PRP over Surgery for a Meniscus Tear?

All surgery carries significant risk. We tend to forget this with how common place surgery is in our society. But things like stroke, infection, and even death are in the fine print on all of the waivers for surgery so really think about what you’re doing.

Removing part of your meniscus increases your chances of osteoarthritis in later years. The meniscus, in addition to being a shock absorber for your knee, helps keep it stable. When you remove a portion of the meniscus, you destabilize the knee and allow it to shift in very small amounts. No articular joint in the body likes shifting or sliding and the result is a gradual deterioration of the joint if you’re not very mindful of what you do. Some surgeries though do not remove the meniscus but repair it which is a much better choice. However, most surgeons make that decision based on the size and general stability of the tear.

It’s less expensive. Yes, PRP is generally not covered by insurance but if, like a lot of people, you have a high deductible plan, then you’re out of pocket expenses for surgery will be more than the cost of PRP.

Surgery is not a quick fix. I’ve met with thousands of people who all seem to have the same idea about surgery – just cut out whatever is wrong and I”ll be good to go. Not true. Yes, sometimes people with a small tear can have surgery and be up and about quickly but if you have a large tear then post-operatively you’ll want to go through rehab (your surgeon may argue about that unless he owns his own rehab – funny how that works) which can be a 2-4 month process. And getting back to impact activities like running or jumping, etc can be even longer. So, don’t delude yourself that surgery is in and out and all is well.

Sometimes you can’t. In my case, the tear was certainly large enough that surgery was a real possibility and likely the only other option if the PRP failed (in fact, the doctor wasn’t at all sure that the PRP would work for me because of the kind of tear I had).

Non-surgical options for meniscus tears continue to improve so before you opt for surgery, investigate all of your options and weigh them carefully.

I have effusion (water on knee). It looks like your knee photo, only on the right side of my right knee. My MRI shows arthropathy (arthritis), meniscus tear, full thickness cartilage loss. one doctor who does PRP would not do it, because he contends that PRP is only good for ligament and tendon injury, not for cartilage or arthritis . I thought that PRP would help my problem. I’m seeing another doctor who might be more positive about PRP for me. I’ll report what I find. Any comments?

I appreciate your article as I am a career long dance professional…I DO however know why some do not do as well with the injections…it is that the doctors currently do not select for autoimmune disease. After a severe meniscus tear I was involved enough to get to the top at a place doing stem cell injections and PRP and ask them direct questions. The data is there to show that we (I have 2 autoimmune diseases) do not have as good a chance of success as our immune systems fight the process and get in the way of the healing.

Many doctors do not select for this and advise you because they don’t want to send patients and $ away. I have asked several through the years “Would you advise this for patients with an autoimmune disease?” and they said no, then I asked “Do you select for those patients?” and most said “No”. I learned to be my own advocate and not trust all the recommendations blindly..others should too…

I had PRP about 6 weeks ago for chronic heel pain, with the MRI showing tenosynovitis. My foot is still slightly swollen from the injections, and more sore than before treatment, with increased pain when I’m on my feet a lot. I am trying to be patient and wait for beneficial results, but it is frustrating.

Twice I’ve needed to follow the program in DK’s book “The Runner’s Knee Bible”. The first time was when I was having trouble with Bakers Cyst’s in both knees. The second time was after a small meniscus tear in my left knee. I started the RKB program after 8 weeks of PT then started the Active Age Blueprint program two months later. My left knee had microfracture surgery six years before the meniscus tear and until three months into the AAB training I could “feel” where the microfacture had been done and had not been able to load the knee when training . Finally my left knee has healed up. The RKB and AAB programs worked for me and changed my life.