Meniscus Gluing/ Bonding
The meniscus in the knee joint is an important organ which functions as a kind of shock absorber. It is also responsible for guiding the movement of the cartilage surfaces. Therefore, it should be tried to preserve the meniscus if it is injured.
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We have developed a new minimally invasive method for refixing a torn meniscus. This allows the tear to grow back together, which contributes to the preservation of the meniscus. The procedure is performed without surgery and without general anesthesia! We rather use local anesthesia and conduct the almost painless invasion under magnetic resonance imaging (MRI) on an outpatient basis. The whole procedure takes about 1/2 to 1 hour, after which the patients can immediately strain themselves. Subsequently, growth factors are injected once a week also under local anaesthesia into the knee in the immediate vicinity of the meniscus tear. The growth factors are obtained from the patient's own blood, which will be taken only once. The injections into the knee then take place over a period of 4 weeks, once a week. After 6 weeks the healing process of the meniscus is completed, which will be controlled by MRT.
Since mid-2016, we have successfully performed over 478 treatments with this procedure, of which the first therapy results were already very promising. Meanwhile, we examined the first therapy results one year after refixation of the meniscus, of which all patients were largely symptom-free. However, five of these patients have undergone meniscus surgery, since the healing process did not proceed as expected. We are currently working on the exact statistical processing of the examination results 4 years after refixation. The therapy method has been presented for the first time at the international EFORT Congress in Vienna (31.5.2017). We then presented the results 1 year after refixation at the international meeting of the ICRS (International Cartilage Repair Society) in December 2018 in Milan.
The following illustrations show the principle of the minimally invasive treatment method:
Fig. 1) Shows the view of a right knee joint with inner meniscus and outer meniscus. A typical tear is shown in the inner meniscus (bottom left in the picture).
Fig. 2) Shows the introduction of an MRI-compatible introducer under MRI control into the meniscus tear.
Fig. 3) After checking the position of the introducer in the MRT, the fibrin adhesive is injected.
Advantages of the new method:
1. An operation and thus the operative risk is completely avoided! Arthroscopic surgery also entails the risk of cartilage injuries on the joint surfaces or in vascular-/nerve areas.
2. The risk of general anaesthesia or spinal cord anaesthesia is completely avoided!
3. The meniscus as an important organ in the knee joint is preserved!
4. The new method is almost painless.
5. No radiation exposure, as the procedure is performed by MRI (magnetic resonance imaging).
6. Immediate loadability (no weakening of the musculature), relatively low expenditure of time for the patient.
7. The fibrin-adhesive used is a well proven product which has been in use for 29 years.
Watch video about the new method
Frequently Asked Questions:
Is the new method completely risk free?
- No, there is a very low risk of infection when inserting the fine needle, although we work according to high sterile standards and use only sterile disposable material and disposable gowns.
Can all meniscus tears be treated with it?
- Unfortunately not, so-called dislocated cracks, i.e. if a larger meniscus fragment has shifted, it is naturally not possible to glue it back together again. A diagnostic MRI (magnetic resonance imaging), which will be discussed prior the treatment, shows whether a tear is suitable for this purpose.
Can all patients be treated with it?
- In the case of patients who are not allowed to undergo an MRI, e.g. patients with pacemakers, the procedure can also be performed in CT.
Which fibrin adhesive is used?
- We use a well-known product of an international company, operating worldwide. It is a product which has been tried and tested for years and which has already been used successfully in many countries for the refixation of joint cartilage or other surgical procedures. However, despite very careful production and cleaning, a small residual risk of infection cannot be completely excluded. In addition, allergic reactions can rarely occur.
Can the patient drive a car immediately after the procedure (refixation)?
- Since a local anaesthetic is applied to the knee, the patient is not roadworthy and should not drive a car on the day after the procedure.
Comparision pictures of a torn medial meniscus in the right knee joint, before and after the refixation with fibrin adhesive.
Before the procedure
6 Weeks after the procedure (refixation)
6 Months after the procedure (refixation)
1 Year after the procedure (refixation)
Diese MRT-Bilder zeigen im Verlauf die nahezu vollständige Signal-Normalisierung im Innenmeniskus-Hinterhorn nach 1 Jahr. Der Patient ist vollkommen beschwerdefrei.
These MRI-Pictures show a complete normalization of the medial meniscus after 1 Year. The patient is completely free of complaints.