title: Percutaneous injections of Platelet rich plasma for treatment of intrasubstance meniscal lesions.
abstract: BACKGROUND
  management of intrasubstance meniscal lesions is still controversial. Intrasubstance meniscal lesions can lead to reduced sports activity and meniscal rupture. Physical therapy is often not satisfactory. Therefore new treatment methods are requested. Platelet Rich Plasma (PRP) has the ability to regenerate tissue; this was proved in several experimental studies. Whether percutaneous injections of PRP are effective in intrasubstance meniscal lesions is unknown. We hypothesize that percutaneous PRP injections lead to pain relief and halt of progression on MRI over 6 months in patients with grade 2 meniscal lesions.
  
  
  METHODS
  ten recreational athletes with intrasubstance meniscal lesions (grade II according to Reicher) proven by MR-Imaging (MRI) were treated by percutaneous injections of PRP in the affected meniscal area. Three sequential injections in seven day intervals were performed in every patient. All injections were performed with image converter. Follow-up MRI was done six months after last injection in every patient. Level of sports activity and amount of pain at athletic loads according to numeric rating scale (NRS-11) were noted in each patient before injections and at the time of follow up MRI after six months. The t-test was used to determine statistical differences.
  
  
  RESULTS
  four of ten patients (40%) showed decrease of meniscal lesion in follow up MRI after six months. Nine of ten patients (90%) complained about short episodes of heavy pain after the injections with average NRS-Score of 7.9 at daily loads after the last injection. Six of ten patients (60%) showed Improvement of NRS-Score at final follow up. Average NRS-Score improved significantly (p=0.027) from 6.9 before injections to 4.5 six month after treatment. Six of ten patients (60%) reported increase of sports activity compared to the situation before injections. In four patients (40%) additional surgical treatment was necessary because of persistent knee pain or progression of meniscal lesion.
  
  
  CONCLUSIONS
  percutaneous injections of PRP have the ability to achieve pain relief and halt of progression on MRI over 6 months in patients with grade 2 meniscal lesions. Therefore it could be considered as a treatment option in patients with persisting pain.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Blanke
authors.affiliation: University Hospital Basel, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.affiliation: Department of Orthopaedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Haenle
authors.affiliation: University Hospital Basel, Switzerland.
authors.forename: Lutz
authors.initials: L
authors.lastname: von Wehren
authors.affiliation: University Hospital Basel, Switzerland.
authors.forename: Geert
authors.initials: G
authors.lastname: Pagenstert
authors.affiliation: University Hospital Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Majewski
keywords: PRP; grade II; intrasubstance; meniscal lesion; percutaneous