IS THERE A PLACE FOR ARTHROSCOPY?
Ross Hauser, M.D.
 

Arthroscopy is useful to repair complete ligament and tendon tears and also to shave bone like under the acromion when a person has an impingement syndrome in the shoulder when it doesn’t heal completely with Prolotherapy. The number of arthroscopies ever recommended at Caring Medical can probably be counted on one's hands. The number of arthroscopies that have been prevented is in the hundreds.

OVERUSE INJURIES
The traditional model of non healed sports injuries is that often an athletes pain is due to over training. Most chronic athletic injuries are diagnosed as overuse injuries. In other words the athlete is blamed for their pain…they are training to hard. The treatment is then to have the athlete rest. This makes no sense to us because all that happens to the athletes while they rest is their connective tissue including the ligaments and tendons become weaker. We do not believe this is what athletes want…to rest and become weaker.

Histologically (under the microscope) when one looks at non healed sports injuries the tissues are found to be degenerated not inflamed. In a tendon this is termed tendinosis.  Thus a more accurate look at non healed athletic injuries is that these tissues need to be stimulated to heal, not antiinflammed or rested which will just cause them to become more degenerated. Prolotherapy to the affected areas causes an inflammatory reaction to occur, taking a tendinosis and making it a tendonitis. For most people, this tendonitis or inflamming of the tissue can be felt as pain or stiffness in the structures injected for one to two days. Eventually when the healing is complete, the athlete is left with a normal strong tendon after Prolotherapy. 

WHAT IS THE M.EA.T. PROTOCOL?
Most athletes after a soft tissue injury to such structures as tendons or ligaments are told to rest, ice, compress, and elevate the area. This is the infamous RICE treatment. It is taught in every medical school and practiced in every hospital across the country. Prolo Your Pain Away! was the first book to expose how wrong this treatment is for newly injured ligaments and tendons. Every subsequent book on Prolotherapy that we have written has further supported the notion that the R.I.C.E. protocol inhibits healing whereas the M.E.A.T. protocol enhances it. For those athletes who really want to learn about the research involved in these statements is encouraged to read Prolo Your Sports Injuries Away!

M.E.A.T. stands for movement, exercise, analgesics and therapy. This is the pneumotic that should replace R.I.C.E.. R.I.C.E. is anti-healing for structures such as ligaments and tendons which have a very poor blood supply. Rest, ice, compression, and elevation decreases circulation and thus the amount of immune cells that are needed to heal an area. By an athlete moving, exercising, taking natural analgesics like Bromelaine (enzymes), and using specific therapies such as ultrasound, heat, Neural Therapy, and Prolotherapy circulation and healing is enhanced. If moving an injured limb is too painful after an injury, isometric (nonmovement) exercises can be done. M.E.A.T. allows athletic injuries to not only heal quicker but complete healing is enhanced.

HOW ABOUT STRETCHING AND OTHER EXERCISE TECHNIQUES?
There are many things that athletes do that have not been shown to enhance healing or prevent injuries. In our book Prolo Your Sports Injuries Away! we talk about (as well as co-authors) the misnomer that braces, taping, and stretching prevent injuries. Of course, everything has its place but the place for bracing, taping, and ‘traditional’ stretching needs to be somewhere besides mainstream sports medicine. For those who are aghast at reading this, please read our book before making a judgment. Most people who consult with us have non healed joint, tendon, ligament, menisci, or cartilage injuries and what they need is not a new exercise regime or to change sports, they just need a bunch of shots into the injured structures to stimulate their repair.
 

RELATED ARTICLES
Arthroscopy: Permanent Repair or Permanent Damage?

Professional teams have orthopedic surgeons as their team physicians. Their healing tools primarily consist of the RICE treatment (Rest, Immobilize, Ice, Elevate), NSAIDS, cortisone shots, the arthroscope, and the scalpel. Which one of these actually heals or repairs the injury? The answer is none of them. What these treatments actually do is weaken or "damage" the athlete and decrease the chances of healing. It is a sad fact that after the team physician has gone through the arsenal of RICE, anti-inflammatories, and cortisone shots, the infamous "scope recommendation" will soon follow for the non-healing athletic injury. The problem is that athletes have no idea what is involved with arthroscopy. Arthroscopy is surgery, the myth that athletes have been fed is that a scope can find out the problem and solve it. Nothing could be farther from the truth for the average sports injury. All the arthroscope can do is look at the tissue.
 

Arthroscopy: The Quickest Route to an Athletic Injury

The easiest and most overt way athletes are injured is not from a cheap shot from an opponent, but by one of their supposed allies, the arthroscope. This subtle stoic instrument is slipped into the knees, ankles, and shoulders of athletes while they are asleep. The subtle intruder has razor-sharp teeth that slice through tissue easier than the slick blade of a butcher. The arthroscope is capable of producing more irreversible damage than the most vicious opponent produces. The damage is, however, often masked by the incredible feeling of vitality following the procedure. The athlete's euphoria, because someone has finally fixed the problem is followed by a tenacious rehabilitation course, as the athlete is eager to get back to the field. The problem is that the scope did nothing but make the athlete's knee, shoulder, ankle, or whatever joint weaker. The weakness is masked by the massive amount of exercise that the athlete does after the procedure. The athlete experiences continued pain, but the orthopedist insists that more exercise is needed. The athletes often return to their sports, perhaps with less pain than before the scope, but report that their joints "just never felt the same" after the surgery. There is a sense that something is not quite right, but they cannot put a finger on it. This is a sure sign that weakness is the cause of that "just not quite right" feeling. The knee is now weaker. The shoulder is now weaker. The ankle is now weaker. This is why the athlete does not feel quite right.
 

What is Arthroscopy?

The word arthroscopy comes from the prefix arth-, which means joint, and scope, which means scope. Arthroscopy involves inserting a scope into a joint to look at it. The guise under which arthroscopy flourishes is that it is supposed to help with diagnosis of an athlete's problem and allows the orthopedist the ability to fix the problem immediately.

It is important to know exactly what is involved in receiving arthroscopy. It is a surgical procedure. The majority of arthroscopic surgeries in the United States are currently performed with either spinal block or general anesthesia. This means that the person is totally anesthetized (knocked out) or paralyzed from the waist down (spinal block). These procedures obviously carry their own risks.

The following instruments are normally needed to perform arthroscopic procedures:

1. 4.0-mm diameter arthroscope with a 30-degree viewing lens

2. 4.0-mm diameter arthroscope with a 70-degree viewing lens

3. Video camera

4. Recorder

5. Pump

6. Motorized shavers or bur (a rotary cutting instrument)

7. Probe

8. Assorted hand instruments (e.g., grasper, clamps, curette).
 

At any one time during arthroscopy of the knee, four instruments could be stuck into an athlete's knee-including scopes, probes, shavers, pumps, and various other instruments of local destruction. The question to ask is how can so many instruments be stuck into such a small space? This is a great question. The knee joint normally contains only a small amount of fluid, approximately five millimeters. During a scope, one of the ports (place for a probe) is for the pump. This device pumps saline water into the knee. Depending on the knee, up to 120 milliliters of fluid may be pumped into the knee under force. The question to ask is would not ballooning up the knee to this degree cause the ligaments, meniscus, cartilage, and joints to become stretched, inflamed, and injured? Could it be possible that this forceful pumping of fluid in-and-of-itself might cause the tears, rough edges, and inflammation that are so often reported on arthroscopy reports? What about the presence of all of these probes, shavers, and other instruments in such a small area?
 

Another interesting question is, perhaps, what are the benefits of arthroscopy? What is meant by this question is, does arthroscopy produce immediate pain relief, often experienced after the surgery, or are these results from the joint being flushed?
 

Early Arthroscopic Complications
The most common complication is bleeding into the joint after the arthroscopy. This is expected because the knee joint is pumped with 100 milliliters of fluid and then three large probes are inserted. Infection accounted for 12.1 percent of the complications and blood clots (thromboembolic disease) accounted for 6.9 percent.

It should be noted that specific kinds of arthroscopic procedures have their own kinds of complications. For instance, in ACL reconstruction (ligament reconstruction of the knee) all of the following types of complications have been reported: hemarthrosis, hematoma (blood clot), sepsis, skin necrosis, arthrofibrosis (excessive scar tissue), deep venous thrombosis (vein blood clot), recurrent effusion (fluid keeps filling in the knee), sensory nerve injury, reflex sympathetic dystrophy (formation of severe chronic knee pain), tourniquet paralysis, tissue irritation over a metallic device, and compartmental syndrome.
 

The most common complication in ACL reconstruction, however, is arthrofibrosis, resulting in loss of flexion, extension, or both. This means that, after the arthroscopy, the person cannot move the knee normally. It is fibrosed, or scarred down, so normal movement is not possible. The incidence of this has been shown to be as high as 3.7 percent. ACL reconstruction complications also occur due to use of the synthetic or natural grafts. Some people react to both the synthetic and natural grafts and reject them.
 

Shoulder arthroscopy is also fraught with complications. Complications have included nerve injury, Rotator Cuff tear, as well as the usual hemarthrosis and infections.
 

One of the most common arthroscopic procedures is partial meniscectomy, which has a high rate for development of long-term arthritis because of the high pressures generated on the tibial cartilage when the meniscus is removed. Anterior cruciate ligament (ACL) reconstruction is not much better, with a high percentage of athletes not returning to their presurgerical level of athletics, even after a year of rehabilitation. Shoulder arthroscopic surgery is also not very effective at getting the athlete back to playing their sport either, especially if the shoulder joint has some instability. The reason for all of these suboptimal outcomes is because arthroscopy does not heal anything. Arthroscopy typically involves looking into the joint and shaving or removing tissue. This has nothing to do with repairing the damaged area. Even putting in artificial ligaments and tendon grafts, though helpful for some, is not truly repairing the area. Only Prolotherapy, by stimulating the actual proliferation (growth) of normal collagen tissue, will start the normal repair process of the injured ligaments and tendons. It is for this reason that many athletes are saying the verdict is in--say nope to scope and yes to Prolotherapy.

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The information on this website is presented as information only and not a self-help guide NOR AS SPECIFIC HEALTH RECOMMENDATIONS. Never alter or change your health management or begin any new health plans without first consulting your personal health care provider. Some statements on this site regarding the value of nutritional supplements have not been evaluated by the FDA.

As with any medical technique, Prolotherapy may not be effective for every individual and there are risks involved, these risks should be discussed with your physician. Results achieved with some may not be typical of all. Please consult a physician. Please read Prolotherapy Risks

There is no known cure for arthritis. Prolotherapy and nutritional supplements can help alleviate, reverse, or end arthritic pain by treating an underlying cause that contributes to degenerative disease, ligament laxity. Strengthening ligaments and other connective tissue can help prevent bone on bone arthritis from developing.

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