Marc Darrow MD,JD

I have written a few articles on this website on the subject of meniscus tears. In this article I want to more focus on the golfer and his/her meniscus tear. There is not much by way of research specific to meniscus tears in golfers. Most of the literature surrounding the knee in golfers relates to how fast can I play after knee replacement and “will I be better than before because my knee is fixed?” You can read that article here: Can stem cell therapy help you play golf again? Golf, stem cells and knee replacement.

Must I have surgery to play golf again? 

For some people the answer maybe yes, for some people maybe no. When there is a meniscus injury that is significant enough that you can not straighten your leg or your knee is locked in a semi bent position, a surgical option may need to be explored. One of the problems with the surgery is that for many people, no matter if they have had an MRI or not, the surgeons does not know what to expect or do until they are actually in your knee and looking around. So you will get recommended to a knee arthroscopy and once inside the surgeon will look to repair what he/she can or take out what they think cannot be repaired and you will have a Partial Meniscectomy, a complete meniscectomy, or a suture repair if the tissue is “sew able.”

Playing golf by making adjustments

There are many websites that will offer various guidelines to playing golf with a meniscus tear. These will include recommendations for warm ups, stretching, yoga, playing the short game and avoiding long drives as the force and twist required my tear the meniscus again or aggravate the condition.

A study in the publication Sports biomechanics (1):

“Knee injuries in golf comprise approximately 8% of all injuries, and are considered to result from overuse, technical faults or a combination of those factors. . .  The golf swing generates forces and torques which tend to cause internal or external rotation of the tibia on the femur, and these are resisted by the knee ligaments and menisci. Research has shown that both maximum muscle forces and the forces sustained during a golf swing are less than that required to cause damage to the ligaments. However, the complex motion of the golf swing, involving both substantial forces and ranges of rotational movement, demands good technique if the player is to avoid injuring their knee joint. Most knee injury in golf is likely related to joint laxity, previous injuries or arthritis, and such damage may be exacerbated by problems in technique or overuse. In addition to appropriate coaching, strategies to remedy discomfort include specific exercise programs, external bracing, orthotics and equipment choices.”

In the above study one way to help your knee and your meniscus problem is to develop a good technique.

the complex motion of the golf swing, involving both substantial forces and ranges of rotational movement, demands good technique if the player is to avoid injuring their knee joint.”

It’s the front knee that takes the load

Here is a December 2017 paper (2) on risk factors for knee injury in golf

“A knee injury prevalence of 3-18% was established among both professional and amateur players, with no clear dependence on skill level or sex; however, older players appear at greater risk of injury. Studies reporting kinematics indicate that the lead knee is exposed to a complex series of motions involving rapid extension and large magnitudes of tibial internal rotation, conditions that may pose risks to the structures of a natural knee or (a total knee replacement). To date, the loads experienced by the lead knee during a golf swing have been reported inconsistently in the literature. Compressive loads ranging from 100 to 440% bodyweight have been calculated and measured using methods including inverse dynamics analysis and instrumented knee implants. Additionally, the magnitude of loading appears to be independent of the club used.”

What the researchers are suggesting is simply:

  • Tibial internal rotation (how the large shin bone rotates within the knee) may risk the meniscus and other knee structures.
  • The load of this rotation can be up to 440% of body weight. That means a golfer who weighs 150 pounds can put force on his/her knee equivalent to that of a 660 pound human. This is why your knee may swell – to provide a cushion.
  • It is your lead knee taking the brunt of this.

The researchers concluded: “recommendations regarding return to golf following knee injury or surgical intervention should carefully consider the laterality (the load on the front knee) of the injury.”

Treatments for your  knee pain

It used to be that if a doctor told you, “I’m recommending arthroscopic surgery to clean up your knee” or “You need a total knee replacement,” you had just two choices: surgery or painkillers.
With the advent of “biomedicine” (blood and stem cell therapies and injections), the choices have changed dramatically. From this point of view, arthroscopic surgery is now seen as the least desirable option, and knee replacement something that should be delayed as long as possible. Stimulating the growth of cartilage and damaged or worn tissue is now seen as the most desirable option.

Can stem cell therapy regenerate meniscus tissue?

For many people, the long rehabilitation, possible need for secondary surgery, and other post-surgical factors weigh heavily in their decision making process as to how to proceed to fix their meniscus tear. For many people, regenerative medicine in the form of stem cell therapy may be something to be explored.

  • New research into the healing world of the knee meniscus is fascinating. Despite decades of traditional medical beliefs that because of its poor or even absent network of blood vessels and blood supply, parts of the knee meniscus cannot heal. Researchers are discovering the meniscus is in fact, always trying to heal itself.
  • HOWEVER, the expectation that stem cell therapy can regrow a meniscus from nothing or regenerate extensive amounts of meniscus tissue removed in meniscectomy must be tempered with a realistic expectation of what these treatments can and cannot do.
  • Stem cell therapy for meniscus tears can help repair deficits in the existing meniscus.
  • Stem cell therapy when administered as a multi-injection treatment as opposed to a single one-time shot, can also help support, rebuild, and stabilize the knee capsule and help restore a more normal knee function. A more normal knee function can remove stress from the meniscus and other supportive knee tissue such as ligaments and tendons.
  • What your realistic expectation of what stem cell therapy can do for your meniscus tear must be discussed with a doctor knowledgeable and experienced in the treatment.

Bone Marrow Stem Cell Knee treatment

Marc Darrow, MD., JD. is the medical director and founder of the Darrow Stem Cell Institute in Los Angeles, California. With over 23 years experience in regenerative medicine techniques and the treatment of thousands of patients, Dr. Darrow is considered a leading pioneer in the non-surgical treatment of degenerative Musculoskeletal Disorders and sports related injuries.

Do you have questions about your knee pain? Ask Dr. Darrow

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Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References

1 Marshall RN, McNair PJ. Biomechanical risk factors and mechanisms of knee injury in golfers. Sports biomechanics. 2013 Sep 1;12(3):221-30.
2 Baker ML, Epari DR, Lorenzetti S, Sayers M, Boutellier U, Taylor WR. Risk factors for knee injury in golf: A systematic review. Sports Medicine. 2017 Dec;47(12):2621-39.

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