Meniscus tears are one of the most common causes of knee pain in active adults and aging athletes alike. If you’ve been told you have a “degenerative meniscus tear,” you may have also heard that surgery isn’t always the best option—and that’s increasingly supported by medical research, with outcomes after arthroscopic partial meniscectomy shown to be no better than those after a sham surgical procedure (Sihvonen et al, 2013).

In recent years, intra-meniscal biologic injections, particularly platelet-rich plasma (PRP), have emerged as a promising non-surgical treatment aimed at reducing pain, improving function, and potentially delaying or avoiding surgery. A 2024 systematic review published in the Journal of Orthopaedics provides the most comprehensive summary to date of how PRP performs for degenerative meniscus tears (Elphingstone et al, 2024).

This article explains what intra-meniscal biologic injections are, how they work, who may benefit most, and what the current evidence actually shows—without hype or exaggeration.

Understanding Degenerative Meniscus Tears

The meniscus is a crescent-shaped cartilage structure that helps absorb shock and distribute load in the knee. Over time, repetitive stress, reduced blood supply, and age-related tissue changes can lead to degenerative meniscus tears, even without a specific injury.

Unlike traumatic tears in young athletes, degenerative tears:

• Often develop gradually
• Commonly occur in adults over 40
• Frequently coexist with early cartilage wear or osteoarthritis
• May cause pain, swelling, clicking, or stiffness

Importantly, large studies have shown that arthroscopic surgery for degenerative meniscus tears often provides little long-term benefit and may accelerate knee osteoarthritis. Research for nearly two decades has consistently shown that arthroscopic meniscus surgery may accelerate knee degeneration rather than prevent it.

• New England Journal of Medicine (Sham-Controlled Trial)

• Sihvonen et al. (2013)
  A high-quality randomized trial in the New England Journal of Medicine compared arthroscopic partial meniscectomy to a sham (placebo) surgery in middle-aged adults with painful degenerative medial meniscus tears but no radiographic knee osteoarthritis. Patients in both the real meniscus surgery group and the sham group experienced similar improvements in pain and function, with no significant advantage seen from removing meniscal tissue. This suggests that for many people with degenerative meniscus tears, the symptom relief often attributed to surgery may be largely a placebo effect or due to natural improvement over time.
• Boyd & Gradisar (2016)
  A large study of 68,090 patients older than 50 years in Orthopedics, found that knee replacement occurred surprisingly often within just a few years after arthroscopic meniscus surgery. About 10% of patients required knee replacement within one year, increasing to nearly 16% by three years.
• Rongen et al. (2017)
  In Osteoarthritis and Cartilage, researchers reported that arthroscopic meniscus surgery tripled the risk of eventually needing a knee replacement. Rather than slowing joint degeneration, surgery appeared to accelerate progression toward end-stage arthritis. These findings challenged the idea that meniscus surgery protects the knee in degenerative cases and supported more conservative treatment strategies.
• Collins et al. (2022)
  In this MRI-based study in Arthritis & Rheumatology, patients treated with arthroscopic partial meniscectomy versus physical therapy. Both groups developed osteoarthritis over time, but patients who were treated surgically showed faster and more widespread joint damage within the first 18 months, including cartilage loss, swelling, and bone spur formation. The researchers concluded that meniscus surgery is linked to early, rapid structural knee deterioration, rather than long-term joint preservation.

This has shifted treatment strategies toward non-operative and biologic approaches.

What Are Intra-Meniscal Biologic (PRP) Injections?

Platelet-rich plasma (PRP) is created from a small sample of your own blood. After centrifugation, the plasma portion contains a higher concentration of platelets, which release growth factors involved in tissue repair and inflammation modulation.

PRP can be delivered in several ways:

• Intra-articular (IA): injected into the knee joint
• Intra-meniscal (IM): injected directly into the meniscus tear under ultrasound guidance
• Combined IA + IM: addressing both the joint environment and the meniscus itself

How PRP May Help Meniscus Healing

Laboratory and animal studies provide a biologic rationale for PRP use in meniscal pathology. PRP has been shown to:

• Promote meniscal cell proliferation and migration (Freymann et al., 2016; Howard et al. 2014; Xu et al, 2020)
• Increase extracellular matrix production (Howard et al. 2014; Wong et al, 2017)
• Reduce inflammatory cytokines and catabolic enzymes (Hunter et al. 2022; Qi et al, 2021; Wang et al, 2015)
• Support angiogenic signaling in poorly vascularized tissue (Hagmeijer et al, 2021; Xu et al, 2020)

In simpler terms, PRP may help shift the meniscus from a degenerative, inflammatory state toward a more reparative one .

What Does the Clinical Evidence Show?

The 2024 systematic review by Elphingstone et al. analyzed 10 human clinical studies involving 686 patients treated non-operatively with PRP for degenerative meniscus tears .

Key Findings at a Glance

Across multiple studies:

• Pain and function improved by 3 months in most patients
• Improvements often persisted for 12 months or longer
• Many patients avoided or delayed meniscus surgery
• Complications were rare and generally limited to temporary injection-site discomfort

Pain Relief and Function

Patients treated with PRP consistently reported:

• Lower pain scores (VAS or NRS)
• Improved knee function (KOOS, Lysholm, IKDC scores)
• Better ability to return to daily activities and sports

Some studies showed benefits lasting up to 2–3 years, especially when multiple PRP injections were used.

Intra-Meniscal vs Intra-Articular PRP: Does Location Matter?

One important insight from the Elphingstone et al. review is that how PRP is delivered matters.

• Intra-articular PRP alone reliably improves pain and function, especially in early degenerative cases
• Intra-meniscal PRP may better target the tear itself and has been associated with:
  • Higher rates of MRI-documented stability or partial healing
  • Lower failure rates compared to control treatments
  • Greater “arthroscopy-free survival” (fewer patients needing surgery later)

Studies using combined intra-articular + intra-meniscal injections showed some of the most durable improvements, suggesting a complementary effect .

Who Is the Best Candidate?

Intra-meniscal biologic injections may be most effective for patients who:

• Have degenerative (non-traumatic) meniscus tears
• Have mild or no knee osteoarthritis
• Want to avoid or delay surgery
• Have persistent symptoms despite physical therapy
• Are active adults seeking function rather than quick surgical fixes

Patients with advanced arthritis, large displaced tears, or mechanical locking may still require surgical evaluation.

Safety and Recovery

Across all studies reviewed:

• No serious complications were reported
• Most patients experienced only temporary soreness
• NSAIDs were typically avoided around the time of injection
• Return to activity was gradual and guided

Ultrasound guidance improves injection accuracy and safety, particularly for intra-meniscal delivery.

As research continues to refine dosing, technique, and patient selection, biologic treatments like PRP are increasingly becoming part of modern, tissue-preserving knee care.

If you’ve been told “nothing can be done except surgery,” it may be worth discussing whether a biologic, image-guided approach is right for you.

References:

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Collins JE, Shrestha S, Losina E, Marx RG, Guermazi A, Jarraya M, Jones MH, Levy BA, Mandl LA, Williams EE, Wright RW, Spindler KP, Katz JN; METEOR Investigator Group. Five-Year Structural Changes in the Knee Among Patients With Meniscal Tear and Osteoarthritis: Data From a Randomized Controlled Trial of Arthroscopic Partial Meniscectomy Versus Physical Therapy. Arthritis Rheumatol. 2022 Aug;74(8):1333-1342.

Elphingstone JW, Alston ET, Colorado BS. Platelet-rich plasma for nonoperative management of degenerative meniscal tears: A systematic review. J Orthop. 2024 Mar 12;54:67-75.

Freymann U, Metzlaff S, Krüger JP, Hirsh G, Endres M, Petersen W, Kaps C. Effect of Human Serum and 2 Different Types of Platelet Concentrates on Human Meniscus Cell Migration, Proliferation, and Matrix Formation. Arthroscopy. 2016 Jun;32(6):1106-16.

Hagmeijer MH, Korpershoek JV, Crispim JF, Chen LT, Jonkheijm P, Krych AJ, Saris DBF, Vonk LA. The regenerative effect of different growth factors and platelet lysate on meniscus cells and mesenchymal stromal cells and proof of concept with a functionalized meniscus implant. J Tissue Eng Regen Med. 2021 Jul;15(7):648-659.

Howard D, Shepherd JH, Kew SJ, Hernandez P, Ghose S, Wardale JA, Rushton N. Release of growth factors from a reinforced collagen GAG matrix supplemented with platelet rich plasma: Influence on cultured human meniscal cells. J Orthop Res. 2014 Feb;32(2):273-8.

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Rongen JJ, Rovers MM, van Tienen TG, Buma P, Hannink G. Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2017 Jan;25(1):23-29.

Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369(26):2515-24.

Qi Y, Tang R, Shi Z, Feng G, Zhang W. Wnt5a/Platelet-rich plasma synergistically inhibits IL-1β-induced inflammatory activity through NF-κB signaling pathway and prevents cartilage damage and promotes meniscus regeneration. J Tissue Eng Regen Med. 2021 Jul;15(7):612-624.

Wang CC, Lee CH, Peng YJ, Salter DM, Lee HS. Platelet-Rich Plasma Attenuates 30-kDa Fibronectin Fragment-Induced Chemokine and Matrix Metalloproteinase Expression by Meniscocytes and Articular Chondrocytes. Am J Sports Med. 2015 Oct;43(10):2481-9.

Wong CC, Kuo TF, Yang TL, Tsuang YH, Lin MF, Chang CH, Lin YH, Chan WP. Platelet-Rich Fibrin Facilitates Rabbit Meniscal Repair by Promoting Meniscocytes Proliferation, Migration, and Extracellular Matrix Synthesis. Int J Mol Sci. 2017 Aug 7;18(8):1722.

Xu H, Zou X, Xia P, Aboudi MAK, Chen R, Huang H. Differential Effects of Platelets Selectively Activated by Protease-Activated Receptors on Meniscal Cells. Am J Sports Med. 2020 Jan;48(1):197-209.