Ayurvedic Management of Meniscal Injuries Around The Knee- A Case Study

172 International Journal of Advance and Applied Research www.ijaar.co.in ISSN – 2347-7075 Impact Factor – 8.141 Peer Reviewed Bi-Monthly Vol. 12 No. 6 July – August 2025 Ayurvedic Management of Meniscal Injuries Around The KneeA Case Study Dr. Sarika1, Dr. Chandramouleeswaran P2, Sakunthala Priya Suresh Kumar3, Saraswathi. S3 1Assistant Professor, Department of Shalya Tantra, Ayurveda College and Hospital, Coimbatore 2Professor, Principal, Ayurveda College & Hospital, Coimbatore 3Undergraduate Scholar, Ayurveda College and Hospital, Coimbatore Corresponding Author - Dr. Sarika DOI - 10.5281/zenodo.17512740 Abstract: The knee joint is a complex synovial hinge that is central in supporting body weight, enabling stability and smooth movement. The cartilage in the knee, the meniscus, which cushions the joint and distributes the weight is prone to frequent injury due to repetitive stress, degeneration and sudden twisting and pivoting. Generally, the management includes rest, NSAIDS or surgery. However, Ayurveda involves a way less invasive approach and this single case study is an effort to manage the injuries of meniscus with simple yet effective Upanaham, Lepam and Cupping therapy. In a period of 15 days, there was a significant reduction in pain and swelling. Objectives: To treat patients with acute meniscal injuries with simple, effective, non-invasive Ayurvedic treatments in a short duration and provide effective relief. Methodology: A single case study of a 45-year-old patient diagnosed with meniscus injury was prescribed internal medication and was treated with ayurvedic procedures such a Lepam, Upanaham and also cupping therapy. Result: Significant improvement in pain, swelling and stiffness Conclusion: Ayurvedic management proved effective in the treatment of acute meniscal injury of knee. Keywords: Cupping Therapy, Lepam, Meniscal Injury, Upanaham. Introduction: In terms of gross anatomy, the menisci are C-shaped or semicircular fibrocartilaginous structures with bony attachments at the anterior and posterior aspects of the tibial plateau [1] present in the knee, wrist, temporomandibular, acromioclavicular and sternoclavicular joints of the human body. It is concave at the top and flat at the bottom with a small depression in the middle called fossa. The menisci around the knee joint helps to disperse the body weight and to reduce the friction during locomotion. The mean annual incidence of meniscal tears is about 60-70 per 100,000 with a male to female ratio ranging from 2.5:1 to 4:1. The reason why meniscal tears are so common is, the wear and tear of knees as the age progresses, obesity and more athletic activities [2]. Patient may present with pain, jerk on IJAAR Vol.12 No.6 ISSN – 2347-7075 Dr. Sarika, Dr. Chandramouleeswaran P, Sakunthala Priya Suresh Kumar, Saraswathi. S 173 walking, swelling and restricted range of movements. Management [3]: The current management of meniscal injury includes PRICE method (protection, rest, ice, compression, elevation) and surgical methods like Arthroscopic meniscus suturing, partial meniscectomy and meniscus replacement. In cases of locking, manipulation under general anesthesia, immobilization for 2 to 3 weeks and physiotherapy are viable options. A meniscal tear with non-surgical management takes around 6-8 weeks to heal, adequate rest being the key factor for faster recovery. Meniscal Injury in Ayurveda: There is no exact reference of meniscal tear in ayurveda but it can be correlated with abhighataja sandhigata vatam and the treatment adapted is similar to that of vata vyadhi chikitsa. The treatment mainly focuses on healing the meniscal injury, promoting strength to the surrounding areas and balancing vata dosha. Through this article an attempt is made to bridge the gap between the existing knowledge and clinical efficacy in treating meniscal tear through Ayurveda. Case History: A 45-year-old female patient, came to Shalya Tantra department, of Ayurveda college and Hospital, Coimbatore with complaints of severe shifting type of pain and swelling over left knee post an injury during a sports activity a day before. Patient consulted an allopathic physician and was prescribed T.Ezact 6mg, T.Panpraz 40mg, Tapol er 50 for a period of 3days. On examination, notable swelling over anteromedial aspect of left knee was observed with no bruising or deformity. Flexion and extension were restricted due to pain and there was localized tenderness, with mild increase in temperature over left knee. McMurray’s test and Apley’s test were positive for the left knee. An MRI scan was then suggested. MRI Findings: Partial tear of medial patellar with menisco capsular separation, Focal complex tear in outer rim of anterior horn of medial meniscus, grade 1 injury of posteromedial structure, and moderate haemarthrosis of knee joint. Patient was diagnosed with meniscus tear on the basis of MRI report. Treatment Protocol: Internal Medication: 1.Mustadhi marma kashayam 15ml with 45ml warm water twice before food 2.Bonton granules – 1tsp with milk at night 3.T.lakshadi guggulu 1-1-1 after food IJAAR Vol.12 No.6 ISSN – 2347-7075 Dr. Sarika, Dr. Chandramouleeswaran P, Sakunthala Priya Suresh Kumar, Saraswathi. S 174 External Treatment: SI.NO NO.OF DAYS TREATMENT MEDICINES OBSERVATION 1 Day 1 and 2 Sthanika dhara Lepam Dhanyamla Jadamayadhi churnam + dhanyamla Tenderness reduced 2 3rd day Lepam Cupping therapy(wet) Sthanika dhanyamla dhara Jadamayadhi churnam + dhanyamla Slight relief in pain Stiffness persisted Swelling reduced 3 DAY 4 to 14 Upanaham Ajamamsa, egg, masha, murivenna and eranda patra for bandaging. Profound relief from pain. Stiffness and swelling. The treatment was given for a period of 14 days (26.11.2024 – 10.12.2024) comprising of sthanika dhanyamladhara and lepam for first three days followed by cupping therapy on the third day. From days 4 to 14, upanaham with bandhanam were performed. Result: S.NO SYMPTOMS BEFORE TREAMENT AFTER TREATMENT 1 Pain Severe shifting type of pain 90% reduction of pain 2 Swelling Present Mild swelling 3 Stiffness Present Reduced 4 Range of motion Flexion restricted due to pain Extension not possible Flexion possible without pain Extension possible with mild pain Discussion: Arthroscopic partial meniscectomy (APM) has been the gold standard treatment for meniscal injuries in the last few years. However, statistically no significant difference between the APM and placebo surgery for symptomatic patients with a degenerative meniscus tear and no osteoarthritis (OA) in any of the used outcome measures over the course of 24month follow-up were observed [4], A meniscal repair is an effective alternative option without the adverse effects of partial and total meniscectomy. Although the short- IJAAR Vol.12 No.6 ISSN – 2347-7075 Dr. Sarika, Dr. Chandramouleeswaran P, Sakunthala Priya Suresh Kumar, Saraswathi. S 175 term outcome of meniscus repair shows less than a 10% failure rate at a two-year followup, the long-term failure rates have stayed consistent between 23% and 30% despite using various techniques [5] While in Ayurveda, the combination of upanaham, lepam and cupping therapy, simple outpatient procedures with no major complication, are effective in management of meniscal injury. Upanaham, one of the Sapta upakrams (seven treatments) mentioned in Sushrutha sutra sthana , is a kind of sudation therapy effective in swelling and pain. It is the localized application of the medicated paste, prepared with ajamamsa(meat of goat), egg, masha churnam (black gram powder), murivenna and finally bandaging with eranda pathra (leaves of castor)offers prevention of loss of heat, increased effective absorption of active ingredients through a long duration contact of medicine with the affected area and presence of solubility enhancer. Goat meat, that is homologous to human body muscle is guru and brhmana [6](heavy and nourishing). On topical application it may promote the production of flaggirin and aquaporin, improving the skin barrier and providing anti-inflammatory action [7]. Egg with its cholesterol-rich composition, is readily absorbed into the skin, and is deeply hydrating. Black gram powder is snigdha(unctuous) and ushna(hot) and balances vata dosha to a great extent [6].Murivenna contains phytochemicals such as alkaloids, glycosides, Tannins, saponins and steroids that support natural wound healing (8)Kera tailam (coconut oil), karanja (pongamia glabra), tuka( spermacoce articularis), thambula (piper bettle), kumari (alovera), Shigru (moringa olifera), palandu(allium cepa), kanjika(fermented liquid), shatavari (Asperagus racemosus)in Murivenna provides relief from pain, swelling and sprain. Eranda patra used to cover the joints ensures continuous fomentation during the procedure. Dhanyamla dhara by nature is Ushna Rooksha thus causing Vata Kaphahara (9) and can bring the Dosha back from Shaakha to Koshta, thus showing evident reduction in symptoms of pain and swelling (10). Ingredients such as Brahmi (Bacopa monnieri), Turushka(Hydnocarpus laurifolia), Pushkaramoola(Inula racemose), Tagara (Valeriana jatamansi), Aswagandha (Withania somnifera) Usira (Vetiveria zizanioides) Rasna (Alpinia galangal) Sarala (Pinus longifolia) in Jadamayadhi churnam [7]when used as lepam with dhanyamla (fermented rice water)helps in reducing the inflammation and swelling and also helps in relieving the pain effectively. In cupping therapy, the vacuum created facilitates the movement of stagnated blood, improving blood circulation. This is particularly relevant in cases of joint injuries where heamarthrosis is present. This also helps to relax the muscles surrounding the knee joint which can reduce pain and stiffness. Conclusion: Treatments like lepam, upanaham, dhanyamla dhara and cupping therapy along with internal medications proved excellent in cases of acute meniscal tear of knee joint in a short duration. Future studies should IJAAR Vol.12 No.6 ISSN – 2347-7075 Dr. Sarika, Dr. Chandramouleeswaran P, Sakunthala Priya Suresh Kumar, Saraswathi. S 176 explore controlled studies comparing ayurvedic management with conventional treatments. And a larger cohort and a long term study to establish standardized protocol for ayurvedic interventions in orthopedic cases. References: 1. Amendola, A., Bonasia, D.E. (2012). The menisci: Anatomy, healing response, and biomechanics. In: The Knee Joint. Springer, Paris. https://doi.org/10.1007/978-2-28799353-4_1 2. Chambers, Henry G. MD*; Chambers, Reid C. DO†. The Natural History of Meniscus Tears. Journal of Pediatric Orthopaedics 39():p S53-S55, July 2019. | DOI: 10.1097/BPO.0000000000001386 3. Doral MN, Bilge O, Huri G, Turhan E, Verdonk R. Modern treatment of meniscal tears. EFORT Open Rev. 2018 May 21;3(5):260-268. doi: 10.1302/2058-5241.3.170067. PMID: 29951265; PMCID: PMC5994634. 4. Sihvonen R, Paavola M, Malmivaara A, et al.: Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2year follow-up of the randomised controlled trial. Ann Rheum Dis. 2018, 77:18895. 10.1136/annrheumdis-2017211172 5. Luvsannyam E, Jain MS, Leitao AR, Maikawa N, Leitao AE. Meniscus Tear: Pathology, Incidence, and Management. Cureus. 2022 May 18;14(5):e25121. doi: 10.7759/cureus.25121. PMID: 35733484; PMCID: PMC9205760. 6. Ashtanga Hrudaya Sutra Sthana Chapter 6: Annaswarupa Vijnaniyam Adhyayam , mamsa vargam, ajamamsa guna, page 72 7. Bae IS, Hoa VB, Lee JA, Park WS, Kim DG, Kim HW, Seong PN, Ham JS. Skin Function Improvement and Anti-Inflammatory Effects of Goat Meat Extract. Foods. 2024 Dec 5;13(23):3934. doi: 10.3390/foods13233934. PMID: 39683006; PMCID: PMC11641237. 8. 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