Human meniscus transplantation

Peripheral fixation of meniscal allograft does not reduce coronal extrusion under physiological load

PURPOSE

Meniscal graft extrusion is a concern following meniscal allograft transplantation (MAT). MAT surgical techniques continue to evolve in an effort to reduce extrusion; however, improvements remain difficult to measure in vivo. A novel MRI-compatible in vitro loading device capable of applying physiologically relevant loads has been developed, allowing for the measurement of extrusion under a variety of controllable conditions. The objective of this study was to compare maximal medial MAT extrusion (1) with and (2) without an additional peripheral third point of fixation on the tibial plateau.

METHODS

Twelve human cadaveric knees underwent medial MAT, utilizing soft tissue anterior and posterior root fixation via transosseous suture, with a third transosseous suture tied over a button providing peripheral fixation on the tibial plateau. The joint was positioned at 5 degrees of flexion and loaded to 1 × body weight (647.7 ± 159.0 N) during MR image acquisition, with and without peripheral fixation. The joint was then positioned at 30 degrees of flexion and the process was repeated. Maximal coronal extrusion was measured.

RESULTS

An increase in maximal coronal meniscal extrusion was noted between the unloaded and loaded states. At 30 degrees of flexion, with the addition of a peripheral fixation point, a statistically significant difference in absolute extrusion (p = 0.02) and relative percent extrusion (p = 0.04) between the unloaded and loaded state was found. The addition of a peripheral fixation suture resulted in an overall mean percent difference of - 2.49% (SD 14.1; 95% CI - 11.95, 6.97; n.s.) in extrusion at 5 degrees of flexion and a mean percent difference of - 0.95% (SD 7.3; 95% CI - 5.62, 3.71; n.s.) in extrusion at 30 degrees of flexion. These differences were not statistically significant.

CONCLUSION

These results suggest that the addition of a peripheral anchor in medial MAT does not reduce the amount of maximal coronal extrusion and, therefore, may not confer any clinical benefit. Surgical techniques utilized to reduce MAT extrusion need further investigation to understand if the added technical difficulty and potential expense is warranted.

Meniscal Preservation is Important for the Knee Joint

Native joint preservation has gained importance in recent years. This is mostly to find solutions for limitations of arthroplasty. In the knee joint, the menisci perform critical functions, adding stability during range of motion and efficiently transferring load across the tibiofemoral articulation while protecting the cartilage. The menisci are the most common injury seen by orthopedicians, especially in the younger active patients. Advances in technology and our knowledge on functioning of the knee joint have made meniscus repair an important mode of treatment. This review summarizes the various techniques of meniscus tear repair and also describes biological enhancements of healing.

The cryopreservation of composite tissues: Principles and recent advancement on cryopreservation of different type of tissues

Cryopreservation of human cells and tissue has generated great interest in the scientific community since 1949, when the cryoprotective activity of glycerol was discovered. Nowadays, it is possible to reach the optimal conditions for the cryopreservation of a homogeneous cell population or a one cell-layer tissue with the preservation of a high pourcentage of the initial cells. Success is attained when there is a high recovery rate of cell structures and tissue components after thawing. It is more delicate to obtain cryopreservation of composite tissues and much more a whole organ. The present work deals with fundamental principles of the cryobiology of biological structures, with special attention to the transfer of liquids between intra and extracellular compartments and the initiation of the formation and aggregation of ice during freezing. The consequences of various physical and chemical reactions on biological tissue are described for different cryoprotective agents. Finally, we report a review of results on cyropreservation of various tissues, on the one hand, and various organs, on the other. We also report immunomodulation of antigenic responses to cryopreserved cells and organs.

The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures

This paper reports a series of comparative tests in vitro, that examined how meniscectomy and meniscal allografting affected tibio-femoral joint contact pressure. Knees were loaded in axial compression and pressure maps obtained from the lateral compartment using Fuji Prescale film inserted below the meniscus. This was repeated after meniscectomy, and then after meniscal allografting with fixation by a bone plug for the insertional ligaments, plus sutures. Finally, the pressure, when the allograft was secured by sutures alone, was measured. The peak pressure rose significantly after meniscectomy, and then was reduced significantly by both allograft methods so that it was not significantly different to normal. Allografts fixed by sutures only allowed slightly higher contact pressure than when they had bone fixation. This study suggests that meniscal allografting should have a chondroprotective effect and that there is a small advantage from adding bony fixation to suture fixation.