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Bian Y, Cai X, Zhou R, Lv Z, Xu Y, Wang Y, Wang H, Zhu W, Sun H, Zhao X, Feng B, Weng X. Advances in meniscus tissue engineering: Towards bridging the gaps from bench to bedside. Biomaterials 2025; 312:122716. [PMID: 39121731 DOI: 10.1016/j.biomaterials.2024.122716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/12/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
Meniscus is vital for maintaining the anatomical and functional integrity of knee. Injuries to meniscus, commonly caused by trauma or degenerative processes, can result in knee joint dysfunction and secondary osteoarthritis, while current conservative and surgical interventions for meniscus injuries bear suboptimal outcomes. In the past decade, there has been a significant focus on advancing meniscus tissue engineering, encompassing isolated scaffold strategies, biological augmentation, physical stimulus, and meniscus organoids, to improve the prognosis of meniscus injuries. Despite noteworthy promising preclinical results, translational gaps and inconsistencies in the therapeutic efficiency between preclinical and clinical studies exist. This review comprehensively outlines the developments in meniscus tissue engineering over the past decade (Scheme 1). Reasons for the discordant results between preclinical and clinical trials, as well as potential strategies to expedite the translation of bench-to-bedside approaches are analyzed and discussed.
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Affiliation(s)
- Yixin Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xuejie Cai
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Runze Zhou
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yiming Xu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yingjie Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Han Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hanyang Sun
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiuli Zhao
- Department of Medical Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Li W, Luo Y, Zhao X, Wang J. Meniscal Allograft versus Synthetic Graft in Treatment Outcomes of Meniscus Repair: A Mini-review and Meta-analysis. ACS Biomater Sci Eng 2024; 10:4757-4770. [PMID: 39042061 DOI: 10.1021/acsbiomaterials.4c00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Meniscal injuries are highly correlated with osteoarthritis (OA) onset and progression. Although meniscal allograft transplantation (MAT) is a therapeutic option to restore meniscal anatomy, a shortage of donor material and the donor-derived infectious risk may be concerns in clinics. This review summarizes the literature reporting meniscus repair status in preclinical models and clinical practice using allografts or synthetic grafts. The advantages and limitations of biodegradable polymer-based meniscal scaffolds, applied in preclinical studies, are discussed. Then, the long-term treatment outcomes of patients with allografts or commercial synthetic scaffolds are compared. A total of 47 studies are included in our network meta-analysis. Compared with the meniscal allografts, the commercial synthetic products significantly improved clinical treatment outcomes in terms of the Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS) scores, and Lysholm scores. In addition, development strategies for the next generation of novel synthetic scaffolds are proposed through optimization of structural design and fabrication, and selection of cell sources, external stimuli, and active ingredients. This review may inspire researchers and surgeons to design and fabricate clinic-orientated grafts with improved treatment outcomes.
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Affiliation(s)
- Weirong Li
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
- Dongguan Eontec Co., Ltd., Dongguan 523808, P. R. China
| | - Ying Luo
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Xibang Zhao
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Jiali Wang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
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Dong J, Huang M, Lin J, Sun Y, Zhang X, Chen J. Outcome comparison of meniscal allograft transplantation (MAT) and meniscal scaffold implantation (MSI): a systematic review. Int J Surg 2024; 110:5112-5123. [PMID: 38742839 PMCID: PMC11325955 DOI: 10.1097/js9.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Although numerous studies have reported successful clinical outcomes of meniscal allograft transplantation (MAT) or meniscal scaffold implantation (MSI), the difference between the outcome of MAT and MSI remains unclear. PURPOSE To compare the overall outcomes and survival rates of MAT and MSI, aiming to provide comprehensive evidence for determining the optimal treatment strategy for meniscal defects. METHODS A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of MAT or MSI were included according to the inclusion and exclusion criteria. The Lysholm score was chosen as the primary outcome measure, while secondary outcomes encompassed patient-reported outcome measures (PROMs), return to sports (RTS) rates, survival rates, and complication rates. The outcomes were stratified into two groups: MAT group and MSI group, followed by statistical comparison ( P <0.05). The quality of the included studies was assessed by the Cochrane Risk of Bias 2 (RoB2) assessment tool for randomized controlled trials (RCTs) and the Coleman Methodology Score (CMS) for non-randomized controlled trials. RESULTS A total of 3932 patients (2859 MAT, 1073 MSI) in 83 studies (51 MAT, 32 MSI) had the overall significant improvement in all clinical scores. The group MSI had a higher Lysholm score of both preoperative ( P =0.002) and postoperative ( P <0.001) than group MAT; however, the mean improvements were similar between the two groups ( P =0.105). Additionally, MSI had higher improvements of IKDC ( P <0.001), KOOS symptom ( P =0.010), KOOS pain ( P =0.036), and KOOS ADL ( P =0.004) than MAT. Interestingly, MAT had higher preoperative ( P =0.018) and less postoperative VAS pain ( P =0.006), which was more improved in MAT ( P <0.001). Compared with MAT, MSI had a higher 10-year survival rate ( P =0.034), a similar mid-term survival rate MAT ( P =0.964), and a lower complication rate ( P <0.001). CONCLUSION Both MAT and MSI could have good clinical outcomes after surgery with a similar improvement in Lysholm score. MSI had a higher 10-year survival rate and fewer complications than MAT. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Jize Dong
- Department of Sports Medicine, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University, Hongkou District
| | - Moran Huang
- Department of Sports Medicine, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University, Hongkou District
| | - Jinrong Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaying Sun
- Department of Sports Medicine, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University, Hongkou District
| | - Xingyu Zhang
- Department of Sports Medicine, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University, Hongkou District
| | - Jiwu Chen
- Department of Sports Medicine, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University, Hongkou District
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Inoue T, Kano T, Nakasa T, Ishikawa M, Inoue K, Kawabata S, Miyaki S, Kamei N, Adachi N. Development of a novel approach for restoration of the meniscus using silk-elastin in a rabbit meniscus injury model. BMC Musculoskelet Disord 2024; 25:545. [PMID: 39010063 PMCID: PMC11247742 DOI: 10.1186/s12891-024-07675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Limited healing potential of the meniscus remains a burden for the successful repair of meniscus injuries in the orthopaedic fields. Silk-elastin (SE) is a novel recombinant protein with favorable properties for wound healing. This proof-of-concept study aimed to investigate the therapeutic effect of silk-elastin in a rabbit meniscal defect model. METHODS A migration assay using rabbit meniscus and synovial cells with various concentrations of SE in a culture medium was conducted to investigate the mechanism of meniscal healing by SE. Additionally, cylindrical defects with a 1.5 mm diameter were created at the anterior horn of the medial meniscus of rabbits. The animals were divided into three groups: 1) the Blank group; defect only, 2) the Col I group; implantation of type I atelocollagen sponge, and 3) the SE group; implantation of SE (150 mg/ml) sponge. Whole medial menisci were harvested at 4, 8, 12, and 24 weeks after surgery. Histological analyses including immunohistochemical staining were performed to assess meniscal healing. RESULTS In vitro study, Migration assay demonstrated a significantly higher number of migrated cells only in synovial cells. Especially, the SE concentration of 10 µg/mL demonstrated the highest number of migrated cells compared with other concentrations. In vivo study, the SE group exhibited significantly higher Ishida scores than other groups at all time points. Furthermore, the SE group showed higher synovial coverage scores than the Col I group at 4 and 8 weeks. Immunohistochemical staining demonstrated higher type II collagen staining in the SE group compared to other groups at 12 weeks. Implanted SE was efficiently replaced by safranin-O staining positive tissue within 8 weeks. CONCLUSIONS SE could effectively repair a meniscal defect by inducing coverage of synovial cells. SE has the potential to be a useful material for meniscal repair.
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Affiliation(s)
- Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Toshiya Kano
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
| | - Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | - Shigeru Miyaki
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
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Torres-Claramunt R, Alós-Mairal J, Ibáñez M, Perelli S, Gelber P, Monllau JC. Clinical Outcomes After Polyurethane Meniscal Scaffolds Implantation Remain Stable Despite a Joint Space Narrowing at 10-Year Follow-Up. Arthroscopy 2024; 40:1256-1261. [PMID: 37716635 DOI: 10.1016/j.arthro.2023.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To report the clinical outcomes, radiologic evolution, and survivorship of a series of patients affected by the postmeniscectomy syndrome and treated with a polyurethane scaffold at a minimum 10-year follow-up. In addition, the radiologic evolution of these patients was also assessed. METHODS All the patients operated on with a polyurethane meniscal scaffold implantation to treat postmeniscectomy syndrome from 2008 to 2011 were prospectively followed. Clinical evaluations and radiologic studies were assessed at the preoperative period, at 5-year follow-up, and at minimum 10-year follow-up. Clinical outcomes were based on patient-reported outcomes (e.g., the Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, Lysholm, and Tegner). Radiographical evaluation of the joint-space narrowing was done in the Rosenberg view. Failure was defined as patients who required surgery to remove the scaffold or those patients who needed surgery for a total or partial knee replacement. RESULTS Twenty-one of 27 patients, with a mean age of 56 ± 9.8 years, were available for the final follow-up. The mean follow-up was 11.8 (range, 10-12.7) years. Six patients were lost to follow-up. All functional scores showed a significant improvement (P < .001) at the 5- and 10-year follow-up. The exception was the Tegner score, which remained stable. The joint-space width was maintained from the preoperative period (1.9 ± 1.2 mm) up to the 5-year follow-up (1.3 ± 1.5 mm, P = .3) and decreased by the last evaluation (0.6 ± 1.2 mm, P = .001) at the last follow-up. Two (9.5%) of 21 patients were converted to a total knee replacement during the study period. None of the other patients needed revision surgery during the study period. CONCLUSIONS The polyurethane meniscal scaffold provides significant and stable pain relief over time and improved functional outcomes at a minimum of 10 years after surgery. However, degenerative changes progressed in the treated compartment, with a joint-space narrowing over the 10-year period. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Raúl Torres-Claramunt
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Orthopaedic Department, ICATME-Institut Universitari Quirón-Dexeus, Universitat Autònoma Barcelona, Barcelona, Spain.
| | - Judith Alós-Mairal
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Spain
| | - Maximiliano Ibáñez
- Orthopaedic Department, ICATME-Institut Universitari Quirón-Dexeus, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Simone Perelli
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Spain; Orthopaedic Department, ICATME-Institut Universitari Quirón-Dexeus, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Pablo Gelber
- Orthopaedic Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Carles Monllau
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Orthopaedic Department, ICATME-Institut Universitari Quirón-Dexeus, Universitat Autònoma Barcelona, Barcelona, Spain
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Bian Y, Cai X, Wang H, Xu Y, Lv Z, Feng B, Weng X. Short-Term but Not Long-Term Knee Symptoms and Functional Improvements of Tissue Engineering Strategy for Meniscus Defects: A Systematic Review of Clinical Studies. Arthroscopy 2024; 40:983-995. [PMID: 37414105 DOI: 10.1016/j.arthro.2023.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects. METHODS A search was performed by 3 independent reviewers on PubMed, MEDLINE, EMBASE, and Cochrane from 2016 to June 18, 2023, with the term "meniscus" with all the following terms: "scaffolds," "constructs," "implant," and "tissue engineering." Inclusion criteria included "Clinical trials" and "English language articles" that involved isolated meniscus tissue engineering strategies for meniscus injuries. Only Level I to IV clinical studies were considered. The modified Coleman Methodology score was used for quality analysis of included clinical trials. The Methodological Index for Non-Randomized Studies was employed for analysis of the risk of study bias and methodological quality. RESULTS The search identified 2,280 articles, and finally 19 original clinical trials meeting the inclusion criteria were included. Three types of tissue-engineered meniscus implants (CMI-Menaflex, Actifit, and NUsurface) have been clinically evaluated for meniscus reconstruction. Lack of standardized outcome measures and imaging protocols limits comparison between studies. CONCLUSIONS Tissue-engineered meniscus implants can provide short-term knee symptom and function improvements, but no implants have been shown to propose significant long-term benefits for meniscus defects. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Yixin Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuejie Cai
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Han Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yiming Xu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Mabrouk A, Ollivier M, Fayard JM, Batailler C, Bouguennec N, Tardy N, Rochcongar G. High tibial osteotomy is equally effective for varus malaligned knees with either virgin or wrecked medial meniscus: An age and gender-matched secondary analysis of a Francophone Arthroscopy Society Symposium. Orthop Traumatol Surg Res 2023; 109:103650. [PMID: 37364820 DOI: 10.1016/j.otsr.2023.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Despite the growing concept of meniscal preservation, partial meniscectomy could be the definitive procedure in specific scenarios. And total meniscectomy was once before a frequent procedure, with current sequelae of degenerate knees. High tibial osteotomy (HTO) is an effective treatment for patients suffering from unicompartmental degenerative changes, and substantial deformities. However, it is yet to be answered, whether HTO is similarly effective in both post-meniscectomy knees and knees with not previously operated meniscus. HYPOTHESIS Outcomes of HTO is similar with or without previous history of total or subtotal meniscectomy. METHODS This study compared the clinical and radiological outcomes of 41 patients who received HTO and had no previous history of surgery in the ipsilateral knee (group I), and 41 age, and gender-matched patients who had meniscectomy surgery in the ipsilateral knee (group II). Preoperatively and postoperatively, all patients were clinically evaluated; the visual analogue scale scores, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including hip-knee-ankle angle, femoral mechanical angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were reported. RESULTS A total of 82 patients were included; group I (n=41) and group II (n=41). The mean age was 51.18±8.64 (27-68) and 90.24% were male. The duration since the onset of symptoms was longer in group II vs. group I, 43.34±41.03 versus 38.07±36.11months respectively. No significant differences in the clinical evaluation between the two groups with a greater proportion of patients demonstrating moderate degenerative changes. Similar preoperative and postoperative radiographic parameters were reported, in group I, Δ HKA was 7.19±4.14 versus 7.65±3.16 in group II. Preoperative pain VAS scores were slightly higher in group II vs. group I, 79.23±26.35 vs. 76.31±24.45, respectively. However, postoperatively, the pain scores significantly improved in group I vs. group II, 22.84±3.65 vs. 41.69±17.33, respectively. Tegner activity scores and WOMAC scores were comparable between both groups preoperatively and postoperatively. Only the WOMAC function scores were better in group I when compared to group II, 26.13±25.84 versus 20.01±17.98. All patients returned to work at an average of 0.82±0.38months. CONCLUSION Knee preservation with high tibial osteotomy is equally effective in managing unicompartmental degenerative changes in varus malaligned knees with either no previous history of meniscal surgeries or where a meniscal sacrifice was inevitable, either with subtotal or total meniscectomy. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Ahmed Mabrouk
- Leeds Teaching Hospitals, Department of trauma and Orthopaedics, Leeds, United Kingdom; Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France.
| | | | - Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | | | - Nicolas Tardy
- Centre Ostéo-Articulaire Des Cèdres, Clinique Des Cèdres, 5, rue des Tropiques, 38130 Échirolles, France
| | - Goulven Rochcongar
- Orthopaedics and Traumatology Department, Normandie University, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
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Sabater-Martos M, Chimeno-Pigrau C, Tornero Dacasa E, Sastre Solsona S, Isern Kebschull J, Popescu D. Placement of a polyurethane implant is not associated with a chondroprotective effect: comparative study with cases of isolated medial meniscectomy with at least five years of follow-up. Arch Orthop Trauma Surg 2023; 143:3213-3218. [PMID: 36315256 DOI: 10.1007/s00402-022-04664-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Our main objective was to evaluate clinically and radiologically and compare patients who had undergone partial meniscectomy alone, with those who had received a partial meniscectomy in which a polyurethane implant was placed, with a minimum follow-up of 5 years. METHODS We performed a prospective cohort study. Patients were randomly distributed into Group A if they only received meniscectomy or Group B if they received meniscectomy plus a meniscal implant (Actifit®). We performed preoperative, postoperative, and 5-year-follow-up functional and radiological evaluations (magnetic resonance imaging). RESULTS Twelve patients (40%) were treated with meniscal implants (Group B); 18 (60%) were treated with a conventional meniscectomy (Group A). Tegner, Lysholm and KOOS scores were evaluated prior to surgery and at 5-year follow-up. Only the Lysholm score showed a significant difference between groups, with a score increase between the preoperative evaluation and the 5-year follow-up evaluation (p = 0.013). Preoperative and postoperative MRIs were both available in 19 cases (63.3%). Long-term follow-up MRIs were performed in 11 cases of group B. No significant differences were found in functional outcomes or MRI findings (WORMS cartilage score increase p = 0.360). Although total reabsorptions of the collagen meniscus implant were not statistically significant in younger patients, a tendency towards a higher reabsorption process was seen in older patients (p = 0.015). CONCLUSION The placement of a polyurethane implant after a wide meniscectomy is not accompanied by a chondroprotective effect over time. There is no functional difference between implant placement and isolated meniscectomy. There is a discrepancy between good clinical results and radiologic appearance of these implants and their underlying cartilage. LEVEL OF EVIDENCE II, therapeutic study.
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Affiliation(s)
- Marta Sabater-Martos
- Knee Unit, Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Clara Chimeno-Pigrau
- Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Carrer Villarroel 170, Barcelona, Spain.
| | - Eduard Tornero Dacasa
- Spine Unit, Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sergi Sastre Solsona
- Artrhoscopy and Upper Limb Unit, Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jaime Isern Kebschull
- Musculoeskeletal Radiology Unit, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Dragos Popescu
- Knee Unit, Department of Orthopaedic Surgery, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
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Spierings J, Velthuijs W, Mansoor A, Bertrand ME, Uquillas JA, Ito K, Janssen RPA, Foolen J. A decellularized and sterilized human meniscus allograft for off-the-shelf meniscus replacement. J Exp Orthop 2022; 9:116. [PMID: 36464727 PMCID: PMC9719875 DOI: 10.1186/s40634-022-00555-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Meniscus tears are one of the most frequent orthopedic knee injuries, which are currently often treated performing meniscectomy. Clinical concerns comprise progressive degeneration of the meniscus tissue, a change in knee biomechanics, and an early onset of osteoarthritis. To overcome these problems, meniscal transplant surgery can be performed. However, adequate meniscal replacements remain to be a great challenge. In this research, we propose the use of a decellularized and sterilized human meniscus allograft as meniscal replacement. METHODS Human menisci were subjected to a decellularization protocol combined with sterilization using supercritical carbon dioxide (scCO2). The decellularization efficiency of human meniscus tissue was evaluated via DNA quantification and Hematoxylin & Eosin (H&E) and DAPI staining. The mechanical properties of native, decellularized, and decellularized + sterilized meniscus tissue were evaluated, and its composition was determined via collagen and glycosaminoglycan (GAG) quantification, and a collagen and GAG stain. Additionally, cytocompatibility was determined in vitro. RESULTS Human menisci were decellularized to DNA levels of ~ 20 ng/mg of tissue dry weight. The mechanical properties and composition of human meniscus were not significantly affected by decellularization and sterilization. Histologically, the decellularized and sterilized meniscus tissue had maintained its collagen and glycosaminoglycan structure and distribution. Besides, the processed tissues were not cytotoxic to seeded human dermal fibroblasts in vitro. CONCLUSIONS Human meniscus tissue was successfully decellularized, while maintaining biomechanical, structural, and compositional properties, without signs of in vitro cytotoxicity. The ease at which human meniscus tissue can be efficiently decellularized, while maintaining its native properties, paves the way towards clinical use.
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Affiliation(s)
- Janne Spierings
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wietske Velthuijs
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Amal Mansoor
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Jorge Alfredo Uquillas
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Keita Ito
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rob P. A. Janssen
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.414711.60000 0004 0477 4812Maxima Medical Centre Eindhoven/Veldhoven, Eindhoven, The Netherlands ,grid.448801.10000 0001 0669 4689Health Innovations and Technology, Department of Paramedical Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Jasper Foolen
- grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands ,grid.6852.90000 0004 0398 8763Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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Kohli S, Schwenck J, Barlow I. Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review. Knee Surg Relat Res 2022; 34:27. [PMID: 35692048 PMCID: PMC9190156 DOI: 10.1186/s43019-022-00155-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds. Methods MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature. Results Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3–31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0–11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI. Conclusion The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data.
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11
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Pedersen DD, Kim S, Wagner WR. Biodegradable polyurethane scaffolds in regenerative medicine: Clinical translation review. J Biomed Mater Res A 2022; 110:1460-1487. [PMID: 35481723 DOI: 10.1002/jbm.a.37394] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
Early explorations of tissue engineering and regenerative medicine concepts commonly utilized simple polyesters such as polyglycolide, polylactide, and their copolymers as scaffolds. These biomaterials were deemed clinically acceptable, readily accessible, and provided processability and a generally known biological response. With experience and refinement of approaches, greater control of material properties and integrated bioactivity has received emphasis and a broadened palette of synthetic biomaterials has been employed. Biodegradable polyurethanes (PUs) have emerged as an attractive option for synthetic scaffolds in a variety of tissue applications because of their flexibility in molecular design and ability to fulfill mechanical property objectives, particularly in soft tissue applications. Biodegradable PUs are highly customizable based on their composition and processability to impart tailored mechanical and degradation behavior. Additionally, bioactive agents can be readily incorporated into these scaffolds to drive a desired biological response. Enthusiasm for biodegradable PU scaffolds has soared in recent years, leading to rapid growth in the literature documenting novel PU chemistries, scaffold designs, mechanical properties, and aspects of biocompatibility. Despite the enthusiasm in the field, there are still few examples of biodegradable PU scaffolds that have achieved regulatory approval and routine clinical use. However, there is a growing literature where biodegradable PU scaffolds are being specifically developed for a wide range of pathologies and where relevant pre-clinical models are being employed. The purpose of this review is first to highlight examples of clinically used biodegradable PU scaffolds, and then to summarize the growing body of reports on pre-clinical applications of biodegradable PU scaffolds.
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Affiliation(s)
- Drake D Pedersen
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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A Comparison Between Polyurethane and Collagen Meniscal Scaffold for Partial Meniscal Defects: Similar Positive Clinical Results at a Mean of 10 Years of Follow-Up. Arthroscopy 2022; 38:1279-1287. [PMID: 34571182 DOI: 10.1016/j.arthro.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare, at long-term follow-up, the clinical outcomes and failures of collagen and polyurethane meniscal scaffolds for the treatment of partial meniscal defects. METHODS Patients affected by partial meniscal defect with intact anterior and posterior meniscal attachments and an intact rim at the circumference of the missing meniscus were included, treated with a collagen meniscal implant or with polyurethane scaffold, and clinically evaluated by analysis of the subjective International Knee Documentation Committee score, the visual analog scale score for the evaluation of knee function and symptoms, and the Tegner score to assess the activity level. RESULTS After 3 patients dropped out, a total of 47 patients, comprising 31 men and 16 women, with a mean age of 43 ± 14.1 years and mean body mass index of 25 ± 1.4, were clinically evaluated up to a mean of 10 years' follow-up. The International Knee Documentation Committee score improved from 42.9 ± 15.9 to 67.4 ± 12.4 (P < .0005) in the polyurethane implant group and from 46.8 ± 16.7 to 62.1 ± 22.6 (P < .0005) in the collagen meniscal implant group. The visual analog scale score decreased significantly from baseline values of 5.4 ± 2.3 and 4.4 ± 1.7, to 3.4 ± 2.5 and 2.7 ± 2.4, respectively, at final follow-up in the polyurethane implant (P = .002) and collagen meniscal implant (P < .0005) groups. The Tegner score improved in both groups without reaching the preinjury activity level. No significant differences in the scores were found between the polyurethane and collagen scaffold groups. A total of 10 implants failed, 5 per group, for a cumulative failure rate of 21.3%, with no differences between the 2 scaffolds. CONCLUSIONS The long-term comparison showed positive and similar results for both polyurethane- and collagen-based meniscal scaffolds, with an implant survival rate of about 80% at 10 years of follow-up and no differences in terms of pain, function, and activity level. LEVEL OF EVIDENCE Level IV, case-control comparative study.
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13
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No differences in clinical outcome between CMI and Actifit meniscal scaffolds: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:328-348. [PMID: 33864114 DOI: 10.1007/s00167-021-06548-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the results of two meniscal scaffolds, CMI and Actifit, for the treatment of partial meniscal lesions. METHODS A systematic review was performed on the PubMed, Web of Science, Scopus, Embase, and Cochrane databases in January 2021, including randomized controlled trails (RCTs) and prospective and retrospective observational studies on the clinical results of meniscal scaffolds. A meta-analysis of the clinical results was performed; the rate of failures was recorded, as well as radiological results. The quality of the included studies was assessed with a modified Coleman Methodology Score (CMS). RESULTS The search identified 37 studies (31 in the last 10 years): 2 RCTs, 5 comparative studies, 26 prospective and 4 retrospective series on a total of 1276 patients (472 CMI, 804 Actifit). The quality of evidence was generally low. An overall significant improvement in all clinical scores was documented for both scaffolds. The meta-analysis showed no differences between the two scaffolds in terms of patient reported outcome measures and activity level. The meta-analysis on the risk of failures documented a risk of failures of 7% in the CMI and of 9% in the Actifit group. CONCLUSIONS There is a growing interest on the results of meniscal scaffolds, with most studies published recently. However, long-term data on the Actifit scaffold and high-level comparative studies are missing. Both CMI and Actifit offered good clinical results with a significant and comparable improvement in symptoms and function, and with a low number of failures over time. Accordingly, with the proper indication, their use may be encouraged in the clinical practice. LEVEL OF EVIDENCE Level IV.
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14
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Veronesi F, Di Matteo B, Vitale N, Filardo G, Visani A, Kon E, Fini M. Biosynthetic scaffolds for partial meniscal loss: A systematic review from animal models to clinical practice. Bioact Mater 2021; 6:3782-3800. [PMID: 33898878 PMCID: PMC8044909 DOI: 10.1016/j.bioactmat.2021.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Acute or degenerative meniscus tears are the most common knee lesions. Meniscectomy provides symptomatic relief and functional recovery only in the short- to mid-term follow-up but significantly increases the risk of osteoarthritis. For this reason, preserving the meniscus is key, although it remains a challenge. Allograft transplants present many disadvantages, so during the last 20 years preclinical and clinical research focused on developing and investigating meniscal scaffolds. The aim of this systematic review was to collect and evaluate all the available evidence on biosynthetic scaffolds for meniscus regeneration both in vivo and in clinical studies. Three databases were searched: 46 in vivo preclinical studies and 30 clinical ones were found. Sixteen natural, 15 synthetic, and 15 hybrid scaffolds were studied in vivo. Among them, only 2 were translated into clinic: the Collagen Meniscus Implant, used in 11 studies, and the polyurethane-based scaffold Actifit®, applied in 19 studies. Although positive outcomes were described in the short- to mid-term, the number of concurrent procedures and the lack of randomized trials are the major limitations of the available clinical literature. Few in vivo studies also combined the use of cells or growth factors, but these augmentation strategies have not been applied in the clinical practice yet. Current solutions offer a significant but incomplete clinical improvement, and the regeneration potential is still unsatisfactory. Building upon the overall positive results of these "old" technologies to address partial meniscal loss, further innovation is urgently needed in this field to provide patients better joint sparing treatment options.
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Affiliation(s)
- F. Veronesi
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - B. Di Matteo
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- First Moscow State Medical University - Sechenov University, Bol'shaya Pirogovskaya Ulitsa, 19c1, 119146, Moscow, Russia
| | - N.D. Vitale
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - G. Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - A. Visani
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E. Kon
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M. Fini
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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15
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Figueroa D, Figueroa F, Calvo R, Gomez C, Vaisman A. Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up. J Clin Orthop Trauma 2021; 15:16-21. [PMID: 33717911 PMCID: PMC7920011 DOI: 10.1016/j.jcot.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. METHODS Prospective study in patients with PU meniscal scaffolds implanted during 2014-2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Post-operative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. RESULTS Fourteen patients with an average age of 25.8 years (range: 17-47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39-66) months. Post-operative mean clinical outcomes scores showed significantly improved results compared to the pre-operative scores. Lysholm scores increased from 62.4 to 80.2 (P = 0.0023), KOOS from 68.9 to 80 (P = 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P = 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3-6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. CONCLUSION The use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. LEVEL OF EVIDENCE IV. Case series.
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Affiliation(s)
| | - Francisco Figueroa
- Clínica Alemana-Universidad del Desarrollo, Chile
- Hospital Sótero del Río, Chile
| | - Rafael Calvo
- Clínica Alemana-Universidad del Desarrollo, Chile
| | - Carlos Gomez
- Hospital Padre Hurtado, Chile
- Hospital del Trabajador, Chile
| | - Alex Vaisman
- Clínica Alemana-Universidad del Desarrollo, Chile
- Hospital Padre Hurtado, Chile
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16
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DePhillipo NN, LaPrade RF, Zaffagnini S, Mouton C, Seil R, Beaufils P. The future of meniscus science: international expert consensus. J Exp Orthop 2021; 8:24. [PMID: 33791890 PMCID: PMC8012449 DOI: 10.1186/s40634-021-00345-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the main focus areas for research and development for furthering the state of meniscus science in 2021. Methods An electronic survey including 10 questions was sent in a blind fashion to the faculty members of the 5th International Conference on Meniscus Science and Surgery. These faculty served as an expert consensus on the future of research and development areas of meniscus science. Survey responses were analyzed using descriptive statistics and ranking weighted averages were calculated to score survey questions. Results Of the 82 faculty, 76 (93%) from 18 different countries completed the survey (84% male, 16% female). The highest ranked future research and development focus areas were meniscus repair, biologics, osteotomy procedures, addressing meniscus extrusion, and the development of new therapies for the prevention of posttraumatic osteoarthritis. Currently, the most ‘valuable’ type of biologic reported for meniscus treatment was platelet-rich plasma. The main reported global research limitation was a lack of long-term clinical outcomes data. The most promising emerging medical technologies for improving meniscus science were 3-D printing, personalized medicine, and artificial implants. Conclusions This survey suggests that the future of meniscus science should be focused on meniscal preservation techniques through meniscus repair, addressing meniscal extrusion, and the use of orthobiologics. The lack of long-term clinical outcomes was the main reported research limitation globally for meniscus treatment. Future product development utilizing emerging medical technologies suggest the use of 3-D printing for meniscal transplants/scaffolds, personalized treatment, and bioengineering for artificial implants. Level of Evidence Level V. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00345-y.
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Affiliation(s)
| | | | | | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, Clinique d'Eich, Luxembourg city, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg city, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, Clinique d'Eich, Luxembourg city, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg city, Luxembourg.,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg city, Luxembourg
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17
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Li W, Pan J, Li J, Guo J, Zeng C, Xie D. Clinical application of polyurethane meniscal scaffold: A meta-analysis. J Orthop 2021; 24:173-181. [PMID: 33716423 PMCID: PMC7933599 DOI: 10.1016/j.jor.2021.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/14/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE In patients with partial meniscus defect, the implantation of polyurethane meniscal scaffold has become a common method for the treatment of meniscus vascular entry and tissue regeneration. However, it is unclear whether polyurethane meniscal scaffold will yield better clinical and MRI results after surgery. This meta-analysis compared the clinical and MRI results of polyurethane meniscal scaffold in some patients with meniscus defects. METHODS By searching PubMed, Embase, and Cochrane Library, a systematic review of studies evaluating the clinical outcomes of patients with polyurethane meniscal scaffold implantation. The search terms used are: "meniscus", "meniscal", "scaffold", "Actifit" "polyurethane" and "implant". The study was evaluated based on the patient's reported outcome score, accompanying surgery, and radiology results. Genovese scale was used to evaluate morphology and signal intensity, and Yulish score was used to evaluate the imaging performance of articular cartilage. RESULTS There were 16 studies that met the inclusion criteria, a total of 613 patients, and the overall average follow-up time was 41 months. The clinical scores at the final follow-up, such as VAS, IKDC, Tegner, and KOOS, were significantly improved compared with preoperatively. The MS, SI, and IIRMC scores evaluated in MRI showed no significant difference between preoperative and final follow-up. However, for AC (OR 0.34, 95% CI 0.11-1.00; P = 0.05) and AME (OR 0.08, 95% CI 0.03-0.22; P < 0.01), the final follow-up results were worse than preoperatively. CONCLUSIONS This meta-analysis found that compared with preoperative, the clinical effect of the final follow-up was significantly improved. However, MS, SI, and IIRMC in MRI parameters did not change significantly. In addition, the final follow-up results of AC and AME showed a deteriorating trend. Therefore, for patients with partial meniscus defects, polyurethane meniscal scaffold seem to be a viable option, and further research is needed to determine whether the deterioration of AC and AME is clinically relevant.
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Affiliation(s)
- Wei Li
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Jianying Pan
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Jintao Li
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Jinshan Guo
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
- Department of Histology and Embryology, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Chun Zeng
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Denghui Xie
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
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18
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Polyurethane scaffold implants for partial meniscus lesions: delayed intervention leads to an inferior outcome. Knee Surg Sports Traumatol Arthrosc 2021; 29:109-116. [PMID: 31654130 DOI: 10.1007/s00167-019-05760-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the clinical outcomes of the implantation of an aliphatic polyurethane scaffold for the treatment of partial loss of meniscal tissue at a mean follow-up of 36 months. METHODS A retrospective review on prospectively collected data was performed on patients who underwent implantation of an aliphatic polyurethane-based synthetic meniscal scaffold. Patients were evaluated for demographics data, lesion and implant characteristics (sizing, type and number of meniscal sutures), previous and combined surgeries and complications. Clinical parameters were rated using NRS, IKDC subjective, Lysholm, KOOS, and Tegner activity score, both preoperatively and at final follow-up. RESULTS Sixty-seven patients were evaluated at a mean follow-up of 36 months (48 M and 19 F; mean age 40.8 ± 10.6 years; mean BMI 25.4 ± 4.3). The scaffold was implanted on the medial side in 54 cases, and on the lateral one in 13. Forty-seven patients had undergone previous surgical treatment at the same knee and 45 required combined surgical procedures. All evaluated scores improved significantly from the baseline. Among possible prognostic factors, a delayed scaffold implantation had lower post-operative clinical scores: IKDC subjective (P = 0.049), KOOS Sport (P = 0.044), KOOS total (p = 0.011), and Tegner (P = 0.03) scores at follow-up. CONCLUSIONS The polyurethane meniscal scaffold implantation led to a significant clinical benefit in a large number of patients. A delayed intervention correlated with worse results. LEVEL OF EVIDENCE IV.
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19
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Akkaya M, Gursoy S, Ozberk N, Simsek ME, Korkusuz F, Bozkurt M. Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application. Musculoskelet Surg 2020; 106:145-153. [PMID: 32960435 DOI: 10.1007/s12306-020-00681-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess the impact of biodegradable polyurethane meniscus scaffold implantation (BPMSI) on muscle strength and balance in comparison with the healthy contralateral knee in patients with irreparable medial meniscus defect. METHODS This observational and prospective case-cohort study was conducted with patients who had irreparable meniscal defects and underwent arthroscopic meniscus scaffold implantation. Surgeries were carried out on the medial meniscus of 16 right and 4 left knees. Visual analog scale (VAS) was used to assess the degree of pain relief. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm (LYS) score were used to evaluate the functional improvement at weeks 12, 24 and 36. Concentric and eccentric quadriceps and hamstring peak torque (PT) as well as the peak torque-to-body weight (PTB) ratio, anterior-posterior, mediolateral and overall stability indexes were assessed at the same time points. RESULTS Twenty male patients with a mean age and body mass index of 32.2 ± 8.8 years and 26.2 ± 4.2 kg/m2, respectively, were included in the study. The amount of pain decreased from 7.6 ± 1.5% to 2.9 ± 1.5% at postoperative week 36. Range of motion, Lysholm score and KOOS increased from 87.0ο ± 9.5ο to 115.0ο ± 15.1ο, 30.8 ± 4.3 to 81.5 ± 5.3 and 37.4 ± 5.3 to 74.1 ± 7.2, respectively. Concentric quadriceps and hamstring peak torque values and peak torque/body weight ratios were improved in the knees that received a meniscus scaffold implant. Anterior/posterior, medial/lateral, and overall stability indexes with or without biofeedback exhibited a slight improvement, which was not statistically significant. CONCLUSION BPMSI led to decreased pain and improved function at postoperative week 36. Although muscle strength almost returned to normal, balance parameters did not recover within 36 weeks after the procedure.
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Affiliation(s)
- M Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey.
| | - S Gursoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
| | - N Ozberk
- Department of Physical Treatment and Rehabilitation, Middle East Technical University Medical Center, 06100, Ankara, Turkey
| | - M E Simsek
- Department of Orthopedics and Traumatology, Lokman Hekim University, 06100, Ankara, Turkey
| | - F Korkusuz
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06800, Ankara, Turkey
| | - M Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
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20
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Butt U, Vuletić F, Stenhouse G, Hudetz D, Bradbury N. Meniscal scaffold for the treatment of partial meniscal defect-clinical and radiological outcomes in a two-year follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 45:977-983. [PMID: 32949258 DOI: 10.1007/s00264-020-04811-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of meniscal scaffolds is to fill the defect, allow regeneration of meniscal-like tissues, and to prevent long-term risk of cartilage wear and tear. The aim of this study was to evaluate clinical results after two years and magnetic resonance imaging (MRI) results a year after implantation of a meniscal scaffold. METHODS Fifteen patients were recruited into a prospective, single-arm, single-center study, and treated with meniscal scaffolds as a result of segmental meniscal defect due to previous partial meniscectomy. Patients were evaluated using functional knee scores used pre-operatively and 6, 12, and 24 months postoperatively. The radiological outcome was assessed using MRI at 12 months by evaluating scaffold size, morphology, and intensity according to the Genovese grading system. Cartilage assessment was completed according to The International Cartilage Repair Society (ICRS) score. RESULTS All patients completed a follow-up of 24 months. A statistically significant increase in mean levels of all functional scores was present in all patients. On the MRI, all but one of the patients presented an incorporated meniscal implant. In most of the patients (73%), the meniscal implant was a Genovese type III. Type II and III signal intensities were present in all scaffolds when compared with the residual meniscal tissue. A stable cartilage (ICRS) status was observed in 80% of the patients compared with the pre-operative cartilage scores. CONCLUSION In our case series of patients treated with the meniscal scaffold implant, we observed good clinical results at a two year follow-up. Furthermore, MRI findings suggest that meniscal scaffolds might have a beneficial effect on articular cartilage.
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Affiliation(s)
- Umer Butt
- AO Clinic (Institute of Trauma, Orthopaedics and Sports Injury), Nazimabad No.4, Karachi, Pakistan
- Circle Bath Hospital, Bath, UK
| | - Filip Vuletić
- Department of Orthopaedic Surgery, University Hospital 'Sveti Duh', Zagreb, Croatia.
| | | | - Damir Hudetz
- Department of Orthopaedic Surgery, University Hospital 'Sveti Duh', Zagreb, Croatia
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21
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Winkler PW, Rothrauff BB, Buerba RA, Shah N, Zaffagnini S, Alexander P, Musahl V. Meniscal substitution, a developing and long-awaited demand. J Exp Orthop 2020; 7:55. [PMID: 32712722 PMCID: PMC7382673 DOI: 10.1186/s40634-020-00270-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
The menisci represent indispensable intraarticular components of a well-functioning knee joint. Sports activities, traumatic incidents, or simply degenerative conditions can cause meniscal injuries, which often require surgical intervention. Efforts in biomechanical and clinical research have led to the recommendation of a meniscus-preserving rather than a meniscus-resecting treatment approach. Nevertheless, partial or even total meniscal resection is sometimes inevitable. In such circumstances, techniques of meniscal substitution are required. Autologous, allogenic, and artificial meniscal substitutes are available which have evolved in recent years. Basic anatomical and biomechanical knowledge, clinical application, radiological and clinical outcomes as well as future perspectives of meniscal substitutes are presented in this article. A comprehensive knowledge of the different approaches to meniscal substitution is required in order to integrate these evolving techniques in daily clinical practice to prevent the devastating effects of lost meniscal tissue.
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Affiliation(s)
- Philipp W Winkler
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Center for Cellular and Molecular Engineering, University of Pittsburgh, 450 Technology Drive, Suite 239, Pittsburgh, PA, 15219, USA
| | - Rafael A Buerba
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Neha Shah
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Stefano Zaffagnini
- 2° Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, IRCCS, University of Bologna, Bologna, Italy
| | - Peter Alexander
- Center for Cellular and Molecular Engineering, University of Pittsburgh, 450 Technology Drive, Suite 239, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
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22
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Accadbled F, Pham TT, Thevenin Lemoine C, Sales de Gauzy J. Implantation of an Actifit® Polyurethane Meniscal Scaffold 18 Months After Subtotal Lateral Meniscectomy in a 13-Year-Old Male Adolescent. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920688. [PMID: 32474567 PMCID: PMC7286186 DOI: 10.12659/ajcr.920688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patient: Male, 13-year-old Final Diagnosis: Meniscectomy Symptoms: Knee joint pain Medication: — Clinical Procedure: Arthroscopy Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Franck Accadbled
- Department of Pediatrics - Orthopedic, Trauma and Plastic Surgery, Children's Hospital, Toulouse University Hospital Center, Toulouse, France
| | - Thuy Trang Pham
- Department of Pediatrics - Orthopedic, Trauma and Plastic Surgery, Children's Hospital, Toulouse University Hospital Center, Toulouse, France
| | - Camille Thevenin Lemoine
- Department of Pediatrics - Orthopedic, Trauma and Plastic Surgery, Children's Hospital, Toulouse University Hospital Center, Toulouse, France
| | - Jérôme Sales de Gauzy
- Department of Pediatrics - Orthopedic, Trauma and Plastic Surgery, Children's Hospital, Toulouse University Hospital Center, Toulouse, France
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23
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Schenk L, Bethge L, Hirschmann A, Berbig R, Lüthi U, Arnold MP, Hirschmann MT. Ongoing MRI remodeling 3-7 years after collagen meniscus implantation in stable knees. Knee Surg Sports Traumatol Arthrosc 2020; 28:1099-1104. [PMID: 31535191 DOI: 10.1007/s00167-019-05714-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the clinical and radiological 3-7 years outcomes of patients who underwent collagen meniscus implantation in stable or stabilized knees. It was the hypothesis that using the collagen meniscus (CMI) good clinical 3-7 years outcomes with low pain levels are achieved. METHODS Thirty-nine patients (male:female = 30:9, mean age 34 ± 10 years) underwent arthroscopic CMI after subtotal medial (n = 32) or lateral meniscectomy (n = 7). A 7-mm CMI was performed due to prophylactic (n = 25) or therapeutic indication (n = 14). IKDC score, Tegner score preinjury, preoperatively and at follow-up, Lysholm score and visual analogue scale for pain and satisfaction (follow-up rate 90%) were assessed. MRI scans were analyzed according to the Genovese criteria (n = 19). Implant failure was defined as infection or mechanical failure of the device. The minimum follow-up time was 36 months (range 36-84 months). RESULTS The mean VAS satisfaction preoperatively and at follow-up was 4.0 ± 0 and 1.6 ± 1.0. The mean VAS pain was 4.3 ± 3.2 preoperatively and at last follow-up 2.1 ± 1.7. The median Tegner score preinjury was 7 (range 3-10), it decreased preoperatively to median 3.5 (range 1-8) and nearly reached the preinjury level at last follow-up 6 (range 3-10). The mean Lysholm score before surgery was 66 ± 20 and 91 ± 8 at last follow-up. Seven patients (38.9%) had a normal total IKDC score (A), 10 patients were nearly normal (B) and 1 patient slightly abnormal (C). In MRI the CMI was entirely resorbed in 4 patients (21%) and partially resorbed in 15 (79%). In 4 patients (21%) the CMI was isointense, in 14 (74%) slightly hyperintense and in 1 (5%) highly hyperintense. Ten patients (53%) showed marked signs of bone marrow edema. In 13 patients (68%) an extrusion of the meniscus > 3 mm at last follow-up was found. CONCLUSIONS Meniscal substitution with the CMI showed good to excellent clinical 3-7 results. The CMI shows an ongoing remodelling with decreased signal intensity and decreased size. However, as meniscus extrusion remained at the same level and bone marrow edema decreased from 1 year to longer term follow-up, it appears that the remodeling comes to an end at about 5 years after CMI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- L Schenk
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - L Bethge
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - A Hirschmann
- Radiology and Nuclear Medicine, University Basel Hospital, Basel, Switzerland
| | - R Berbig
- Sportclinic Zürich, Zurich, Switzerland
| | - U Lüthi
- Sportclinic Zürich, Zurich, Switzerland
| | - M P Arnold
- LEONARDO, Clinic Hirslanden Birshof, Münchenstein, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
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24
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Zhou Z, Wang Y, Qian Y, Pan X, Zhu J, Zhang Z, Qian Z, Sun Z, Pi B. Cystine dimethyl ester cross-linked PEG-poly(urethane-urea)/nano-hydroxyapatite composited biomimetic scaffold for bone defect repair. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 31:407-422. [PMID: 31747530 DOI: 10.1080/09205063.2019.1696004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Polyurethane (PU) and polyurea (PUA) materials have shown significant potential for application in tissue repair. Herein, we design a glycerol ethoxylate (PEG)-based poly(urethane-urea) for bone tissue repair. The polymer precursor was prepared from the reaction of PEG and isophorone diisocyanate (IPDI). The cystine dimethyl ester was used as a cross-linker for the preparation of poly(urethane-urea) elastomers. The material was further strengthened by physical blending of nano-hydroxyapatite (nHA). The physical and biological properties of final material were evaluated by mechanical testing, scanning electron microscopy characterization, degradation tests, cell proliferation and cell differentiation assays. The obtained scaffolds showed good mechanical strength, excellent biocompatibility and osteogenic capability. All the evidences demonstrated that this type of materials has good prospects for bone tissue repair application.
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Affiliation(s)
- Zhangzhe Zhou
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yimeng Wang
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuqing Qian
- Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, China
| | - Xiangqiang Pan
- Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, China
| | - Jian Zhu
- Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, China
| | - Zhengbiao Zhang
- Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, China
| | - Zhonglai Qian
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiyong Sun
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin Pi
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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25
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A shape-memory and spiral light-emitting device for precise multisite stimulation of nerve bundles. Nat Commun 2019; 10:2790. [PMID: 31243276 PMCID: PMC6594927 DOI: 10.1038/s41467-019-10418-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 05/11/2019] [Indexed: 11/21/2022] Open
Abstract
We previously demonstrated that for long-term spastic limb paralysis, transferring the seventh cervical nerve (C7) from the nonparalyzed side to the paralyzed side results in increase of 17.7 in Fugl-Meyer score. One strategy for further improvement in voluntary arm movement is selective activation of five target muscles innervated by C7 during recovery process. In this study, we develop an implantable multisite optogenetic stimulation device (MOSD) based on shape-memory polymer. Two-site stimulation of sciatic nerve bundles by MOSD induces precise extension or flexion movements of the ankle joint, while eight-site stimulation of C7 nerve bundles induce selective limb movement. Long-term implant of MOSD to mice with severed and anastomosed C7 nerve is proven to be both safe and effective. Our work opens up the possibility for multisite nerve bundle stimulation to induce highly-selective activations of limb muscles, which could inspire further applications in neurosurgery and neuroscience research. Optogenetic stimulation of damaged peripheral nerves has advantages over electrical stimulation but it’s limited to single-site stimulation. Here the authors develop a spiral-shaped LED implant for precise optogenetic stimulation of peripheral nerve bundles at multiple sites and use it to induce distinct limb movements in mice.
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26
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Drobnič M, Ercin E, Gamelas J, Papacostas ET, Slynarski K, Zdanowicz U, Spalding T, Verdonk P. Treatment options for the symptomatic post-meniscectomy knee. Knee Surg Sports Traumatol Arthrosc 2019; 27:1817-1824. [PMID: 30859265 DOI: 10.1007/s00167-019-05424-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/15/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. METHODS A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. RESULTS Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA. CONCLUSIONS Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000, Ljubljana, Slovenia. .,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Ersin Ercin
- Department of Orthopaedics and Traumatology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Joao Gamelas
- Department of Orthopaedics and Traumatology, Lusíadas Hospital, NOVA Medical School, Lisbon, Portugal
| | | | | | - Urszula Zdanowicz
- Carolina Medical Center, Warsaw, Poland.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium
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27
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Filardo G, Petretta M, Cavallo C, Roseti L, Durante S, Albisinni U, Grigolo B. Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold. Bone Joint Res 2019; 8:101-106. [PMID: 30915216 PMCID: PMC6397325 DOI: 10.1302/2046-3758.82.bjr-2018-0134.r1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives Meniscal injuries are often associated with an active lifestyle. The damage of meniscal tissue puts young patients at higher risk of undergoing meniscal surgery and, therefore, at higher risk of osteoarthritis. In this study, we undertook proof-of-concept research to develop a cellularized human meniscus by using 3D bioprinting technology. Methods A 3D model of bioengineered medial meniscus tissue was created, based on MRI scans of a human volunteer. The Digital Imaging and Communications in Medicine (DICOM) data from these MRI scans were processed using dedicated software, in order to obtain an STL model of the structure. The chosen 3D Discovery printing tool was a microvalve-based inkjet printhead. Primary mesenchymal stem cells (MSCs) were isolated from bone marrow and embedded in a collagen-based bio-ink before printing. LIVE/DEAD assay was performed on realized cell-laden constructs carrying MSCs in order to evaluate cell distribution and viability. Results This study involved the realization of a human cell-laden collagen meniscus using 3D bioprinting. The meniscus prototype showed the biological potential of this technology to provide an anatomically shaped, patient-specific construct with viable cells on a biocompatible material. Conclusion This paper reports the preliminary findings of the production of a custom-made, cell-laden, collagen-based human meniscus. The prototype described could act as the starting point for future developments of this collagen-based, tissue-engineered structure, which could aid the optimization of implants designed to replace damaged menisci. Cite this article: G. Filardo, M. Petretta, C. Cavallo, L. Roseti, S. Durante, U. Albisinni, B. Grigolo. Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold. Bone Joint Res 2019;8:101–106. DOI: 10.1302/2046-3758.82.BJR-2018-0134.R1.
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Affiliation(s)
- G Filardo
- Applied and Translational Research (ATR) Center, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Petretta
- Laboratory RAMSES, Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; RegenHu Ltd, Villaz-St-Pierre, Switzerland
| | - C Cavallo
- Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Roseti
- Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Durante
- Struttura Complessa Radiologia Diagnostica ed Interventistica, Dipartimento Patologie Ortopediche-Traumatologiche Complesse, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - U Albisinni
- Struttura Complessa Radiologia Diagnostica ed Interventistica, Dipartimento Patologie Ortopediche-Traumatologiche Complesse, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - B Grigolo
- Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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28
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González-García DM, Marcos-Fernández Á, Rodríguez-Lorenzo LM, Jiménez-Gallegos R, Vargas-Becerril N, Téllez-Jurado L. Synthesis and in Vitro Cytocompatibility of Segmented Poly(Ester-Urethane)s and Poly(Ester-Urea-Urethane)s for Bone Tissue Engineering. Polymers (Basel) 2018; 10:E991. [PMID: 30960916 PMCID: PMC6403855 DOI: 10.3390/polym10090991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 12/11/2022] Open
Abstract
Two series of segmented polyurethanes were obtained and their mechanical and thermal properties as well as their biodegradability and cytotoxicity were evaluated. The chemical nature of the polyurethanes was varied by using either 1,4 butanediol (poly-ester-urethanes, PEUs) or l-lysine ethyl ester dihydrochloride (poly-ester-urea-urethanes, PEUUs) as chain extenders. Results showed that varying the hard segment influenced the thermal and mechanical properties of the obtained polymers. PEUs showed strain and hardness values of about 10⁻20 MPa and 10⁻65 MPa, respectively. These values were higher than the obtained values for the PEUUs due to the phase segregation and the higher crystallinity observed for the polyester-urethanes (PEUs); phase segregation was also observed and analyzed by XRD and DSC. Moreover, both series of polymers showed hydrolytic degradation when they were submerged in PBS until 90 days with 20% of weight loss. In vitro tests using a Human Osteoblastic cell line (Hob) showed an average of 80% of cell viability and good adhesion for both series of polymers.
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Affiliation(s)
- Dulce María González-García
- Departamento de Ingeniería Metalúrgica, Instituto Politécnico Nacional, ESIQIE, UPALM-Zacatenco, Col Lindavista, México City 07738, Mexico.
| | - Ángel Marcos-Fernández
- Instituto de ciencia y tecnología de Polímeros, ICTP-CSIC calle Juan de la Cierva 3, 28006 Madrid, Spain.
| | - Luis M Rodríguez-Lorenzo
- Instituto de ciencia y tecnología de Polímeros, ICTP-CSIC calle Juan de la Cierva 3, 28006 Madrid, Spain.
- CIBER-BBN, C. Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain.
| | - Rodrigo Jiménez-Gallegos
- Departamento de Ingeniería Metalúrgica, Instituto Politécnico Nacional, ESIQIE, UPALM-Zacatenco, Col Lindavista, México City 07738, Mexico.
| | - Nancy Vargas-Becerril
- Departamento de Ingeniería Metalúrgica, Instituto Politécnico Nacional, ESIQIE, UPALM-Zacatenco, Col Lindavista, México City 07738, Mexico.
| | - Lucía Téllez-Jurado
- Departamento de Ingeniería Metalúrgica, Instituto Politécnico Nacional, ESIQIE, UPALM-Zacatenco, Col Lindavista, México City 07738, Mexico.
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Liang X, Duan P, Gao J, Guo R, Qu Z, Li X, He Y, Yao H, Ding J. Bilayered PLGA/PLGA-HAp Composite Scaffold for Osteochondral Tissue Engineering and Tissue Regeneration. ACS Biomater Sci Eng 2018; 4:3506-3521. [PMID: 33465902 DOI: 10.1021/acsbiomaterials.8b00552] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Xiangyu Liang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Pingguo Duan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jingming Gao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Runsheng Guo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Zehua Qu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Xiaofeng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yao He
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Haoqun Yao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
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30
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Shin YS, Lee HN, Sim HB, Kim HJ, Lee DH. Polyurethane meniscal scaffolds lead to better clinical outcomes but worse articular cartilage status and greater absolute meniscal extrusion. Knee Surg Sports Traumatol Arthrosc 2018; 26:2227-2238. [PMID: 28748491 DOI: 10.1007/s00167-017-4650-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Implantation of polyurethane (PU) meniscal scaffolds has become a popular procedure to provide a scaffold for vessel ingrowth and meniscal tissue regeneration in patients with partial meniscal defects. However, it is unclear whether PU meniscal scaffolds lead to better clinical and magnetic resonance imaging (MRI) outcomes post-operatively. This meta-analysis compared the clinical and MRI outcomes in patients with partial meniscal defects treated with PU meniscal scaffolds. METHODS This meta-analysis reviewed all studies that assessed Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) for pain, Tegner score, Knee Injury and Osteoarthritis Outcomes Score (KOOS), articular cartilage (AC), absolute meniscal extrusion (AME), morphology and size (MS), signal intensity (SI) of meniscal implant, and interface of the implant-residual meniscus complex (IIRMC) in patients with partial meniscal defects treated with PU meniscal scaffolds. RESULTS Eighteen studies were included in the meta-analysis. The proportion of patients who evaluated MS (OR 0.71, 95% CI 0.38-1.33; n.s.), SI (OR 1.07, 95% CI 0.53-2.18; n.s.), and IIRMC (OR 1.00, 95% CI 0.33-3.06; n.s.) did not differ significantly between baseline and final follow-up. However, AC (OR 0.31, 95% CI 0.11-0.84; P = 0.02) and AME (OR 0.05, 95% CI 0.01-0.18; P < 0.00001) worsened between baseline and final follow-up. Conversely, Lysholm score (95% CI -1.87 to -1.07; P < 0.00001), IKDC score (95% CI -2.19 to -1.08; P < 0.00001), VAS for pain (95% CI -2.29 to -1.07; P < 0.00001), Tegner score (95% CI -0.76 to -0.15; P = 0.003), and overall KOOS (95% CI -29.48 to -23.17; P < 0.00001) were significantly greater at final follow-up when compared to baseline. CONCLUSION This meta-analysis found no significant differences in the tested MRI parameters, including MS, SI, and IIRMC. However, AC and AME worsened between baseline and final follow-up. Conversely, patients treated with PU meniscal scaffolds showed significant functional improvement and pain relief when compared with baseline scores. Thus, PU meniscal scaffolds appear to be a viable alternative for patients with partial meniscal defects, although further studies are needed to determine whether worsened AC and AME are clinically relevant. In particular, precise measurement of PU meniscal scaffolds in combination with thorough investigation of the baseline articular cartilage status and meniscal defect size may be effective for pain relief or functional improvement in patients with PU meniscal scaffold implantation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Hoon-Nyun Lee
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyun-Bo Sim
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
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Houck DA, Kraeutler MJ, Belk JW, McCarty EC, Bravman JT. Similar clinical outcomes following collagen or polyurethane meniscal scaffold implantation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:2259-2269. [PMID: 29340746 DOI: 10.1007/s00167-018-4838-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the current literature in an effort to assess specific clinical outcomes following meniscal scaffold implantation using the two available scaffolds: Collagen Meniscal Implant (CMI) and the Actifit polyurethane meniscal scaffold. METHODS A systematic review was performed by searching PubMed, Embase, and Cochrane Library to find studies evaluating clinical outcomes of patients undergoing meniscal scaffold implantation. Search terms used were "meniscus", "meniscal", "scaffold", and "implant". Studies were evaluated based on scaffold type, treatment failure rates, patient-reported outcome scores, concomitant procedures, and radiological findings. Radiological findings were recorded using the Genovese scale to assess morphology and signal intensity and the Yulish score to assess articular cartilage. RESULTS Nineteen studies (1 level I, 1 level II, 17 level IV evidence) were identified that met inclusion criteria, including a total of 658 patients (347 Actifit, 311 CMI). The overall average follow-up was 45 months. Treatment failure occurred in 9.9% of patients receiving the Actifit scaffold at a mean follow-up of 40 months and 6.7% of patients receiving CMI at a mean follow-up of 44 months (n.s.). However, the rate of failure ranged from 0 to 31.8% amongst the included studies with a variable definition of failure. Additionally, overlapping patients and presence of concomitant surgeries such as anterior cruciate ligament reconstruction (ACLR) and high tibial osteotomy (HTO) may have a significant influence on these results. Outcomes for the Visual Analog Scale (VAS) for pain, Lysholm knee score, and Tegner activity score improved from preoperatively to latest follow-up in both groups, while the Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee scores improved from preoperatively to latest follow-up for Actifit scaffold patients. Overall, patients receiving CMI scaffolds had higher grades for Genovese morphology and signal intensity when compared to Actifit scaffold patients. CONCLUSION Patients undergoing meniscal scaffold implantation with either CMI or Actifit scaffold can both be expected to experience improvement in clinical outcomes when used in association with concomitant procedures such as ACLR and HTO. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Darby A Houck
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Matthew J Kraeutler
- Department of Orthopedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, NJ, 07079, USA
| | - John W Belk
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
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Patel JM, Brzezinski A, Raole DA, Dunn MG, Gatt CJ. Interference Screw Versus Suture Endobutton Fixation of a Fiber-Reinforced Meniscus Replacement Device in a Human Cadaveric Knee Model. Am J Sports Med 2018; 46:2133-2141. [PMID: 29847143 DOI: 10.1177/0363546518773737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal lesions represent one of the most common intra-articular knee injuries. Meniscus replacement devices are needed to restore load distribution and knee stability after meniscectomy. Fixation of these devices is crucial to the generation of hoop stresses and the distribution of loads in the joint. PURPOSE To evaluate 2 different fixation techniques (suture endobutton and interference screw) for implantation of a novel meniscus device. STUDY DESIGN Controlled laboratory study. METHODS In 7 human cadaveric knees (aged 17-61 years), 1 anterior and 2 potential posterior tunnel locations were investigated, and both fixation techniques were tested in each tunnel. The native meniscus roots, devices fixed with a suture endobutton, and devices fixed with an interference screw were gripped with cryoclamps, and tibias were drilled and loaded into a custom jig. Samples were preloaded, preconditioned, loaded for 500 cycles (50-150 N), and tested in tension until failure. RESULTS For all 3 tunnels, suture fixation resulted in greater elongation (54.1%-150.7% greater; P < .05) during cyclic loading than interference screw fixation, which approximated the native roots. Both fixation techniques displayed ultimate tensile loads in the same range as native roots. However, stiffness of the suture fixation groups (36.5-41.6 N/mm) was only 28% to 37% of that of the interference screw fixation groups (98.7-131.6 N/mm), which had values approaching those of the native roots (anterior: 175.4 ± 24.2 N/mm; posterior: 157.6 ± 22.9 N/mm). CONCLUSION Interference screw fixation was found to be superior to suture fixation with regard to elongation and stiffness, a finding that should be considered in the design and implantation of novel meniscus replacement devices. CLINICAL RELEVANCE With the emergence of various devices for total meniscus replacement, the establishment of fixation strategies is crucial for the generation of tensile hoop stresses and the efficacy of these approaches.
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Affiliation(s)
- Jay M Patel
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA.,McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Deep A Raole
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Michael G Dunn
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
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Abstract
The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. It is the orthopaedic surgeon’s responsibility to combine clinical information, radiological images, and clinical experience in an effort to individualize management of meniscal tears, taking into account factors related to the patient and lesion. Surgeons should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. Meniscus surgery has come a long way from the old slogan, “If it is torn, take it out!” to the currently accepted slogan, “Save the meniscus!” which has guided evolving modern treatment methods for meniscal tears. This last slogan will probably constitute the basis for newer alternative biological treatment methods in the future.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170067.
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Affiliation(s)
- Mahmut Nedim Doral
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Ankara, Turkey
| | - Onur Bilge
- Konya N.E. University, Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Konya, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - René Verdonk
- Ghent University, Faculty of Medicine, Department of Orthopaedics and Traumatology, De Pintelaan, Ghent, Belgium
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Tissue Engineering of Large Full-Size Meniscus Defects by a Polyurethane Scaffold: Accelerated Regeneration by Mesenchymal Stromal Cells. Stem Cells Int 2018; 2018:8207071. [PMID: 29853919 PMCID: PMC5964612 DOI: 10.1155/2018/8207071] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
The endogenous healing potential of avascular meniscal lesions is poor. Up to now, partial meniscectomy is still the treatment of choice for meniscal lesions within the avascular area. However, the large loss of meniscus substance predisposes the knee for osteoarthritic changes. Tissue engineering techniques for the replacement of such lesions could be a promising alternative treatment option. Thus, a polyurethane scaffold, which is already in clinical use, loaded with mesenchymal stromal cells, was analyzed for the repair of critical meniscus defects in the avascular zone. Large, approximately 7 mm broad meniscus lesions affecting both the avascular and vascular area of the lateral rabbit meniscus were treated with polyurethane scaffolds either loaded or unloaded with mesenchymal stromal cells. Menisci were harvested at 6 and 12 weeks after initial surgery. Both cell-free and cell-loaded approaches led to well-integrated and stable meniscus-like repair tissue. However, an accelerated healing was achieved by the application of mesenchymal stromal cells. Dense vascularization was detected throughout the repair tissue of both treatment groups. Overall, the polyurethane scaffold seems to promote the vessel ingrowth. The application of mesenchymal stromal cells has the potential to speed up the healing process.
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Pillai MM, Gopinathan J, Senthil Kumar R, Sathish Kumar G, Shanthakumari S, Sahanand KS, Bhattacharyya A, Selvakumar R. Tissue engineering of human knee meniscus using functionalized and reinforced silk-polyvinyl alcohol composite three-dimensional scaffolds: Understanding thein vitroandin vivobehavior. J Biomed Mater Res A 2018; 106:1722-1731. [DOI: 10.1002/jbm.a.36372] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 12/30/2022]
Affiliation(s)
| | - Janarthanan Gopinathan
- Advanced Textile and Polymer Research Laboratory; PSG Institute of Advanced Studies; Coimbatore 641004 India
| | - Rathinasamy Senthil Kumar
- Advanced Textile and Polymer Research Laboratory; PSG Institute of Advanced Studies; Coimbatore 641004 India
| | - Gopal Sathish Kumar
- Advanced Textile and Polymer Research Laboratory; PSG Institute of Advanced Studies; Coimbatore 641004 India
| | - Sivanandam Shanthakumari
- Department of Pathology; PSG Institute of Medical Sciences and Research; Coimbatore 641004 India
| | | | - Amitava Bhattacharyya
- Nanoscience and Technology Laboratory, Department of Electronics and Communication Engineering; PSG College of Technology; Coimbatore 641004 India
| | - Rajendran Selvakumar
- Tissue Engineering Laboratory; PSG Institute of Advanced Studies; Coimbatore 641004 India
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Frank RM, Cotter EJ, Strauss EJ, Gomoll AH, Cole BJ. The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee. J Am Acad Orthop Surg 2018; 26:e11-e25. [PMID: 29261554 DOI: 10.5435/jaaos-d-17-00087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The management of complex cartilage and meniscal pathology in young, athletic patients is extremely challenging. Joint preservation surgery is most difficult in patients with concomitant knee pathologies, including cartilage defects, meniscal deficiency, malalignment, and/or ligamentous insufficiency. Clinical decision making for these patients is further complicated by articular cartilage lesions, which often are incidental findings; therefore, treatment decisions must be based on the confirmed contribution of articular cartilage lesions to symptomatology. Surgical management of any of the aforementioned knee pathologies that is performed in isolation typically results in acceptable patient outcomes; however, concomitant procedures for the management of concomitant knee pathologies often are essential to the success of any single procedure. The use of biologic therapy as an alternative to or to augment more conventional surgical management has increased in popularity in the past decade, and indications for biologic therapy continue to evolve. Orthopaedic surgeons should understand knee joint preservation techniques, including biologic and reconstructive approaches in young, high-demand patients.
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Affiliation(s)
- Rachel M Frank
- From CU Sports Medicine, Department of Orthopaedics, University of Colorado School of Medicine, Boulder, CO (Dr. Frank), the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Mr. Cotter, and Dr. Cole), New York University, Langone Medical Center, New York, NY (Dr. Strauss), and Brigham and Women's Hospital, Boston, MA (Dr. Gomoll)
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Actifit ® polyurethane meniscal scaffold: MRI and functional outcomes after a minimum follow-up of 5 years. Orthop Traumatol Surg Res 2017; 103:609-614. [PMID: 28373139 DOI: 10.1016/j.otsr.2017.02.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/07/2017] [Accepted: 02/13/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Implantation of the Actifit® polyurethane meniscal scaffold in patients who have pain after partial meniscectomy provides short-term pain relief and better function. But there is a lack of information about medium-term outcomes. The objective of this longitudinal study was to evaluate the MRI and functional outcomes after a minimum follow-up of 5 years. It was hypothesized that the results are stable over time. MATERIAL AND METHODS Fifteen consecutive patients (8 men, 7 women; mean age 30 years, range 19-47, mean BMI 25) were enrolled in the study between February 2008 and January 2011. Five patients also underwent ACL reconstruction and one underwent mosaicplasty. Nine lateral and six medial Actifit® implants were evaluated prospectively before the surgery and at a minimum of 12, 24 and 60 months' follow-up using a visual analogue scale (VAS) for pain, the objective and subjective IKDC scores, radiological and MRI analysis with measurement of the ICRS score, Genovese score and extrusion. RESULTS The mean follow-up was 6 years (range 5-8.1). Two patients were lost to follow-up. Three patients were re-operated at 7, 19 and 30 months because they had not improved functionally and the implant appeared damaged on MRI. Partial removal of the implant did not improve the functional outcomes (mean subjective IKDC pre- and post-revision: 37.0 vs. 34.9). Two patients were lost to follow-up. In intention to treat (13 cases), the pain (VAS) and subjective IKDC score were improved between the preoperative period and the last follow-up (5.46 vs. 2.92, P=0.007 and 51.2 vs. 66.1, P=0.05). In per protocol (10 cases, failures excluded), the pain (VAS) and subjective IKDC score were improved (5.3 vs. 1.9, P=0.0009; 49.6 vs. 75.4, P=0.002) along with the pain, daily activities and quality of life components of the KOOS (60.6 vs. 86.0, P=0.0008; 70.3 vs. 90.2, P=0.001; 42.7 vs. 71.0, P=0.0058). The functional scores were stable between months 12, 24 and 60. ICRS cartilage score and mean meniscal extrusion were unchanged at the last follow-up (1.6 vs. 1.6 and 2.41 vs. 2.79). In all patients, the meniscal implant had an intermediate signal and reduced size on MRI. DISCUSSION Despite an abnormal MRI appearance suggesting the meniscal scaffold is not fully mature after 5 years, the functional scores and cartilage status are stable at this time point. However, the failure rate is still high and removing the implant in patients with poor function does not improve the outcome. TYPE OF STUDY Prospective cohort study Level IV.
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Hackl W, Lechner R, Liebensteiner M. Künstlicher Meniskusersatz. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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