1
|
Affiliation(s)
- Ameer Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| | | | | |
Collapse
|
2
|
Steineman BD, LaPrade RF, Santangelo KS, Warner BT, Goodrich LR, Haut Donahue TL. Early Osteoarthritis After Untreated Anterior Meniscal Root Tears: An In Vivo Animal Study. Orthop J Sports Med 2017; 5:2325967117702452. [PMID: 28508006 PMCID: PMC5415046 DOI: 10.1177/2325967117702452] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Meniscal root tears cause menisci and their insertions to inadequately distribute loads and potentially leave underlying articular cartilage unprotected. Untreated meniscal root tears are becoming increasingly recognized to induce joint degradation; however, little information is known about anterior meniscal root tears and how they affect joint tissue. Purpose: To observe the early degenerative changes within the synovial fluid, menisci, tibial articular cartilage, and subchondral bone after arthroscopic creation of untreated anterior meniscal root tears. Study Design: Controlled laboratory study. Methods: Anterolateral meniscal root tears were created in 1 knee joint of 5 adult Flemish Giant rabbits, and anteromedial meniscal root tears were created in 4 additional rabbits. The contralateral limbs were used as nonoperated controls. The animals were euthanized at 8 weeks postoperatively; synovial fluid was aspirated, and tissue samples of menisci and tibial articular cartilage were collected and processed for multiple analyses to detect signs of early degeneration. Results: Significant changes were found within the synovial fluid, meniscal tissue, and tibial subchondral bone of the knees with anterior meniscal root tears when compared with controls. There were no significant changes identified in the tibial articular cartilage when comparing the tear groups with controls. Conclusion: This study demonstrated early degenerative changes within the synovial fluid, menisci, and tibial subchondral bone when leaving anterior meniscal root tears untreated for 8 weeks. The results suggest that meniscal tissue presents measurable, degenerative changes prior to changes within the articular cartilage after anterior meniscal root tears. Anterior destabilization of the meniscus arthroscopically may lead to measurable degenerative changes and be useful for future in vivo natural history and animal repair studies. Clinical Relevance: The present study is the first to investigate various tissue changes after anterior meniscal root tears of both the medial and lateral menisci. The results from this study suggest that degenerative changes occur within the synovial fluid, meniscus, and tibial subchondral bone prior to any measurable changes to the tibial articular cartilage. Further studies should expand on this study to evaluate how these components continue to progress when left untreated for long periods.
Collapse
Affiliation(s)
- Brett D Steineman
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Robert F LaPrade
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Kelly S Santangelo
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA.,Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA
| | | | - Laurie R Goodrich
- Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA
| | - Tammy L Haut Donahue
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA.,Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA
| |
Collapse
|
3
|
Riester SM, Denbeigh JM, Lin Y, Jones DL, de Mooij T, Lewallen EA, Nie H, Paradise CR, Radel DJ, Dudakovic A, Camilleri ET, Larson DR, Qu W, Krych AJ, Frick MA, Im H, Dietz AB, Smith J, van Wijnen AJ. Safety Studies for Use of Adipose Tissue-Derived Mesenchymal Stromal/Stem Cells in a Rabbit Model for Osteoarthritis to Support a Phase I Clinical Trial. Stem Cells Transl Med 2016; 6:910-922. [PMID: 28297568 PMCID: PMC5442773 DOI: 10.5966/sctm.2016-0097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/01/2016] [Indexed: 01/11/2023] Open
Abstract
Adipose‐derived mesenchymal stem cells (AMSCs) offer potential as a therapeutic option for clinical applications in musculoskeletal regenerative medicine because of their immunomodulatory functions and capacity for trilineage differentiation. In preparation for a phase I clinical trial using AMSCs to treat patients with osteoarthritis, we carried out preclinical studies to assess the safety of human AMSCs within the intra‐articular joint space. Culture‐expanded human AMSCs grown in human platelet‐lysate were delivered via intra‐articular injections into normal healthy rabbit knees and knees at risk for the development of osteoarthritis after bilateral medial anterior hemimeniscectomy. Treatment outcomes and safety were evaluated by assessing the general health, function, and behavior of the animals. Joint tissues were analyzed by x‐ray, magnetic resonance imaging, and histopathology. Intra‐articular AMSC therapy was well tolerated in this study. We did not observe adverse systemic reactions, nor did we find evidence of damage to intra‐articular joint tissues. Thus, the data generated in this study show a favorable safety profile for AMSCs within the joint space in support of a phase I clinical trial evaluating the clinical utility of AMSCs to treat osteoarthritis. Stem Cells Translational Medicine2017;6:910–922
Collapse
Affiliation(s)
- Scott M. Riester
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet M. Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yang Lin
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Dakota L. Jones
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering and Physiology, Mayo Graduate School, Mayo Clinic, Rochester, Minnesota, USA
| | - Tristan de Mooij
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric A. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hai Nie
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher R. Paradise
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Darcie J. Radel
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily T. Camilleri
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dirk R. Larson
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wenchun Qu
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew A. Frick
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hee‐Jeong Im
- Department of Biochemistry, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Section of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Allan B. Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering and Physiology, Mayo Graduate School, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Abstract
The meniscus plays a crucial role in maintaining knee joint homoeostasis. Meniscal lesions are relatively common in the knee joint and are typically categorized into various types. However, it is difficult for inner avascular meniscal lesions to self-heal. Untreated meniscal lesions lead to meniscal extrusions in the long-term and gradually trigger the development of knee osteoarthritis (OA). The relationship between meniscal lesions and knee OA is complex. Partial meniscectomy, which is the primary method to treat a meniscal injury, only relieves short-term pain; however, it does not prevent the development of knee OA. Similarly, other current therapeutic strategies have intrinsic limitations in clinical practice. Tissue engineering technology will probably address this challenge by reconstructing a meniscus possessing an integrated configuration with competent biomechanical capacity. This review describes normal structure and biomechanical characteristics of the meniscus, discusses the relationship between meniscal lesions and knee OA, and summarizes the classifications and corresponding treatment strategies for meniscal lesions to understand meniscal regeneration from physiological and pathological perspectives. Last, we present current advances in meniscal scaffolds and provide a number of prospects that will potentially benefit the development of meniscal regeneration methods.
Collapse
|
5
|
Anetzberger H, Mayer A, Glaser C, Lorenz S, Birkenmaier C, Müller-Gerbl M. Meniscectomy leads to early changes in the mineralization distribution of subchondral bone plate. Knee Surg Sports Traumatol Arthrosc 2014; 22:112-9. [PMID: 23160848 DOI: 10.1007/s00167-012-2297-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE It is generally recognized that the subchondral bone plate (SBP) is involved in development of osteoarthritis (OA). However, the pathophysiological significance is not yet clear. The goal of this study is to investigate the extent of the changes that occur in SBP of the tibial plateau in the early stages of experimental OA. METHODS Forty-three female rabbits were assigned to 5 experimental (n = 8 each group) and one sham group (n = 3). OA was induced by medial meniscectomy in the right knee, the left knee served as control. 2, 4, 8, 12, and 24 weeks after meniscectomy, cartilage damage was evaluated, and bone mineral density (BMD) and mineralization distribution of the SBP was measured by computed tomography osteoabsorptiometry (CT-OAM). RESULTS Cartilage damage started 2 weeks after meniscectomy with surface roughening. Cartilage defects increased over time. 24 weeks postoperatively, subchondral bone was exposed. As early as 2 weeks after meniscectomy, BMD in the medial tibial plateau decreased significantly. BMD increased again and reached the values of the non-operated knee 12 weeks postoperatively. In addition, already 4 weeks after meniscectomy a significant shift of the density maximum on the medial tibial plateau, which is normally centrally located toward the margin was observed. CONCLUSIONS In conclusion, the results of this study contribute to the concept of early involvement of the SBP in the development of OA. The hypothesis that changes in the SBP occur simultaneously to cartilage damage was confirmed.
Collapse
Affiliation(s)
- Hermann Anetzberger
- Orthopädische Gemeinschaftspraxis am OEZ, Hanauerstr. 65, 80993, Munich, Germany,
| | | | | | | | | | | |
Collapse
|
6
|
Cake MA, Read RA, Corfield G, Daniel A, Burkhardt D, Smith MM, Little CB. Comparison of gait and pathology outcomes of three meniscal procedures for induction of knee osteoarthritis in sheep. Osteoarthritis Cartilage 2013; 21:226-36. [PMID: 23069853 DOI: 10.1016/j.joca.2012.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 09/10/2012] [Accepted: 10/05/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE(S) Meniscectomy (MX) of sheep induces a well-established animal model of human osteoarthritis (OA). This study compared the clinical (lameness) and pathological outcomes of unilateral, complete medial MX vs two less traumatic and more easily performed meniscal destabilisation procedures. METHODS Four-year old wethers (n = 6/group) underwent sham operation, cranial pole release (CPR), mid-body transection (MBT) or total MX of the medial meniscus. Joints were assessed for gross pathology (cartilage erosion and osteophytes), histomorphometry, two histopathology scoring methods (modified Mankin-type and Pritzker score), and immunohistology for ADAMTS- and MMP-cleaved neoepitopes, at 12 weeks post-op. Ground reaction forces (GRFs) were determined by force plate in a subset (n = 4/group) at baseline, 2.5, 8, and 12 weeks post-op. RESULTS Gross pathology scores of operated groups differed significantly from sham animals (P < 0.05) but not from each other, though qualitative differences were noted: CPR sheep developed more cranial and focal lesions, while MBT and MX joints showed more widespread lesions and osteophyte formation. Similarly, histopathology scores were significantly elevated vs sham but did not differ between operated groups at P < 0.05, except for a trend for lower tibial cartilage histopathology in MBT consistent with the immunohistologic pattern of reduced aggrecanase-cleavage neoepitope in that model. CPR sheep developed less femoral subchondral sclerosis, suggesting some residual biomechanical effect from the destabilised but intact meniscus. Few significant differences were noted between operated groups in force plate analyses, though gait abnormalities appeared to be least in CPR sheep, and most persistent (>12 weeks) in MBT animals. CONCLUSION The well-validated ovine MX model and the simpler meniscal destabilisation procedures resulted in broadly similar joint pathology and lameness. Meniscal CPR or MBT, as easier and more clinically relevant procedures, may represent preferred models for the induction of OA and evaluation of potential disease-modifying therapies.
Collapse
Affiliation(s)
- M A Cake
- School of Veterinary and Biomedical Sciences, Murdoch University, Perth, WA 6150, Australia.
| | | | | | | | | | | | | |
Collapse
|
7
|
Guzzardella GA, Morrone G, Fini M, Rocca M, Torricelli P, Giardino R. Histologic Evaluation of the Repair Process of Chondral and Osteochondral Lesions in a Rabbit Model. JOURNAL OF APPLIED ANIMAL RESEARCH 2011. [DOI: 10.1080/09712119.2000.9706305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
8
|
Abstract
The menisci are two semilunar-shaped fibrocartilagenous structures, which are interposed between the femoral condyles and tibial plateaux. They have an important role in knee function. Long-term follow-up studies showed that virtually all meniscectomized knees develop arthritic changes with time. The meniscus has functions in load bearing, load transmission, shock absorption, joint stability, joint lubrication, and joint congruity. Because of these functions, meniscal tissue should be preserved whenever possible. A well-trained surgeon can safely rely on clinical examination for diagnosing meniscal injuries. History and clinical examination are at least as accurate as magnetic resonance imaging in the skilled orthopedic surgeon’s hand. When meniscal repair is not possible, partial resection of the meniscus is indicated. Meniscal repair has evolved from open to arthroscopic techniques, which include the inside-out and outside-in suture repairs and the all-inside techniques. Meniscal transplantation is generally accepted as a management alternative option for selected symptomatic patients with previous complete or near-complete meniscectomy.
Collapse
Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England
| | | | | | | |
Collapse
|
9
|
Luther JK, Cook CR, Cook JL. Meniscal release in cruciate ligament intact stifles causes lameness and medial compartment cartilage pathology in dogs 12 weeks postoperatively. Vet Surg 2009; 38:520-9. [PMID: 19538675 DOI: 10.1111/j.1532-950x.2009.00520.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate after 12 weeks the effects of caudal medial meniscal release (MR) in the cranial cruciate ligament-intact canine stifle. STUDY DESIGN Blinded, prospective in vivo study. ANIMALS Purpose-bred hound dogs (n=10). METHODS Either MR (n=5) or a sham (SH) surgery (n=5) was performed via arthroscopy. Orthopedic examination and subjective lameness evaluation were performed in each dog preoperatively and at 4, 8, and 12 weeks after surgery. Twelve weeks postoperatively, ultrasonographic, radiographic, and arthroscopic examinations were performed on the operated stifles. Gross pathology of the articular cartilage, cruciate ligaments, and menisci was assessed. India ink staining of the femoral and tibial articular surfaces was performed to determine the percent area of articular cartilage damage. RESULTS At 8 and 12 weeks after surgery, MR dogs were lamer than SH dogs. At 12 weeks, the degree of radiographic OA was significantly higher in MR stifles than in SH stifles. Gross and sonographic meniscal pathology was more severe in MR stifles compared with SH stifles. MR stifles had significantly more severe articular cartilage pathology compared with SH stifles 12 weeks after surgery; pathology was most severe in the medial compartment. CONCLUSIONS MR alone is associated with articular cartilage loss, further meniscal pathology, degenerative joint disease, and lameness. CLINICAL RELEVANCE Subsequent osteoarthritis and dysfunction of the stifle joint should be considered when making clinical decisions regarding MR in dogs.
Collapse
Affiliation(s)
- Jill K Luther
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA.
| | | | | |
Collapse
|
10
|
López G, Maestro A, Llopis J, Leyes M, Forriol F. Implante meniscal de colágeno asociado a rotura del ligamento cruzado anterior. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2008.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
11
|
López G, Maestro A, Llopis J, Leyes M, Forriol F. Collagen meniscal implants with an associated tear of the anterior cruciate ligament. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/s1988-8856(09)70136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
12
|
Abstract
Adult marrow-derived Mesenchymal Stem Cells (MSCs) are capable of dividing and their progeny are further capable of differentiating into one of several mesenchymal phenotypes such as osteoblasts, chondrocytes, myocytes, marrow stromal cells, tendon-ligament fibroblasts, and adipocytes. In addition, these MSCs secrete a variety of cytokines and growth factors that have both paracrine and autocrine activities. These secreted bioactive factors suppress the local immune system, inhibit fibrosis (scar formation) and apoptosis, enhance angiogenesis, and stimulate mitosis and differentiation of tissue-intrinsic reparative or stem cells. These effects, which are referred to as trophic effects, are distinct from the direct differentiation of MSCs into repair tissue. Several studies which tested the use of MSCs in models of infarct (injured heart), stroke (brain), or meniscus regeneration models are reviewed within the context of MSC-mediated trophic effects in tissue repair.
Collapse
Affiliation(s)
- Arnold I Caplan
- Department of Biology, Skeletal Research Center, Case Western Reserve University, 2080 Adelbert Road, Cleveland, OH 44106-7080, USA.
| | | |
Collapse
|
13
|
Maes JA, Haut Donahue TL. Time dependent properties of bovine meniscal attachments: Stress relaxation and creep. J Biomech 2006; 39:3055-61. [PMID: 16360161 DOI: 10.1016/j.jbiomech.2005.09.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 09/15/2005] [Indexed: 11/18/2022]
Abstract
It has been suggested that the success of a meniscal replacement is dependent on several factors, one of which is the secure fixation and firm attachment of the replacement to the tibial plateau [Chen, M.I., Branch, T.P., et al., 1996. Is it important to secure the horns during lateral meniscal transplantation? A cadaveric study. Arthroscopy 12(2), 174-181; Alhalki, M.M., et al., 1999. How three methods for fixing a medial meniscal autograft affect tibial contact mechanics. American Journal of Sports Medicine 27(3), 320-328; Haut Donahue, T.L., et al., 2003. How the stiffness of meniscal attachments and meniscal material properties affect tibio-femoral contact pressure computed using a validated finite element model of the human knee joint. Journal of Biomechanics 36(1), 19-34]. The complex loading environment in the knee lends itself to different loading environments for each meniscal attachment. We hypothesize that the creep and stress relaxation characteristics of the horn attachments will be different for the anterior versus posterior, and medial versus lateral attachments. To test this hypothesis, the stress relaxation and creep characteristics of the meniscal horn attachments were determined. The stress relaxation properties of load/stress at the end of the test, and the load/stress relaxation rate demonstrated no significant statistical differences between the attachments. Unlike the stress relaxation properties, the creep properties demonstrated some significant differences amongst the attachments. The normalized displacement at the end of the test, normalized creep rate and strain creep rate for the lateral anterior attachment were significantly different than those of the medial posterior attachment (p<0.05). The two anterior attachments had significantly different strains at the end of the test, as well as significantly different creep strain rates (p<0.05). The two attachments of the medial meniscus revealed no significant differences between any of the creep properties measured (p>0.05). The time dependent properties obtained in this experiment provide insight into the behavior of meniscal horn attachments under various loading situations. The results indicate that a suitable meniscal replacement may require different properties for the lateral and medial horns.
Collapse
Affiliation(s)
- Jason A Maes
- Department of Mechanical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | | |
Collapse
|
14
|
Abstract
PURPOSE The purpose of this study was to introduce clinical features and characteristics of radial tears of the posterior horn of the medial meniscus and the results of arthroscopic surgery. TYPE OF STUDY Retrospective case series. METHODS From August 1996 to December 1999, 345 consecutive cases of medial meniscal tears were treated using arthroscopic surgery in Asan Medical Center, Seoul, Korea. Of these, 96 cases (27.8%) with radial tears of the posterior horn of the medial meniscus were reviewed. All patients were treated with arthroscopic partial meniscectomy. Based on medical records, including surgical notes and detailed arthroscopic photographs, we reviewed the age distribution of the patients, preoperative physical signs, magnetic resonance imaging, surgical findings, and clinical results using the Lysholm Knee Scoring scale and our own questionnaire. RESULTS Radial tears of the posterior horn of the medial meniscus were more common than previously known and also were more common in elderly patients. Most patients presented mechanical symptoms. Magnetic resonance imaging often failed to reveal the tears. Careful attention to the nature of pain and the physical examination was critical in making a diagnosis. Although most patients were elderly and had degenerated articular cartilages, subjective symptoms improved significantly after arthroscopic partial meniscectomy. CONCLUSIONS Radial tears of the medial meniscus posterior horn are common. Diagnosis of this tear is often difficult because most patients have osteoarthritic knees masking meniscal tears and magnetic resonance imaging shows unacceptably high rates of false-negative results. Following strict surgical indications, arthroscopic partial meniscectomy can help patients with low morbidity. LEVEL OF EVIDENCE Level IV therapeutic study (case series, no or historical control group).
Collapse
Affiliation(s)
- Seong-Il Bin
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, South Korea.
| | | | | |
Collapse
|
15
|
Anetzberger H, Thein E, Löffler G, Messmer K. Fluorescent microsphere method is suitable for chronic bone blood flow measurement: a long-term study after meniscectomy in rabbits. J Appl Physiol (1985) 2003; 96:1928-36. [PMID: 14698991 DOI: 10.1152/japplphysiol.00904.2003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The fluorescent microsphere (FM) method is considered a reliable technique to determine regional bone blood flow (RBBF) in acute experiments. In this study, we verified the accuracy and validity of this technique for measurement of RBBF in a long-term experiment and examined RBBF after meniscectomy. Twenty-four anesthetized female New Zealand white rabbits (3 groups, each n = 8) received consecutive left ventricular injections of FM in defined time intervals after meniscectomy: group 1 from preoperation to 3 wk postoperation; group 2 from 3 to 7 wk postoperation; and group 3 from 7 to 11 wk postoperation. To test the precision of the FM method, two FM species were injected simultaneously at the first and last measurement. After the experiment, humeri, femora, tibiae, and reference organs (kidney, lung, brain) were removed and dissected according to standardized protocols. Fluorescence was determined in each reference blood and tissue sample, and blood flow values were calculated. Blood flow in kidney, lung, and brain revealed no significant difference between right and left side and remained unchanged during the observation period, thus excluding errors due to shunting and dislodging of spheres in our experiments. Comparison of relative bone blood flow values obtained by simultaneously injected FM showed an excellent correlation at the first and last injection, indicating valid RBBF measurements in long-term experiments. We found a significant increase in RBBF 3 wk after meniscectomy in the right tibial condyles compared with the nonoperated left side. Similar changes were found in the femoral condyles. RBBF in other regions of tibia, femur, and humerus revealed no significant differences between right- and left-sided bone samples of the same region. Our results demonstrate that the FM method is valid for measuring RBBF in long-term experiments. In addition, we were able to demonstrate that meniscectomy leads to an increase in RBBF in the tibial condyles at a very early stage. This increase might be caused by stress-induced alterations of the subchondral bone.
Collapse
Affiliation(s)
- H Anetzberger
- Department of Orthopaedics, Klinikum Grosshadern, Ludwig-Maximilians University, 81377 Munich, Germany.
| | | | | | | |
Collapse
|
16
|
Abstract
The influence of suturing on cell infiltration into the meniscus and surrounding tissue is not well known. Histologic changes in the meniscus after suturing and prediction of histologic changes using magnetic resonance imaging were studied. Forty knees in 20 mongrel dogs were studied using four types of 4-0 suture material: nonabsorbable monofilament, nonabsorbable braided, absorbable monofilament, and absorbable braided. Each type of suture material was used for meniscal suture on eight knees each. The other eight knees were not subjected to meniscal suture. Specimens obtained at 1 and 3 months were studied by magnetic resonance imaging and light microscopic analysis. The maximum width of change of meniscal tissue was measured. Changes from the nonabsorbable suture group were smaller than that of the absorbable suture group in magnetic resonance imaging. Histologic changes as seen by light microscope were larger in the absorbable group than in the nonabsorbable group at 1 and 3 months after surgery. Injury was found in the articular cartilage of the femoral condyle in the nonabsorbable braided suture group. Histologic changes were significantly greater when changes in magnetic resonance imaging signal intensity were larger. The current study showed that non-absorbable monofilament suture material results in the least damage to the meniscus and surrounding tissue.
Collapse
Affiliation(s)
- T Yasunaga
- Department of Orthopedic Surgery, Fukushima Medical College, Fukushima City, Japan
| | | | | |
Collapse
|
17
|
Abstract
This review details current efforts to tissue engineer the knee meniscus successfully. The meniscus is a fibrocartilaginous tissue found within the knee joint that is responsible for shock absorption, load transmission, and stability within the knee joint. If this tissue is damaged, either through tears or degenerative processes, then deterioration of the articular cartilage can occur. Unfortunately, there is a dearth in the amount of work done to tissue engineer the meniscus when compared to other musculoskeletal tissues, such as bone. This review gives a brief overview of meniscal anatomy, biochemical properties, biomechanical properties, and wound repair techniques. The discussion centers primarily on the different components of attempting to tissue engineer the meniscus, such as scaffold materials, growth factors, animal models, and culturing conditions. Our approach for tissue engineering the meniscus is also discussed.
Collapse
Affiliation(s)
- M A Sweigart
- Department of Bioengineering, Rice University, Houston, Texas 77251, USA
| | | |
Collapse
|
18
|
|
19
|
Messner K, Verdonk R. It is necessary to anchor the meniscal transplants with bone plugs? A mini-battle. Scand J Med Sci Sports 1999; 9:186-7. [PMID: 10380280 DOI: 10.1111/j.1600-0838.1999.tb00454.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Messner
- Faculty of Health Sciences, Linköping University, Sweden
| | | |
Collapse
|
20
|
Abstract
Owing to the initial necrosis to which any freely transplanted biological graft is subjected, meniscus transplantation is based on similar principles to meniscal regeneration. Both methods rely on repopulation of extrinsic cells of the graft. In the former procedure a biological matrix (meniscus, tendon, fatpad) is used as graft (scaffold), whereas in meniscal regeneration commercially available resorbable or non-resorbable scaffolds are implanted. However, the cellular (re)population and (re)vitalization process is deleterious rather than beneficial for the function of the graft as the remodelling of the tissue leads to shrinkage and narrowing of the implant. In addition, improper fixation and subsequent elongation of the anterior and posterior bony attachments leads to peripheral graft dislocation, loss of the load distribution function, and subsequently to cartilage degeneration. Hence, meniscus transplantation or regeneration faces two major problems: 1) remodelling of graft to inferior tissue properties after allograft transplantation, or lacking establishment of normal tissue properties after use of biological matrixes other than the meniscus (fatpad, tendon), or commercially available matrixes; 2) improper fixation with elongation of the anterior and posterior attachments. Furthermore, use of allografts incorporates the risk for disease transmission. Today we are unable to control these problems, and therefore the concept of meniscal replacement does not work yet. Further research is necessary to control remodelling and improve fixation to make this procedure a successful one in the future.
Collapse
Affiliation(s)
- K Messner
- Faculty of Health Sciences, University of Linköping, Sweden
| |
Collapse
|
21
|
Messner K, Gao J. The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment. J Anat 1998; 193 ( Pt 2):161-78. [PMID: 9827632 PMCID: PMC1467836 DOI: 10.1046/j.1469-7580.1998.19320161.x] [Citation(s) in RCA: 253] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The menisci and their insertions into bone (entheses) represent a functional unit. Thanks to their firm entheses, the menisci are able to distribute loads and therefore reduce the stresses on the tibia, a function which is regarded essential for cartilage protection and prevention of osteoarthrosis. The tissue of the hypocellular meniscal body consists mainly of water and a dense elaborate type I collagen network with a predominantly circumferential alignment. The content of different collagens, proteoglycans and nonproteoglycan proteins shows significant regional variations probably reflecting functional adaptation. The meniscal horns are attached via meniscal insertional ligaments mainly to tibial bone. At the enthesis, the fibres of the insertional ligaments attach to bone via uncalcified and calcified fibrocartilages. This anatomical configuration of gradual transition from soft to hard tissue, which is identical to other ligament entheses, is certainly essential for normal mechanical function and probably protects this vulnerable transition between 2 biomechanically different tissues from failure. Clinical treatment of meniscal tears needs to be based on these special anatomical and functional characteristics. Partial meniscectomy will preserve some of the load distribution function of the meniscus only when the meniscal body enthesis entity is preserved. Repair of peripheral longitudinal tears will heal and probably preserve the load distribution function of the meniscus, whereas radial tears through the whole meniscal periphery or more central and complex tears may be induced to heal, but probably do not preserve the load distribution function. There is no proof that replacement of the meniscus with an allograft can reestablish some of the important meniscal functions, and thereby prevent or reduce the development of osteoarthrosis which is common after meniscectomy. After implantation, major problems are the remodelling of the graft to inferior structural, biochemical and mechanical properties and its insufficient fixation to bone which fails to duplicate a normal anatomical configuration and therefore a functional meniscal enthesis.
Collapse
Affiliation(s)
- K Messner
- Sports Medicine, Faculty of Health Sciences, Linköping University, Sweden.
| | | |
Collapse
|