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Inoue J, Giusto JD, Dadoo S, Nukuto K, Lesniak BP, Musahl V, Hughes JD. Nonanatomic femoral tunnel placement increases the risk of subsequent meniscal surgery after ACLR: Part II-Patients without recurrent ACL injury. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38842025 DOI: 10.1002/ksa.12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The purpose of this study was to identify risk factors for subsequent meniscal surgery following anterior cruciate ligament (ACL) reconstruction (ACLR) in patients without recurrent ACL injury. METHODS Patients aged ≥14 years who underwent primary ACLR with minimum 1-year follow-up and without recurrent ACL injury were retrospectively reviewed. Patient demographics and surgical data at the time of ACLR were collected. Postoperative radiographs were used to measure femoral and tibial tunnel position, and posterior tibial slope. Univariate and multivariate analyses were performed to identify risk factors for subsequent meniscal surgery. RESULTS Of 629 ACLRs that fulfilled the inclusion criteria, subsequent meniscal surgery was performed in 65 [10.3%] patients. Multivariate analysis revealed that medial meniscal repair at the time of ACLR, younger age, anterior femoral tunnel position and distal femoral tunnel position were significantly associated with subsequent meniscal surgery (p < 0.001, p = 0.016, p = 0.015, p = 0.035, respectively). The frequency of femoral tunnel placement >10% outside of the literature-established anatomic position was significantly higher in those who underwent subsequent meniscal surgery compared to those who did not (38.3% vs. 20.3%, p = 0.006). Posterior tibial slope and ACL graft type were not significantly associated with subsequent meniscal surgery. CONCLUSION Medial meniscal repair at the time of ACLR, younger age and nonanatomic femoral tunnel placement were risk factors for subsequent meniscal surgery in patients without recurrent ACL injury. Femoral tunnel placement <10% outside of the native anatomic position is important to reduce the risk of subsequent meniscal surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi, Japan
| | - Joseph D Giusto
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Koji Nukuto
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Marullo M, Russo A, Spreafico A, Romagnoli S. Lateral Unicompartmental Knee Arthroplasty for Osteoarthritis Secondary to Lateral Meniscectomy: High Functional Results and Survivorship and Low Osteoarthritis Progression at a Mean 10 Years of Follow-up. J Bone Joint Surg Am 2024; 106:992-999. [PMID: 38512989 DOI: 10.2106/jbjs.23.00764] [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] [Indexed: 03/23/2024]
Abstract
BACKGROUND Meniscectomy, whether partial or total, is a common knee surgery, but it considerably increases the risk of knee osteoarthritis (OA). Lateral meniscectomy has more severe consequences than medial meniscectomy, leading to faster OA progression and worse clinical outcomes. Unicompartmental knee arthroplasty (UKA) is a suitable treatment option for lateral OA and has demonstrated better outcomes than total knee arthroplasty (TKA). The aims of this study were to evaluate the clinical and functional results, OA progression in the medial compartment, and implant survivorship following lateral UKA in patients with OA secondary to lateral meniscectomy and to compare these outcomes with those of patients who underwent lateral UKA for primary lateral OA. METHODS Between 2001 and 2017, 214 lateral UKAs were performed. Of these, 42 were performed for OA secondary to lateral meniscectomy. The control group was composed of patients who underwent lateral UKA for primary lateral OA and was formed through a 1:1 case-control matching process based on sex, age, body mass index, and operation date. The outcomes that were studied included range of motion, Knee Society Score, University of California Los Angeles (UCLA) Activity Score, Tegner Activity Scale, Forgotten Joint Score, visual analog scale for pain, OA progression in the medial compartment, and implant survivorship. RESULTS At a mean follow-up of 10.2 years, both groups demonstrated significant improvements (p < 0.01) after lateral UKA in all clinical and functional scores except the UCLA Activity Score and Tegner Activity Scale. No significant differences in clinical and functional scores were found between the groups. However, patients with OA secondary to meniscectomy exhibited significantly less OA progression in the medial compartment (p = 0.035) and higher 10-year implant survival (97.6% versus 83.3%). CONCLUSIONS Lateral UKA is an effective treatment option for OA secondary to lateral meniscectomy, providing excellent functional outcomes and survivorship. Patients with post-meniscectomy OA exhibited less OA progression in the medial compartment than patients with primary OA and, consequently, had better 10-year implant survivorship. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matteo Marullo
- Department of Joint Replacement, IRCCS Galeazzi Orthopedic Institute, Milano, Italy
| | - Antonio Russo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Spreafico
- Department of Joint Replacement, IRCCS Galeazzi Orthopedic Institute, Milano, Italy
| | - Sergio Romagnoli
- Department of Joint Replacement, IRCCS Galeazzi Orthopedic Institute, Milano, Italy
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Bracey L, Parsons D, Zhao AY, Agarwal AR, Mikula JD, Fraychineaud T, Thakkar SC, Doerre T, Best MJ. The cumulative incidence and risk factors associated with 5-year conversion to knee arthroplasty following primary meniscus repair or primary meniscectomy. J Orthop 2024; 52:17-20. [PMID: 38404702 PMCID: PMC10881408 DOI: 10.1016/j.jor.2024.02.018] [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: 01/24/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background This study aimed to observe the 5-year knee arthroplasty conversion incidence rate and associated risk factors in patients who underwent meniscus procedures. Methods Using a national database, we analyzed patients who had undergone primary meniscus repair or meniscectomy without prior knee surgeries. The cumulative knee arthroplasty conversion incidence was determined via Kaplan Meier analysis. Risk factors for conversion within 5 years were assessed using a Cox proportional hazard ratio model, with results as hazard ratios (HR). Results 8125 patients had meniscus repair, while 240,209 had meniscectomy. 5-year conversion rates: repair 1.7%, meniscectomy 8.4%. Arthroplasty likelihood decreased as age decreased for repair (70+ [HR: 162.20]; 60-69 [HR: 81.64]; 50-59 [HR: 49.85]; 40-49 [HR: 17.79]; p < 0.001 all). Additional risk factors included male sex (HR: 0.35; p < 0.001) and higher Charlson Comorbidity Index (CCI) (CCI1 [HR: 1.28; p = 0.012]). For meniscectomy, arthroplasty likelihood also decreased with age (70+ [HR: 99.41]; 60-69 [HR: 84.57]; 50-59 [HR: 66.60]; 40-49 [HR: 36.15]; 30-39 [HR: 10.18]; p < 0.001 all). Additional risk factors included male sex (HR: 0.68; p < 0.001), obesity (HR: 1.18; p < 0.001), smoking (HR: 0.1.12; p = 0.010), and higher CCI (CCI1 [HR: 1.25]; CCI2 [HR 1.39]; CCI3+ [HR 1.46]; p < 0.001 all). Conclusion This study revealed the national 5-year conversion incidence following primary meniscus repair (1.7%) and meniscectomy (8.4%). It also enhanced understanding of age, sex, obesity, smoking, comorbidities (CCI), and knee arthroplasty likelihood after meniscus procedures.
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Affiliation(s)
- Lauren Bracey
- Department of Orthopaedic Surgery, George Washington Hospital, Washington DC, USA
| | - Dylan Parsons
- Department of Orthopaedic Surgery, George Washington Hospital, Washington DC, USA
| | - Amy Y. Zhao
- Department of Orthopaedic Surgery, George Washington Hospital, Washington DC, USA
| | - Amil R. Agarwal
- Department of Orthopaedic Surgery, George Washington Hospital, Washington DC, USA
| | - Jacob D. Mikula
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Thomas Fraychineaud
- Department of Orthopaedic Surgery, George Washington Hospital, Washington DC, USA
| | | | - Teresa Doerre
- Department of Orthopaedic Surgery, George Washington Hospital, Washington DC, USA
| | - Matthew J. Best
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Wong PC, Chen KH, Wang WR, Chen CY, Wang YT, Lee YB, Wu JL. Injectable ChitHCl-DDA tissue adhesive with high adhesive strength and biocompatibility for torn meniscus repair and regeneration. Int J Biol Macromol 2024; 270:132409. [PMID: 38768918 DOI: 10.1016/j.ijbiomac.2024.132409] [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: 03/16/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
Suture pull-through is a clinical problem in meniscus repair surgery due to the sharp leading edge of sutures. Several tissue adhesives have been developed as an alternative to traditional suturing; however, there is still no suitable tissue adhesive specific for meniscus repair treatment due to unsatisfactory biosafety, biodegradable, sterilizable, and tissue-bonding characteristics. In this study, we used a tissue adhesive composed of chitosan hydrochloride reacted with oxidative periodate-oxidized dextran (ChitHCl-DDA) combined with a chitosan-based hydrogel and oxidative dextran to attach to the meniscus. We conducted viscoelastic tests, viscosity tests, lap shear stress tests, Fourier transform infrared (FTIR) spectroscopy, swelling ratio tests, and degradation behavior tests to characterize these materials. An MTT assay, alcian blue staining, migration assay, cell behavior observations, and protein expression tests were used to understand cell viability and responses. Moreover, ex vivo and in vivo tests were used to analyze tissue regeneration and biocompatibility of the ChitHCl-DDA tissue adhesive. Our results revealed that the ChitHCl-DDA tissue adhesive provided excellent tissue adhesive strength, cell viability, and cell responses. This tissue adhesive has great potential for torn meniscus tissue repair and regeneration.
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Affiliation(s)
- Pei-Chun Wong
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Hao Chen
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Ru Wang
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Ying Chen
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yu-Tzu Wang
- Department of Mechanical and Electro-Mechanical Engineering, TamKang University, New Taipei City, Taiwan
| | - Yu-Bin Lee
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Republic of Korea
| | - Jia-Lin Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Orthopedics Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Berk AN, Cregar WM, Wang S, Habet NA, Ifarraguerri AM, Trofa DP, Piasecki DP, Fleischli JE, Saltzman BM. The Effect of Lower Limb Alignment on Tibiofemoral Joint Contact Biomechanics after Medial Meniscus Posterior Root Repair: A Finite-Element Analysis. J Am Acad Orthop Surg 2024; 32:e558-e567. [PMID: 38669669 DOI: 10.5435/jaaos-d-23-00702] [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: 07/28/2023] [Accepted: 02/25/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine how variations in lower limb alignment affect tibiofemoral joint contact biomechanics in the setting of medial meniscus posterior root tear (MMPRT) and associated root repair. METHODS A finite-element model of an intact knee joint was developed. Limb alignments ranging from 4° valgus to 8° varus were simulated under a 1,000 N compression load applied to the femoral head. For the intact, MMPRT, and root repair conditions, the peak contact pressure (PCP), total contact area, mean and maximum local contact pressure (LCP) elevation, and total area of LCP elevation of the medial tibiofemoral compartment were quantified. RESULTS The PCP and total contact area of the medial compartment in the intact knee increased from 2.43 MPa and 361 mm 2 at 4° valgus to 9.09 MPa and 508 mm 2 at 8° of varus. Compared with the intact state, in the MMPRT condition, medial compartment PCP was greater and the total contact area smaller for all alignment conditions. Root repair roughly restored PCPs in the medial compartment; however, this ability was compromised in knees with increasing varus alignment. Specifically, elevations in PCP relative to the intact state increased with increasing varus, as did the total contact area with LCP elevation. After root repair, medial compartment PCP remained elevated above the intact state at all degrees tested, ranging from 0.05 MPa at 4° valgus to 0.27 MPa at 8° of varus, with overall PCP values increasing from 2.48 to 9.09 MPa. For varus alignment greater than 4°, root repair failed to reduce the total contact area with LCP elevation relative to the MMPRT state. DISCUSSION Greater PCPs and areas of LCP elevation in varus knees may reduce the clinical effectiveness of root repair in delaying or preventing the development of tibiofemoral osteoarthritis.
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Affiliation(s)
- Alexander N Berk
- From the OrthoCarolina-Sports Medicine Center, Charlotte, NC (Berk, Cregar, Ifarraguerri, Piasecki, Fleischli, and Saltzman), the OrthoCarolina Research Institute, Charlotte, NC (Berk, Cregar, Ifarraguerri, Piasecki, Fleischli, and Saltzman), the Atrium Health-Musculoskeletal Institute, Charlotte, NC (Berk, Cregar, Wang, Habet, Ifarraguerri, Piasecki, Fleischli, and Saltzman), and the Columbia University Medical Center-Department of Orthopaedics, New York Presbyterian, New York, NY (Trofa)
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Ahmed MM, Zaino M, Moustafa M, Alajam RA, Alameer AH, Morsy WE, Fayed EM, Malik S, Amin WM. Kinesio Taping Increases Peak Torque of Quadriceps Muscle After Arthroscopic Meniscectomy, Double-Blinded RCT. Int J Gen Med 2024; 17:1897-1908. [PMID: 38736667 PMCID: PMC11086643 DOI: 10.2147/ijgm.s463753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study was conducted to release the debate and examine the short-term impact of KT on the quadriceps muscle following arthroscopic surgery for partial meniscectomy. Patients and Methods As part of a double-blind, randomized controlled trial, 40 people who had an arthroscopic partial meniscectomy (APM) were randomly put into two groups, A and B. Group A received Kinesio tape (KT) for the superficial heads of the quadriceps muscle, while group B received placebo KTk. After 10 minutes of KT application, the peak torque of both groups was measured using a Biodex isokinetic dynamometer. Results Peak torque showed a significant increase in group A in comparison with group B during angular velocity 60◦/Sec. (F (1, 130) = 58.9, p <0.001, ƞ2 =0.31) and during angular velocity 180◦/Sec. (F (1, 38) = 25.0, p <0.001, ƞ2 =0.40). Conclusion After APM, individuals experienced an immediate and significant improvement in the quadriceps' peak torque following KT application to the Rectus femoris, Vastus medialis, and Vastus lateralis muscles from origin to insertion.
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Affiliation(s)
- Mohamed M Ahmed
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Basic Science Department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohammad Zaino
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mahmoud Moustafa
- Diagnostic Radiography Technology Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ramzi Abdu Alajam
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdulaziz H Alameer
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Walaa E Morsy
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Esraa Mohammed Fayed
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Shazia Malik
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Wafaa Mahmoud Amin
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Basic Science for Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Gültekin MZ, Keskin Z, Arslan S, Dinç E, Dinçel YM. Three Morphological Risk Factors for Predicting Isolated Meniscal Bucket-handle Tear. Indian J Orthop 2024; 58:517-526. [PMID: 38694694 PMCID: PMC11058177 DOI: 10.1007/s43465-024-01124-4] [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: 07/10/2023] [Accepted: 02/11/2024] [Indexed: 05/04/2024]
Abstract
Purpose The study aimed to investigate whether morphometric variables of the knee can predict isolated meniscal bucket-handle tears and identify the risk factors. Methods The study included 146 participants with a mean age of 36.547 ± 12.279 years. They included two groups of 73 patients each: one group with isolated meniscal bucket-handle tears and another with no knee injury (control group). Magnetic resonance imaging findings of the participants were retrospectively assessed. A few morphometric variables associated with distal femur, proximal tibia, and cruciate ligaments were measured. Results Cruciate ligament tensity (CLT), medial femoral condylar height (MFCH), and lateral meniscal bone angle (LMBA) were found to be 12.7 ± 0.3, 30.1 ± 2.5 mm, and 21.2° ± 3.4°, respectively, in patients with meniscal bucket-handle tear, compared with 11.9 ± 0.2, 28.3 ± 2.7 mm, and 26.5° ± 3.7° in the control group, respectively. Based on multivariate Firth's logistic regression analysis, CLT (Odds ratio [OR]: 456.533; 95% confidence interval [CI]: 27.582 to > 999.999), MFCH (OR: 1.603; 95% CI: 1.023-2.513), and LMBA (OR: 0.780; 95% CI: 0.624-0.975) could distinguish between meniscal bucket-handle tears and knees without meniscus tears (p < 0.05). Based on the multicategorical multinominal regression model, CLT (OR: > 999.999; 95% CI: 49.937 to > 999.999) and MFCH (OR: 1.903; 95% CI: 1.005-3.606) were the determinant variables in differentiating medial meniscal bucket-handle tears from knees without meniscus tears (p < 0.05). Conclusion Large CLT, high medial condyle, and small LMBA were revealed as the morphometric risk factors for meniscal bucket-handle tear.
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Affiliation(s)
| | - Zeynep Keskin
- Department of Radiology, Konya City Hospital, Konya, Turkey
| | - Serdar Arslan
- Department of Physiotherapy and Rehabilitation, Faculty of Nezehat Keleşoğlu Health Science, Necmettin Erbakan University, Konya, Turkey
| | - Engin Dinç
- Department of Sports Medicine, Konya City Hospital, Konya, Turkey
| | - Yaşar Mahsut Dinçel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
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Bandyopadhyay A, Ghibhela B, Shome S, Hoque S, Nandi SK, Mandal BB. Photo-Polymerizable Autologous Growth-Factor Loaded Silk-Based Biomaterial-Inks toward 3D Printing-Based Regeneration of Meniscus Tears. Adv Biol (Weinh) 2024; 8:e2300710. [PMID: 38402426 DOI: 10.1002/adbi.202300710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Indexed: 02/26/2024]
Abstract
Meniscus tears in the avascular region undergoing partial or full meniscectomy lead to knee osteoarthritis and concurrent lifestyle hindrances in the young and aged alike. Here they reported ingenious photo-polymerizable autologous growth factor loaded 3D printed scaffolds to potentially treat meniscal defects . A shear-thinning photo-crosslinkable silk fibroin methacrylate-gelatin methacrylate-polyethylene glycol dimethacrylate biomaterial-ink is formulated and loaded with freeze-dried growth factor rich plasma (GFRP) . The biomaterial-ink exhibits optimal rheological properties and shape fidelity for 3D printing. Initial evaluation revealed that the 3D printed scaffolds mimic mechanical characteristics of meniscus, possess favourable porosity and swelling characteristics, and demonstrate sustained GFRP release. GFRP laden 3D scaffolds are screened with human neo-natal stem cells in vitro and biomaterial-ink comprising of 25 mg mL-1 of GFRP (GFRP25) is found to be amicable for meniscus tissue engineering. GFRP25 ink demonstrated rigorous rheological compliance, and printed constructs demonstrated long term degradability (>6 weeks), GFRP release (>5 weeks), and mechanical durability (3 weeks). GFRP25 scaffolds aided in proliferation of seeded human neo-natal stem cellsand their meniscus-specific fibrochondrogenic differentiation . GFRP25 constructs show amenable inflammatory response in vitro and in vivo. GFRP25 biomaterial-ink and printed GFRP25 scaffolds could be potential patient-specific treatment modalities for meniscal defects.
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Affiliation(s)
- Ashutosh Bandyopadhyay
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Baishali Ghibhela
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Sayanti Shome
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Samsamul Hoque
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, West Bengal, 700037, India
| | - Samit K Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, West Bengal, 700037, India
| | - Biman B Mandal
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
- Jyoti and Bhupat Mehta School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
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Anaspure O, Patel S, Baumann AN, Anastasio AT, Walley KC, Kelly JD, Lau BC. Examining the Evidence Regarding Smoking and Patient Outcomes for Isolated Meniscus Pathology: A Comprehensive Systematic Review and Meta-Analysis. Life (Basel) 2024; 14:584. [PMID: 38792605 PMCID: PMC11122235 DOI: 10.3390/life14050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.
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Affiliation(s)
- Omkar Anaspure
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Shiv Patel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Albert T. Anastasio
- Department of Orthopedic Surgery, Duke University, Durham, NC 27710, USA; (A.T.A.); (B.C.L.)
| | - Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA;
| | - John D. Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Brian C. Lau
- Department of Orthopedic Surgery, Duke University, Durham, NC 27710, USA; (A.T.A.); (B.C.L.)
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Karjalainen VP, Herrera Millar VR, Modina S, Peretti GM, Pallaoro M, Elkhouly K, Saarakkala S, Mobasheri A, Di Giancamillo A, Finnilä MAJ. Age and anatomical region-related differences in vascularization of the porcine meniscus using microcomputed tomography imaging. J Orthop Res 2024. [PMID: 38685793 DOI: 10.1002/jor.25862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Meniscal lesions in vascularized regions are known to regenerate while lack of vascular supply leads to poor healing. Here, we developed and validated a novel methodology for three-dimensional structural analysis of meniscal vascular structures with high-resolution microcomputed tomography (µCT). We collected porcine medial menisci from 10 neonatal (not-developed meniscus, n-) and 10 adults (fully developed meniscus, a-). The menisci were cut into anatomical regions (anterior horn (n-AH and a-AH), central body (n-CB and a-CB), and posterior horn (n-PH and a-PH). Specimens were cut in half, fixed, and one specimen underwent critical point drying and µCT imaging, while other specimen underwent immunohistochemistry and vascularity biomarker CD31 staining for validation of µCT. Parameters describing vascular structures were calculated from µCT. The vascular network in neonatal spread throughout meniscus, while in adult was limited to a few vessels in outer region, mostly on femoral side. n-AH, n-CB, and n-PH had 20, 17, and 11 times greater vascular volume fraction than adult, respectively. Moreover, thickness of blood vessels, in three regions, was six times higher in adults than in neonatal. a-PH appeared to have higher vascular fraction, longer and thicker blood vessels than both a-AH and a-CB. Overall, neonatal regions had a higher number of blood vessels, more branching, and higher tortuosity compared to adult regions. For the first time, critical point drying-based µCT imaging allowed detailed three-dimensional visualization and quantitative analysis of vascularized meniscal structures. We showed more vascularity in neonatal menisci, while adult menisci had fewer and thicker vascularity especially limited to the femoral surface.
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Affiliation(s)
- Ville-Pauli Karjalainen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Silvia Modina
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Milan, Italy
| | - Giuseppe M Peretti
- Tissue Engineering and Biomaterials Lab, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Milan, Italy
| | - Khaled Elkhouly
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Ali Mobasheri
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Mikko A J Finnilä
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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11
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Lee JH, Lee GB, Chung W, Wang JW, Han SG, Rhim HC, Han SB, Jang KM. Comparison of Functional Outcomes after Anterior Cruciate Ligament Reconstruction with Meniscal Repair for Unstable versus Stable Meniscal Tears. Diagnostics (Basel) 2024; 14:871. [PMID: 38732286 PMCID: PMC11083838 DOI: 10.3390/diagnostics14090871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all p > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months (p < 0.001). Multiple linear regression analysis showed that age (p = 0.027), preoperative OSI in the operated knees (p = 0.005), and postoperative OSI in the operated knees at 6 months (p = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (J.H.L.)
| | - Gyu Bin Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (J.H.L.)
| | - WooYong Chung
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (J.H.L.)
| | - Ji Won Wang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (J.H.L.)
| | - Sun Gyu Han
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (J.H.L.)
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston MA 02114, USA
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea;
| | - Ki-Mo Jang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (J.H.L.)
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea;
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12
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Mundal K, Geeslin AG, Solheim E, Inderhaug E. Differences Between Traumatic and Degenerative Medial Meniscus Posterior Root Tears: A Systematic Review. Am J Sports Med 2024:3635465241237254. [PMID: 38600780 DOI: 10.1177/03635465241237254] [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] [Indexed: 04/12/2024]
Abstract
BACKGROUND Intact meniscus roots are a prerequisite for normal meniscal function, including even distribution of compressive forces across the knee joint. An injury to the root disrupts the hoop strength of the meniscus and may lead to its extrusion and the development of osteoarthritis. A medial meniscus posterior root tear (MMPRT) is often thought to have a primary degenerative pathogenesis. However, there is mention of some cases of MMPRTs where the patients have a solely traumatic injury to a previously healthy meniscus. PURPOSE To describe a subpopulation of patients with traumatic MMPRT. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS The Web of Science database (www.webofscience.com) was queried using the Medical Subject Headings term "medial root tear." Articles were reviewed, and those evaluated for MMPRTs in a degenerative meniscus were excluded. A total of 25 articles describing cases of acute traumatic causes were included in this study. For these articles, the patient characteristics, injury mechanisms, and concomitant injuries evaluated were recorded and pooled. RESULTS The search revealed 660 articles, and 25 were selected for inclusion. A total of 113 patients with a traumatic MMPRT were identified and included in this review. The study population had a mean age of 27.1 years and a high share of men (64%). Also, this review displays how most patients with traumatic MMPRTs also suffer concomitant injuries (68%). CONCLUSION The findings in this review support our hypothesis that there is a unique subgroup with acute traumatic MMPRTs that have unique patient characteristics, injury mechanisms, and combined injuries, compared with previously published reviews on MMPRTs.
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Affiliation(s)
- Kristine Mundal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| | - Andrew G Geeslin
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Eirik Solheim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Aleris Nesttun Bergen, Bergen, Norway
| | - Eivind Inderhaug
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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13
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Hantouly AT, Aminake G, Khan AS, Ayyan M, Olory B, Zikria B, Al-Khelaifi K. Meniscus root tears: state of the art. INTERNATIONAL ORTHOPAEDICS 2024; 48:955-964. [PMID: 38261073 PMCID: PMC10933189 DOI: 10.1007/s00264-024-06092-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Meniscus root tears represent significant pathology that, historically, has been underdiagnosed and undertreated. However, the recognition of their clinical and functional significance has recently surged, mainly due to their frequent association with anterior cruciate ligament injuries. AIM This comprehensive review discusses various aspects of meniscal root tears, including their epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management and surgical techniques.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | | | | | | | - Bruno Olory
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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14
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Hurmuz M, Ionac M, Hogea B, Miu CA, Tatu F. Osteoarthritis Development Following Meniscectomy vs. Meniscal Repair for Posterior Medial Meniscus Injuries: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:569. [PMID: 38674215 PMCID: PMC11052089 DOI: 10.3390/medicina60040569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes.
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Affiliation(s)
- Mihai Hurmuz
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| | - Mihai Ionac
- Department X, Discipline of Vascular Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Bogdan Hogea
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Profesor Universitar Doctor Teodor Șora Research Centre, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Catalin Adrian Miu
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| | - Fabian Tatu
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
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15
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Wang S, Mueller D, Chen P, Pan G, Wilson M, Sun S, Chen Z, Lee T, Damon B, Hepfer RG, Hill C, Kern MJ, Pullen WM, Wu Y, Brockbank KGM, Yao H. Viable Vitreous Grafts of Whole Porcine Menisci for Transplant in the Knee and Temporomandibular Joints. Adv Healthc Mater 2024:e2303706. [PMID: 38523366 DOI: 10.1002/adhm.202303706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/20/2024] [Indexed: 03/26/2024]
Abstract
The shortage of suitable donor meniscus grafts from the knee and temporomandibular joint (TMJ) impedes treatments for millions of patients. Vitrification offers a promising solution by transitioning these tissues into a vitreous state at cryogenic temperatures, protecting them from ice crystal damage using high concentrations of cryoprotectant agents (CPAs). However, vitrification's success is hindered for larger tissues (>3 mL) due to challenges in CPA penetration. Dense avascular meniscus tissues require extended CPA exposure for adequate penetration; however, prolonged exposure becomes cytotoxic. Balancing penetration and reducing cell toxicity is required. To overcome this hurdle, a simulation-based optimization approach is developed by combining computational modeling with microcomputed tomography (µCT) imaging to predict 3D CPA distributions within tissues over time accurately. This approach minimizes CPA exposure time, resulting in 85% viability in 4-mL meniscal specimens, 70% in 10-mL whole knee menisci, and 85% in 15-mL whole TMJ menisci (i.e., TMJ disc) post-vitrification, outperforming slow-freezing methods (20%-40%), in a pig model. The extracellular matrix (ECM) structure and biomechanical strength of vitreous tissues remain largely intact. Vitreous meniscus grafts demonstrate clinical-level viability (≥70%), closely resembling the material properties of native tissues, with long-term availability for transplantation. The enhanced vitrification technology opens new possibilities for other avascular grafts.
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Affiliation(s)
- Shangping Wang
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Dustin Mueller
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Peng Chen
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Ge Pan
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Marshall Wilson
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Shuchun Sun
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Zhenzhen Chen
- Tissue Testing Technologies LLC, North Charleston, SC, 29406, USA
| | - Thomas Lee
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Brooke Damon
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - R Glenn Hepfer
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Cherice Hill
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Michael J Kern
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - William M Pullen
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Yongren Wu
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kelvin G M Brockbank
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Tissue Testing Technologies LLC, North Charleston, SC, 29406, USA
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
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16
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Upshaw WC, Richey JM, Tassin JP, Frolov MV, Miller BC, Kaye AJ, Sterritt J, Fox CJ, Ahmadzadeh S, Shekoohi S, Kaye AD. IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01237-3. [PMID: 38520494 DOI: 10.1007/s11916-024-01237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE OF REVIEW Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy. RECENT FINDINGS 5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block. In most instances, the IPACK + ACB showed superior efficacy in managing patients' pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient's pain following TKR.
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Affiliation(s)
- William C Upshaw
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - John M Richey
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Joseph P Tassin
- School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, 70119, USA
| | - Mark V Frolov
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Benjamin C Miller
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Aaron J Kaye
- WakeMed Anesthesia, 3000 New Bern Ave, Raleigh, NC, 27610, USA
| | - Jeffrey Sterritt
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Charles J Fox
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
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17
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Beel W, Firth AD, Tulloch S, Abdelrehman T, Olotu O, Bryant D, Getgood A. Extrusion After Meniscal Allograft Transplantation Is Lower or Equal With Bony Compared With Soft-Tissue Root Fixation: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00232-9. [PMID: 38521206 DOI: 10.1016/j.arthro.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To provide an update on the incidence and extent of graft extrusion after meniscal allograft transplantation (MAT) and to systematically review the literature to identify whether the type of root fixation or additional surgical techniques may reduce the risk of graft extrusion development. METHODS A systematic search, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, was conducted using the MEDLINE database, EMBASE database, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL) database. Patients undergoing medial meniscal allograft transplantation (MMAT) or lateral meniscal allograft transplantation (LMAT) were included. The primary outcome measure was meniscal extrusion measured on postoperative magnetic resonance imaging scans taken more than 6 weeks after MAT. The following extrusion outcomes were investigated: absolute extrusion (AE), relative percentage of extrusion (RPE), and proportion of major extrusion (PME). Additional surgical techniques that reduced the risk of graft extrusion development in the included comparative studies were identified. RESULTS For MMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.2 mm versus 3.36 mm and RPE of 44.43% versus 33.18%. The pooled mean PME for MMAT with soft-tissue fixation was 51.62%. For LMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.72 mm versus 2.78 mm, RPE of 31.89% versus 29.47%, and PME of 64.37% versus 35.80%. Additional capsulodesis was identified as a technique to reduce LMAT extrusion. CONCLUSIONS This study highlights that graft extrusion is a common finding after MMAT and LMAT, independent of the root fixation technique. However, MAT extrusion with bony fixation was, depending on the outcome measurement, lower than or equal to that with soft-tissue fixation. LEVEL OF EVIDENCE Level IV, systematic review of Level I, III, and IV studies.
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Affiliation(s)
- Wouter Beel
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada
| | - Andrew D Firth
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Scott Tulloch
- Department of Orthopedic Surgery, Western Health, Footscray Hospital, Melbourne, Australia
| | | | - Olumide Olotu
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
| | - Alan Getgood
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada.
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18
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El Zouhbi A, Yammine J, Hemdanieh M, Korbani ET, Nassereddine M. Utility of Platelet-Rich Plasma Therapy in the Management of Meniscus Injuries: A narrative review. Orthop Rev (Pavia) 2024; 16:94240. [PMID: 38505136 PMCID: PMC10950196 DOI: 10.52965/001c.94240] [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: 01/23/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
Menisci are crucial for knee joint functions and meniscal tears are common injuries, especially in sports activities. Platelet-rich plasma (PRP), which enhances healing, has emerged as a promising additive treatment for meniscus injuries, utilizing the regenerative properties of platelets and growth factors for improved clinical outcomes. In studies with a follow-up period of less than one year, the use of platelet-rich plasma (PRP) therapy for meniscus injuries showed significant improvements in knee symptoms and daily activity. Patients experienced enhanced outcomes in terms of pain reduction and increased sports activity, with MRI scans indicating stable meniscus conditions after six months. Studies with a follow-up of more than one year, however, did not find significant differences between groups treated with PRP and groups not treated with PRP in terms of various outcome measures, including pain and knee function. The vascularization of the menisci is vital for their proper function, and insufficient blood supply can affect healing of meniscal injuries. PRP therapy is used to enhance meniscal healing by introducing growth factors and anti-inflammatory agents. PRP therapy may enable athletes with meniscal tears to return to sports more quickly and has less rehabilitation duration. While PRP seems promising as an alternative to failed treatment or as an adjunct to treatment in the short term, its long-term effectiveness remains inconclusive. Patient preferences, commitment to therapy rehabilitation, and cost should all be considered on an individual basis.
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Affiliation(s)
- Anas El Zouhbi
- Faculty of Medicine American University of Beirut, Beirut, Lebanon
| | - Jeffrey Yammine
- Faculty of Medicine American University of Beirut, Beirut, Lebanon
| | - Maya Hemdanieh
- Division of Orthopedic Surgery American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Toni Korbani
- Division of Orthopedic Surgery American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Nassereddine
- Division of Orthopedic Surgery American University of Beirut Medical Center, Beirut, Lebanon
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19
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Nesbitt DQ, Pu X, Turner MW, Zavala AG, Bond L, Oxford JT, Lujan TJ. Age-dependent changes in collagen crosslinks reduce the mechanical toughness of human meniscus. J Orthop Res 2024. [PMID: 38491967 DOI: 10.1002/jor.25824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
The mechanical resilience of the knee meniscus is provided by a group of structural proteins in the extracellular matrix. Aging can alter the quantity and molecular structure of these proteins making the meniscus more susceptible to debilitating tears. In this study, we determined the effect of aging on the quantity of structural proteins and collagen crosslinks in human lateral meniscus, and examined whether the quantity of these molecules was predictive of tensile toughness (area under the stress-strain curve). Two age groups were tested: a young group under 40 and an older group over 65 years old. Using mass spectrometry, we quantified the abundance of proteins and collagen crosslinks in meniscal tissue that was adjacent to the dumbbell-shaped specimens used to measure uniaxial tensile toughness parallel or perpendicular to the circumferential fiber orientation. We found that the enzymatic collagen crosslink deoxypyridinoline had a significant positive correlation with toughness, and reductions in the quantity of this crosslink with aging were associated with a loss of toughness in the ground substance and fibers. The non-enzymatic collagen crosslink carboxymethyl-lysine increased in quantity with aging, and these increases corresponded to reductions in ground substance toughness. For the collagenous (Types I, II, IV, VI, VIII) and non-collagenous structural proteins (elastin, decorin, biglycan, prolargin) analyzed in this study, only the quantity of collagen VIII was predictive of toughness. This study provides valuable insights on the structure-function relationships of the human meniscus, and how aging causes structural adaptations that weaken the tissue's mechanical integrity.
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Affiliation(s)
- Derek Q Nesbitt
- Biomedical Engineering Doctoral Program, Boise State University, Boise, Idaho, USA
| | - Xinzhu Pu
- Biomolecular Research Institute, College of Arts and Sciences, Boise State University, Boise, Idaho, USA
| | - Matthew W Turner
- Department of Biological Sciences, Boise State University, Boise, Idaho, USA
| | - Anamaria G Zavala
- Department of Mechanical & Biomedical Engineering, Boise State University, Boise, Idaho, USA
| | - Laura Bond
- Biomolecular Research Institute, College of Arts and Sciences, Boise State University, Boise, Idaho, USA
| | - Julia T Oxford
- Biomedical Engineering Doctoral Program, Boise State University, Boise, Idaho, USA
- Biomolecular Research Institute, College of Arts and Sciences, Boise State University, Boise, Idaho, USA
- Department of Biological Sciences, Boise State University, Boise, Idaho, USA
| | - Trevor J Lujan
- Biomedical Engineering Doctoral Program, Boise State University, Boise, Idaho, USA
- Department of Mechanical & Biomedical Engineering, Boise State University, Boise, Idaho, USA
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20
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Bandyopadhyay A, Ghibhela B, Mandal BB. Current advances in engineering meniscal tissues: insights into 3D printing, injectable hydrogels and physical stimulation based strategies. Biofabrication 2024; 16:022006. [PMID: 38277686 DOI: 10.1088/1758-5090/ad22f0] [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: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
The knee meniscus is the cushioning fibro-cartilage tissue present in between the femoral condyles and tibial plateau of the knee joint. It is largely avascular in nature and suffers from a wide range of tears and injuries caused by accidents, trauma, active lifestyle of the populace and old age of individuals. Healing of the meniscus is especially difficult due to its avascularity and hence requires invasive arthroscopic approaches such as surgical resection, suturing or implantation. Though various tissue engineering approaches are proposed for the treatment of meniscus tears, three-dimensional (3D) printing/bioprinting, injectable hydrogels and physical stimulation involving modalities are gaining forefront in the past decade. A plethora of new printing approaches such as direct light photopolymerization and volumetric printing, injectable biomaterials loaded with growth factors and physical stimulation such as low-intensity ultrasound approaches are being added to the treatment portfolio along with the contemporary tear mitigation measures. This review discusses on the necessary design considerations, approaches for 3D modeling and design practices for meniscal tear treatments within the scope of tissue engineering and regeneration. Also, the suitable materials, cell sources, growth factors, fixation and lubrication strategies, mechanical stimulation approaches, 3D printing strategies and injectable hydrogels for meniscal tear management have been elaborated. We have also summarized potential technologies and the potential framework that could be the herald of the future of meniscus tissue engineering and repair approaches.
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Affiliation(s)
- Ashutosh Bandyopadhyay
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Baishali Ghibhela
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Biman B Mandal
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Kaushal SG, Barnett SC, Hosseinzadeh S, Perrone GS, Kiapour AM. Changes in Functional Meniscal Morphology During Skeletal Growth and Maturation. Orthop J Sports Med 2024; 12:23259671241237810. [PMID: 38532765 PMCID: PMC10964461 DOI: 10.1177/23259671241237810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 03/28/2024] Open
Abstract
Background Little is known on how meniscal morphology develops during skeletal growth and maturation and its subsequent relationship with the corresponding bony anatomy. Hypotheses (1) Meniscal dimensions and morphology would change by age during skeletal growth and maturation in different ways in boys compared with girls. (2) Morphological features of the medial and lateral menisci would correlate to medial and lateral femoral condyle curvatures. Study Design Cross-sectional study; Level of evidence, 3. Methods Anatomic features of the medial and lateral menisci were measured on magnetic resonance imaging scans from 269 unique knees (age, 3-18 years; 51% female) with no prior history of injury, congenital or growth-related skeletal disorders, or bony deformities. Morphological shape-based measurements were normalized to tibial plateau width or determined as ratios of meniscal dimensions. The association between age and anatomy was analyzed with linear regression. Two-way analysis of variance with the Holm-Šídák post hoc method was used to compare anatomy between sexes in different age groups. Linear regression was used to evaluate the relationship between femoral condyle curvature radius and meniscal morphology in each compartment after adjusting for age and sex. Results Meniscal length, width, horn distance, mean cross-sectional area (CSA), and mean height increased with age in both sexes (R2 > 0.1; P < .001). Age-related changes in meniscal morphology were seen in normalized length, width, horn distance, and mean height; width-to-length ratio; horn distance-to-length ratio (lateral meniscus only); normalized mean CSA (except lateral meniscus in girls); and mean tip angle (R2 > 0.04; P < .02). Sex-based differences were also found, with some morphological differences (normalized length and height) throughout development (P < .03) and size differences (length, width, and mean CSA) in later development (P < .01). After adjusting for age and sex, there were significant correlations between medial condyle curvature radius and normalized width, width-to-length ratio, horn distance, horn distance-to-length ratio, mean CSA, and mean height of the medial meniscus (P≤ .041) and between lateral condyle curvature radius and normalized length, mean height, and mean tip angle of the lateral meniscus (P≤ .004). Conclusion Age-related changes in meniscal dimensions and morphology, most notably a nonuniform growth pattern in meniscal geometry, occurred during skeletal growth and maturation, with different trends in boys than in girls.
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Affiliation(s)
- Shankar G. Kaushal
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel C. Barnett
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shayan Hosseinzadeh
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriel S. Perrone
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedics, Tufts Medical School, Boston, Massachusetts, USA
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Mukherjee A, Das B. The role of inflammatory mediators and matrix metalloproteinases (MMPs) in the progression of osteoarthritis. BIOMATERIALS AND BIOSYSTEMS 2024; 13:100090. [PMID: 38440290 PMCID: PMC10910010 DOI: 10.1016/j.bbiosy.2024.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/04/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Osteoarthritis (OA) is a chronic musculoskeletal disorder characterized by an imbalance between (synthesis) and catabolism (degradation) in altered homeostasis of articular cartilage mediated primarily by the innate immune system. OA degenerates the joints resulting in synovial hyperplasia, degradation of articular cartilage with damage of the structural and functional integrity of the cartilage extracellular matrix, subchondral sclerosis, osteophyte formation, and is characterized by chronic pain, stiffness, and loss of function. Inflammation triggered by factors like biomechanical stress is involved in the development of osteoarthritis. In OA apart from catabolic effects, anti-inflammatory anabolic processes also occur continually. There is also an underlying chronic inflammation present, not only in cartilage tissue but also within the synovium, which perpetuates tissue destruction of the OA joint. The consideration of inflammation in OA considers synovitis and/or other cellular and molecular events in the synovium during the progression of OA. In this review, we have presented the progression of joint degradation that results in OA. The critical role of inflammation in the pathogenesis of OA is discussed in detail along with the dysregulation within the cytokine networks composed of inflammatory and anti-inflammatory cytokines that drive catabolic pathways, inhibit matrix synthesis, and promote cellular apoptosis. OA pathogenesis, fluctuation of synovitis, and its clinical impact on disease progression are presented here along with the role of synovial macrophages in promoting inflammatory and destructive responses in OA. The role of interplay between different cytokines, structure, and function of their receptors in the inter-cellular signaling pathway is further explored. The effect of cytokines in the increased synthesis and release of matrix-decomposing proteolytic enzymes, such as matrix metalloproteinase (MMPs) and a disintegrin-like and metalloproteinase with thrombospondin motif (ADAMTS), is elaborated emphasizing the potential impact of MMPs on the chondrocytes, synovial cells, articular and periarticular tissues, and other immune system cells migrating to the site of inflammation. We also shed light on the pathogenesis of OA via oxidative damage particularly due to nitric oxide (NO) via its angiogenic response to inflammation. We concluded by presenting the current knowledge about the tissue inhibitors of metalloproteinases (TIMPs). Synthetic MMP inhibitors include zinc binding group (ZBG), non-ZBG, and mechanism-based inhibitors, all of which have the potential to be therapeutically beneficial in the treatment of osteoarthritis. Improving our understanding of the signaling pathways and molecular mechanisms that regulate the MMP gene expression, may open up new avenues for the creation of therapies that can stop the joint damage associated with OA.
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Affiliation(s)
- Anwesha Mukherjee
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, India
| | - Bodhisatwa Das
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, India
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Zabrzyńska M, Pasiński M, Gagat M, Kułakowski M, Woźniak Ł, Elster K, Antosik P, Zabrzyński J. The Association between the Extent of the Osteoarthritic Meniscus Degeneration and Cigarette Smoking-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:323. [PMID: 38399610 PMCID: PMC10890507 DOI: 10.3390/medicina60020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking.
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Affiliation(s)
- Maria Zabrzyńska
- Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Maciej Pasiński
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.P.); (J.Z.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Płock, 09-402 Płock, Poland
| | - Michał Kułakowski
- Independent Public Healthcare Center in Rypin, 87-500 Rypin, Poland; (M.K.); (K.E.)
| | - Łukasz Woźniak
- Department of Orthopaedics and Traumatology, University of Medical Sciences, 61-701 Poznan, Poland
| | - Karol Elster
- Independent Public Healthcare Center in Rypin, 87-500 Rypin, Poland; (M.K.); (K.E.)
| | - Paulina Antosik
- Department of Clinical Pathology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
| | - Jan Zabrzyński
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.P.); (J.Z.)
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24
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Waghorne J, Bonomo FP, Rabbani A, Bell D, Barrera O. On the characteristics of natural hydraulic dampers: An image-based approach to study the fluid flow behaviour inside the human meniscal tissue. Acta Biomater 2024; 175:157-169. [PMID: 38159896 DOI: 10.1016/j.actbio.2023.12.042] [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: 08/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
The meniscal tissue is a layered material with varying properties influenced by collagen content and arrangement. Understanding the relationship between structure and properties is crucial for disease management, treatment development, and biomaterial design. The internal layer of the meniscus is softer and more deformable than the outer layers, thanks to interconnected collagen channels that guide fluid flow. To investigate these relationships, we propose an integrated approach that combines Computational Fluid Dynamics (CFD) with Image Analysis (CFD-IA). We analyze fluid flow in the internal architecture of the human meniscus across a range of inlet velocities (0.1 mm/s to 1.6 m/s) using high-resolution 3D micro-computed tomography scans. Statistical correlations are observed between architectural parameters (tortuosity, connectivity, porosity, pore size) and fluid flow parameters (Re number distribution, permeability). Some channels exhibit Re values of 1400 at an inlet velocity of 1.6 m/s, and a transition from Darcy's regime to a non-Darcian regime occurs around an inlet velocity of 0.02 m/s. Location-dependent permeability ranges from 20-32 Darcy. Regression modelling reveals a strong correlation between fluid velocity and tortuosity at high inlet velocities, as well as with channel diameter at low inlet velocities. At higher inlet velocities, flow paths deviate more from the preferential direction, resulting in a decrease in the concentration parameter by an average of 0.4. This research provides valuable insights into the fluid flow behaviour within the meniscus and its structural influences. 3D models and image stack are available to download at https://doi.org/10.5281/zenodo.10401592. STATEMENT OF SIGNIFICANCE: The meniscus is a highly porous soft tissue with remarkable properties of load transfer and energy absorption. We give insight on the mechanism of energy absorption from high resolution uCT scans, never presented before, and a new method which combine CFD and image. The structure is similar to a sandwich structure with a stiff outside layer and a soft internal layer made of collagen channels oriented in a preferential direction guiding the fluid flow, enabling it to accommodate deformation and dissipate energy, making it a potentially optimized damping system. We investigate architectural/ fluid flow parameters- fluid regimes relationship, which is of interest of the readers working on designing suitable biomimetic systems that can be adopted for replacement.
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Affiliation(s)
- Jack Waghorne
- School of Engineering, Computing and Mathematics, Oxford Brookes University, Oxford, United Kingdom
| | - Francesco Paolo Bonomo
- Advanced Technology Network Center (ATeN Center), Universitá degli Studi di Palermo, Palermo 90128, Italy
| | | | - Daniel Bell
- School of Engineering, Computing and Mathematics, Oxford Brookes University, Oxford, United Kingdom
| | - Olga Barrera
- School of Engineering, Computing and Mathematics, Oxford Brookes University, Oxford, United Kingdom; Department of Engineering Science, University of Oxford, United Kingdom.
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25
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Dag N, Sinanoglu MS. Evaluation of meniscal elasticity using shear wave elastography in obese children and adolescents: a preliminary cross-sectional study. Pediatr Radiol 2024; 54:293-298. [PMID: 38153540 DOI: 10.1007/s00247-023-05836-x] [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: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Musculoskeletal problems such as pain, joint pathology, increased risk of fracture, and the development of structural deformities are common in childhood obesity. Increased mechanical stress on the knee joint leads to degenerative changes in the cartilage and meniscus. Meniscal elasticity values increase in meniscal degeneration. Shear wave elastography (SWE) is an ultrasound-based imaging technique based on the principle of measuring tissue elasticity. OBJECTIVE We aimed to investigate the changes in meniscal stiffness and thickness that can be caused by obesity in children and adolescents using SWE. MATERIALS AND METHODS In this prospective cross-sectional study, the menisci of obese (n=44) and age- and sex-matched healthy weight (n=44) children and adolescents were assessed by SWE. Meniscal elasticity was measured in kPa on the coronal plane. Independent samples t-test was used to compare meniscal elasticity values between groups. Additionally, Pearson's correlation test was used to examine the relationships between elasticity values and age, height, weight, and body mass index (BMI). RESULTS Meniscal elasticity values were significantly higher in the obese group than in the control group (P<0.001). In both groups, there was no significant difference in meniscal stiffness between the boys and girls or between the right and left sides. In the obese group, there were weak and moderate positive correlations between meniscal elasticity values and age, weight, and BMI (P<0.05). There was no significant difference in meniscal thickness between the obese and control groups. CONCLUSION Meniscal stiffness is increased in obese children and adolescents.
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Affiliation(s)
- Nurullah Dag
- Department of Radiology, Malatya Training and Research Hospital, Ozalper Mah, Turgut Ozal Bulvari, Yesilyurt, Malatya, 44330, Turkey.
| | - Muhammed S Sinanoglu
- Department of Pediatrics, Malatya Training and Research Hospital, Malatya, Turkey
- Department of Pediatrics, Malatya Turgut Ozal University, Malatya, Turkey
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26
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Giurazza G, Saithna A, An JS, Lahsika M, Campos JP, Vieira TD, Guier CA, Sonnery-Cottet B. Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database. Am J Sports Med 2024; 52:330-337. [PMID: 38205511 DOI: 10.1177/03635465231216364] [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] [Indexed: 01/12/2024]
Abstract
BACKGROUND Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. PURPOSE To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. RESULTS MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). CONCLUSION Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.
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Affiliation(s)
- Giancarlo Giurazza
- Centre Orthopédique Santy, Lyon, France
- Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona, USA
| | - Jae-Sung An
- Centre Orthopédique Santy, Lyon, France
- Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mohammed Lahsika
- Centre Orthopédique Santy, Lyon, France
- Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Joao Pedro Campos
- Centre Orthopédique Santy, Lyon, France
- Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France
- Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Christian A Guier
- San Francisco Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France
- Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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27
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Gehret PM, Dumas AA, Jacobs IN, Gottardi R. A Pilot Study of Decellularized Cartilage for Laryngotracheal Reconstruction in a Neonatal Pig Model. Laryngoscope 2024; 134:807-814. [PMID: 37658705 PMCID: PMC11046979 DOI: 10.1002/lary.31017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Severe subglottic stenosis develops as a response to intubation in 1% of the >200,000 neonatal intensive care unit infants per year and may require laryngotracheal reconstruction (LTR) with autologous hyaline cartilage. Although effective, LTR is limited by comorbidities, severity of stenosis, and graft integration. In children, there is a significant incidence of restenosis requiring revision surgery. Tissue engineering has been proposed to develop alterative grafting options to improve outcomes and eliminate donor-site morbidity. Our objective is to engineer a decellularized, channel-laden xenogeneic cartilage graft, that we deployed in a proof-of-concept, neonatal porcine LTR model. METHODS Meniscal porcine cartilage was freeze-thawed and washed with pepsin/elastase to decellularize and create microchannels. A 6 × 10-mm decellularized cartilage graft was then implanted in 4 infant pigs in an anterior cricoid split. Airway patency and host response were monitored endoscopically until sacrifice at 12 weeks, when the construct phenotype, cricoid expansion, mechanics, and histomorphometry were evaluated. RESULTS The selective digestion of meniscal components yielded decellularized cartilage with cell-size channels. After LTR with decellularized meniscus, neonatal pigs were monitored via periodic endoscopy observing re-epithelization, integration, and neocartilage formation. At 12 weeks, the graft appeared integrated and exhibited airway expansion of 4 mm in micro-CT and endoscopy. Micro-CT revealed a larger lumen compared with age-matched controls. Finally, histology showed significant neocartilage formation. CONCLUSION Our neonatal porcine LTR model with a decellularized cartilage graft is a novel approach to tissue engineered pediatric LTR. This pilot study sets the stage for "off-the-shelf" graft procurement and future optimization of MEND for LTR. LEVEL OF EVIDENCE NA Laryngoscope, 134:807-814, 2024.
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Affiliation(s)
- Paul M Gehret
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexandra A Dumas
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ian N Jacobs
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Riccardo Gottardi
- Department of Surgery, Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Ri.MED Foundation, Palermo, Italy
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Lian L, Xie M, Luo Z, Zhang Z, Maharjan S, Mu X, Garciamendez-Mijares CE, Kuang X, Sahoo JK, Tang G, Li G, Wang D, Guo J, González FZ, Abril Manjarrez Rivera V, Cai L, Mei X, Kaplan DL, Zhang YS. Rapid Volumetric Bioprinting of Decellularized Extracellular Matrix Bioinks. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2304846. [PMID: 38252896 DOI: 10.1002/adma.202304846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Decellularized extracellular matrix (dECM)-based hydrogels are widely applied to additive biomanufacturing strategies for relevant applications. The extracellular matrix components and growth factors of dECM play crucial roles in cell adhesion, growth, and differentiation. However, the generally poor mechanical properties and printability have remained as major limitations for dECM-based materials. In this study, heart-derived dECM (h-dECM) and meniscus-derived dECM (Ms-dECM) bioinks in their pristine, unmodified state supplemented with the photoinitiator system of tris(2,2-bipyridyl) dichlororuthenium(II) hexahydrate and sodium persulfate, demonstrate cytocompatibility with volumetric bioprinting processes. This recently developed bioprinting modality illuminates a dynamically evolving light pattern into a rotating volume of the bioink, and thus decouples the requirement of mechanical strengths of bioprinted hydrogel constructs with printability, allowing for the fabrication of sophisticated shapes and architectures with low-concentration dECM materials that set within tens of seconds. As exemplary applications, cardiac tissues are volumetrically bioprinted using the cardiomyocyte-laden h-dECM bioink showing favorable cell proliferation, expansion, spreading, biomarker expressions, and synchronized contractions; whereas the volumetrically bioprinted Ms-dECM meniscus structures embedded with human mesenchymal stem cells present appropriate chondrogenic differentiation outcomes. This study supplies expanded bioink libraries for volumetric bioprinting and broadens utilities of dECM toward tissue engineering and regenerative medicine.
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Affiliation(s)
- Liming Lian
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Maobin Xie
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Zeyu Luo
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Zhenrui Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
- Ragon Institute of Mass General, MIT, and Harvard, Cambridge, MA, 02139, USA
| | - Sushila Maharjan
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Xuan Mu
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Carlos Ezio Garciamendez-Mijares
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Xiao Kuang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Jugal Kishore Sahoo
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Guosheng Tang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Gang Li
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Di Wang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Jie Guo
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Federico Zertuche González
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Victoria Abril Manjarrez Rivera
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Ling Cai
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Xuan Mei
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
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Popper HR, Fliegel BE, Elliott DM, Su AW. Surgical Management of Traumatic Meniscus Injuries. PATHOPHYSIOLOGY 2023; 30:618-629. [PMID: 38133145 PMCID: PMC10747583 DOI: 10.3390/pathophysiology30040044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
The menisci increase the contact area of load bearing in the knee and thus disperse the mechanical stress via their circumferential tensile fibers. Traumatic meniscus injuries cause mechanical symptoms in the knee, and are more prevalent amongst younger, more active patients, compared to degenerative tears amongst the elderly population. Traumatic meniscus tears typically result from the load-and-shear mechanism in the knee joint. The treatment depends on the size, location, and pattern of the tear. For non-repairable tears, partial or total meniscal resection decreases its tensile stress and increases joint contact stress, thus potentiating the risk of arthritis. A longitudinal vertical tear pattern at the peripheral third red-red zone leads to higher healing potential after repair. The postoperative rehabilitation protocols after repair range from immediate weight-bearing with no range of motion restrictions to non-weight bearing and delayed mobilization for weeks. Pediatric and adolescent patients may require special considerations due to their activity levels, or distinct pathologies such as a discoid meniscus. Further biomechanical and biologic evidence is needed to guide surgical management, postoperative rehabilitation protocols, and future technology applications for traumatic meniscus injuries.
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Affiliation(s)
| | | | - Dawn M. Elliott
- Biomedical Engineering Department, University of Delaware, Newark, DE 19716, USA
| | - Alvin W. Su
- Biomedical Engineering Department, University of Delaware, Newark, DE 19716, USA
- Department of Orthopedics, Nemours (duPont) Children’s Hospital, Delaware, Wilmington, DE 19803, USA
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Dancy ME, Tagliero AJ, Till SE, Saris DB, Levy BA, Camp CL, Krych AJ. Surgical Repair of Hypermobile Lateral Meniscus Secondary to Popliteomeniscal Fascicle Tears Improves Pain and Mechanical Symptoms. Arthrosc Sports Med Rehabil 2023; 5:100802. [PMID: 37766858 PMCID: PMC10520307 DOI: 10.1016/j.asmr.2023.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose To describe the clinical and radiographic features associated with isolated hypermobile lateral meniscus (HLM), and report patient outcomes following surgically repaired isolated HLM. Methods All patients diagnosed with HLM from 2000 to 2020 at a single academic institution were identified and reviewed. Patients were excluded if they had concomitant ligament injury or lacked 2-year follow-up. Preoperative and postoperative visual analog scale (VAS) pain scores were determined from clinical notes. Statistical analysis was performed in JMP, and statistical significance was determined with use of a paired t-test. Results Eighteen knees in 17 patients met inclusion criteria. Mean patient age was 24.1 (range: 6-61) years. Mean follow-up was 73 months (25-151 months). All 18 knees reported pain at presentation; 94% (17/18) had mechanical symptoms. All 18 knees had preoperative MRIs, but only 1 (5.6%) knee was correctly diagnosed by a musculoskeletal trained radiologist. Most repairs were performed with an all-inside technique (61%, 11/18). VAS score improved significantly from 7.2 ± 2.9 preoperatively to 0.7 ± 1.9 postoperatively, with average improvement of VAS score of 6.5 (P < .001). Only one (5.6%) knee required revision meniscal surgery. Conclusion Hypermobile lateral meniscus patients commonly see multiple providers, fail to have their HLM diagnosed on MRI, and undergo various treatments prior to a successful diagnosis. Localized lateral joint line pain, mechanical symptoms, and absence of distinct meniscus tear on MRI are the most frequent clinical presentations. Surgery with meniscus repair is a reliable solution to improve pain and mechanical symptoms. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Malik E. Dancy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Adam J. Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Daniël B. Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
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Albersheim M, Fedje-Johnston W, Carlson C, Arnoczky SP, Toth F, Shea K, Harper L, Rendahl A, Tompkins M. Cell Count and Cell Density Decrease as Age Increases in Cadaveric Pediatric Medial Menisci. Arthrosc Sports Med Rehabil 2023; 5:100795. [PMID: 37868658 PMCID: PMC10585640 DOI: 10.1016/j.asmr.2023.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/04/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To examine the histologic changes in terms of cellularity, cell density, and nuclear shape in medial meniscal cellularity during skeletal development using pediatric cadaver specimens. Methods Medial menisci from 26 pediatric cadavers, 11 female and 15 male (total 36 menisci), were obtained from tissue bank. Mean age of female donors was 34 months (1-108 months) and of male donors was 52 months (1-132 months). Menisci were processed and embedded in paraffin blocks. Each tissue block containing 6 representative areas of meniscus (anterior root, anterior horn, body [n = 2], posterior horn, and posterior root) was sectioned at 4 microns and stained with hematoxylin and eosin for evaluation of chondrocyte nuclei. Each of the 6 representative areas was imaged at 10×; one image on peripheral one-third of section, the second image on central two-thirds of the section. FIJI imaging software was used to measure cell count, cell density, and nuclear morphology (1 = perfect circle). Data analysis included linear mixed models, Type II analysis of variance tests, and pairwise tests with the Tukey correction to assess statistical significance. Results Peripheral meniscus was more cellular than central meniscus. The cell count was found to decrease by 14% per year of age. Peripheral cell count decreased at a rate similar to the cell count in the central meniscus. Meniscal cell density was 2× higher peripherally than centrally. Overall average cell density in all locations in the menisci decreased by an average of 14% per year of age. Conclusions The results of this study reveal decreases in cell count, cell density, and circularity as age increases in cadaveric pediatric medial menisci. Clinical Relevance To better understand the development of pediatric menisci at a cellular level and use this knowledge in the future on how to maintain the menisci in a younger, healthier state.
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Affiliation(s)
- Melissa Albersheim
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - William Fedje-Johnston
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Departments of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Cathy Carlson
- Departments of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Steven P. Arnoczky
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, Michigan, U.S.A
| | - Ferenc Toth
- Departments of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Kevin Shea
- Department of Orthopedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Lindsey Harper
- Departments of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Aaron Rendahl
- Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- TRIA Orthopedic Center, Bloomington, Minnesota, U.S.A
- Gillette Children’s Specialty Healthcare, Minneapolis, Minnesota, U.S.A
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Ye R, Xiong H, Liu X, Yang J, Guo J, Qiu J. Assessment of Knee Menisci in Healthy Adults Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2859-2866. [PMID: 37661827 DOI: 10.1002/jum.16326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES The aim of this study was to explore the application value of shear wave elastography in healthy adults with knee meniscus. METHODS One hundred adult subjects who underwent health checkups at our hospital from December 2022 to February 2023 were selected as research participants. Shear wave elastography was used to evaluate the periphery of the lateral and medial meniscus in both knees. To assess the mean differences in Young's modulus values between male and female groups, a one-way analysis of variance (ANOVA) and independent samples t-test were conducted. In addition, a Pearson correlation coefficient test was used to analyze the correlation between the elastic values of the meniscus and age, height, weight, and body mass index (BMI). RESULTS There were no significant differences in elastic values between the lateral meniscus of the left and right sides or between the medial meniscus of the left and right sides within the same gender group (P > .05). Stiffness values of the medial meniscus were higher in each gender group than those of the lateral meniscus (P < .01). Additionally, males demonstrated higher stiffness values than females (P < .01). As age increased, the Young's modulus of the meniscus increased significantly (r > .75, P < .01). CONCLUSION Shear wave elastography can serve as an adjunctive tool to aid in the assessment of knee meniscal elasticity.
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Affiliation(s)
- Ran Ye
- Department of Physical Examination, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
- Guaduate School, Guangzhou Medical University, Guangzhou, China
| | - Huahua Xiong
- Department of Ultrasound, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiao Liu
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Junxing Yang
- Department of Orthopedics, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiandong Guo
- Department of Radiology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jianwen Qiu
- Department of Physical Examination, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
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Di Paolo S, Lucidi GA, Grassi A, Macchiarola L, Ambrosini L, Agostinone P, Dal Fabbro G, Zaffagnini S. Isolated meniscus allograft transplantation with soft-tissue technique effectively reduces knee laxity in the presence of previous meniscectomy: In-vivo navigation of 18 consecutive cases. J ISAKOS 2023; 8:430-435. [PMID: 37739345 DOI: 10.1016/j.jisako.2023.09.004] [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: 07/03/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Although meniscal allograft transplantation (MAT) is a well-established procedure with satisfactory clinical results, limited in vivo kinematic information exists on the effect of medial and lateral MAT performed in the clinical setting. The purpose of the present study was to evaluate the biomechanical effect of arthroscopic isolated medial and lateral MAT with a soft-tissue fixation on pre- and post-operative knee laxity using a surgical navigation system. METHODS 18 consecutive patients undergoing MAT (8 medial, 10 lateral) were enrolled. A surgical navigation system was used to quantify the anterior-posterior displacement at 30 and 90 degrees of knee flexion (AP30 and AP90), the varus-valgus rotation at 0 and 30 degrees of knee flexion (VV0 and VV30) and the dynamic laxity on the pivot-shift test (PS), which was determined through the anterior displacement of the lateral tibial compartment (APlat) and posterior acceleration of the lateral tibial compartment during tibial reduction (ACC). Data from laxity before and after MAT were compared through paired t-test (p < 0.05). RESULTS After medial MAT, there was a significant decrease in tibial translation of 3.1 mm (31%; p = 0.001) for AP30 and 2.3 mm (27%; p = 0.020) for AP90, a significant difference of 2.5° (50%; p = 0.002) for VV0 and 1.7° (27%; p = 0.012) for VV30. However, medial MAT did not determine any reduction in the PS kinematic data. Lateral MAT determined a significant decrease in the tibial translation of 2.5 mm (38%; p < 0.001) for AP30 and 1.9 mm (34%; p = 0.004) for AP90 as well as a significant difference of 3.4° (59%; p < 0.001) for VV0 and of 1.7° (23%; p = 0.011) for VV30. There was also a significant reduction of the PS of 4.4 mm (22%; p = 0.028) for APlat and 384.8 mm/s2 (51%; p = 0.005) for ACC. CONCLUSION MAT with soft-tissue fixation results in a significant laxity reduction in an in-vivo setting. Medial MAT improved knee kinematics by determining a significant reduction with particular emphasis on AP translation and VV manoeuvre. Conversely, Lateral MAT determined a massive reduction of the PS and a mild decrease of the AP translation and VV manoeuvre. STUDY DESIGN Controlled laboratory study.
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Affiliation(s)
- Stefano Di Paolo
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, 40100, Italy
| | - Gian Andrea Lucidi
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, 40100, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Luca Ambrosini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy.
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Sproul D, Agarwal A, Malyavko A, Mathur A, Kreulen RT, Thakkar SC, Best MJ. Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:5823-5829. [PMID: 37938327 DOI: 10.1007/s00167-023-07653-z] [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: 06/09/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. METHODS A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. RESULTS There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). CONCLUSIONS This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. LEVEL OF EVIDENCE Level III, prognostic trial.
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Affiliation(s)
- David Sproul
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA.
| | - Amil Agarwal
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Alisa Malyavko
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Abhay Mathur
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - R Timothy Kreulen
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Matthew J Best
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
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Goshima A, Etani Y, Hirao M, Yamakawa S, Okamura G, Miyama A, Takami K, Miura T, Fukuda Y, Kurihara T, Ochiai N, Oyama S, Otani S, Tamaki M, Ishibashi T, Tomita T, Kanamoto T, Nakata K, Okada S, Ebina K. Basic fibroblast growth factor promotes meniscus regeneration through the cultivation of synovial mesenchymal stem cells via the CXCL6-CXCR2 pathway. Osteoarthritis Cartilage 2023; 31:1581-1593. [PMID: 37562758 DOI: 10.1016/j.joca.2023.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To investigate the efficacy of basic fibroblast growth factor (bFGF) in promoting meniscus regeneration by cultivating synovial mesenchymal stem cells (SMSCs) and to validate the underlying mechanisms. METHODS Human SMSCs were collected from patients with osteoarthritis. Eight-week-old nude rats underwent hemi-meniscectomy, and SMSCs in pellet form, either with or without bFGF (1.0 × 106 cells per pellet), were implanted at the site of meniscus defects. Rats were divided into the control (no transplantation), FGF (-) (pellet without bFGF), and FGF (+) (pellet with bFGF) groups. Different examinations, including assessment of the regenerated meniscus area, histological scoring of the regenerated meniscus and cartilage, meniscus indentation test, and immunohistochemistry analysis, were performed at 4 and 8 weeks after surgery. RESULTS Transplanted SMSCs adhered to the regenerative meniscus. Compared with the control group, the FGF (+) group had larger regenerated meniscus areas, superior histological scores of the meniscus and cartilage, and better meniscus mechanical properties. RNA sequencing of SMSCs revealed that the gene expression of chemokines that bind to CXCR2 was upregulated by bFGF. Furthermore, conditioned medium derived from SMSCs cultivated with bFGF exhibited enhanced cell migration, proliferation, and chondrogenic differentiation, which were specifically inhibited by CXCR2 or CXCL6 inhibitors. CONCLUSION SMSCs cultured with bFGF promoted the expression of CXCL6. This mechanism may enhance cell migration, proliferation, and chondrogenic differentiation, thereby resulting in superior meniscus regeneration and cartilage preservation.
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Affiliation(s)
- Atsushi Goshima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Yuki Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi-machi, Kawachinagano, Osaka 586-8521, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai 591-8025, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan
| | - Kenji Takami
- Department of Orthopedic Surgery, Nippon Life Hospital, 2-1-54 Enokojima, Nishi-ku, Osaka 550-0006, Japan
| | - Taihei Miura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Yuji Fukuda
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Takuya Kurihara
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Nagahiro Ochiai
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Shohei Oyama
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Shunya Otani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Masashi Tamaki
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Teruya Ishibashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Tetsuya Tomita
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16, Nankou-kita, Suminoe, Osaka, Japan
| | - Takashi Kanamoto
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
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Barceló X, Eichholz K, Gonçalves I, Kronemberger GS, Dufour A, Garcia O, Kelly DJ. Bioprinting of scaled-up meniscal grafts by spatially patterning phenotypically distinct meniscus progenitor cells within melt electrowritten scaffolds. Biofabrication 2023; 16:015013. [PMID: 37939395 DOI: 10.1088/1758-5090/ad0ab9] [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: 05/02/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
Meniscus injuries are a common problem in orthopedic medicine and are associated with a significantly increased risk of developing osteoarthritis. While developments have been made in the field of meniscus regeneration, the engineering of cell-laden constructs that mimic the complex structure, composition and biomechanics of the native tissue remains a significant challenge. This can be linked to the use of cells that are not phenotypically representative of the different zones of the meniscus, and an inability to direct the spatial organization of engineered meniscal tissues. In this study we investigated the potential of zone-specific meniscus progenitor cells (MPCs) to generate functional meniscal tissue following their deposition into melt electrowritten (MEW) scaffolds. We first confirmed that fibronectin selected MPCs from the inner and outer regions of the meniscus maintain their differentiation capacity with prolonged monolayer expansion, opening their use within advanced biofabrication strategies. By depositing MPCs within MEW scaffolds with elongated pore shapes, which functioned as physical boundaries to direct cell growth and extracellular matrix production, we were able to bioprint anisotropic fibrocartilaginous tissues with preferentially aligned collagen networks. Furthermore, by using MPCs isolated from the inner (iMPCs) and outer (oMPCs) zone of the meniscus, we were able to bioprint phenotypically distinct constructs mimicking aspects of the native tissue. An iterative MEW process was then implemented to print scaffolds with a similar wedged-shaped profile to that of the native meniscus, into which we deposited iMPCs and oMPCs in a spatially controlled manner. This process allowed us to engineer sulfated glycosaminoglycan and collagen rich constructs mimicking the geometry of the meniscus, with MPCs generating a more fibrocartilage-like tissue compared to the mesenchymal stromal/stem cells. Taken together, these results demonstrate how the convergence of emerging biofabrication platforms with tissue-specific progenitor cells can enable the engineering of complex tissues such as the meniscus.
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Affiliation(s)
- Xavier Barceló
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Kian Eichholz
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Inês Gonçalves
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Gabriela S Kronemberger
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Alexandre Dufour
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Orquidea Garcia
- Johnson & Johnson 3D Printing Innovation & Customer Solutions, Johnson & Johnson Services, Inc, Dublin D02 R590, Ireland
| | - Daniel J Kelly
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland
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Şirik M, Yetkin Dİ, İnan İ. Assessment of the relationship between smoking and meniscal injury. Radiol Bras 2023; 56:336-342. [PMID: 38504814 PMCID: PMC10948157 DOI: 10.1590/0100-3984.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/19/2023] [Accepted: 08/17/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To determine whether being a smoker and the years of smoking correlate with the presence and degree of meniscal injury. Materials and Methods Individuals who underwent magnetic resonance imaging of the knee were divided into two groups: smokers and nonsmokers. For each smoker, the total smoking history was calculated by multiplying the daily consumption (packs/day) by the years of smoking, and the result is expressed as pack-years. In the evaluation of meniscal injury, the grade of injury was recorded. The thickness of the subcutaneous adipose tissue, as an indicator of obesity, was measured at the medial knee on axial plane images. The relationships that smoking and obesity had with meniscal injury were analyzed statistically. Results A total of 156 individuals were included in the study. The smoker group consisted of 48 individuals (30.8%), and the nonsmoker group consisted of 108 (69.2%). The meniscus was normal in one (2.1%) of the smokers and in 32 (29.6%) of the nonsmokers (p < 0.0001). The median subcutaneous adipose tissue thickness was 23 mm and 24 mm in the smokers and nonsmokers, respectively (p = 0.900). A moderate but statistically significant correlation was observed between packs/day and injury grade, as well as between pack-years and injury grade (r = 0.462, p = 0.001 and r = 0.523, p = 0.001, respectively). Smoking and age significantly increased the risk of meniscal injury, by 31.221 times (p = 0.001) and 1.076 times (p < 0.001), respectively. Conclusion Our findings indicate that current smoking and smoking history correlate significantly with meniscal injury grade.
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Affiliation(s)
- Mehmet Şirik
- Department of Radiology, Faculty of Medicine, Adıyaman
University, Adıyaman, Turkey
| | - Duygu İmre Yetkin
- Department of Radiology, Faculty of Medicine, Adıyaman
University, Adıyaman, Turkey
| | - İbrahim İnan
- King’s College Hospital, Dubai, United Arab Emirates
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38
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Huang L, Zhang S, Wu J, Guo B, Gao T, Shah SZA, Huang B, Li Y, Zhu B, Fan J, Wang L, Xiao Y, Liu W, Tian Y, Fang Z, Lv Y, Xie L, Yao S, Ke G, Huang X, Huang Y, Li Y, Jia Y, Li Z, Feng G, Huo Y, Li W, Zhou Q, Hao J, Hu B, Chen H. Immunity-and-matrix-regulatory cells enhance cartilage regeneration for meniscus injuries: a phase I dose-escalation trial. Signal Transduct Target Ther 2023; 8:417. [PMID: 37907503 PMCID: PMC10618459 DOI: 10.1038/s41392-023-01670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023] Open
Abstract
Immunity-and-matrix-regulatory cells (IMRCs) derived from human embryonic stem cells have unique abilities in modulating immunity and regulating the extracellular matrix, which could be mass-produced with stable biological properties. Despite resemblance to mesenchymal stem cells (MSCs) in terms of self-renew and tri-lineage differentiation, the ability of IMRCs to repair the meniscus and the underlying mechanism remains undetermined. Here, we showed that IMRCs demonstrated stronger immunomodulatory and pro-regenerative potential than umbilical cord MSCs when stimulated by synovial fluid from patients with meniscus injury. Following injection into the knees of rabbits with meniscal injury, IMRCs enhanced endogenous fibrocartilage regeneration. In the dose-escalating phase I clinical trial (NCT03839238) with eighteen patients recruited, we found that intra-articular IMRCs injection in patients was safe over 12 months post-grafting. Furthermore, the effective results of magnetic resonance imaging (MRI) of meniscus repair and knee functional scores suggested that 5 × 107 cells are optimal for meniscus injury treatment. In summary, we present the first report of a phase I clinical trial using IMRCs to treat meniscus injury. Our results demonstrated that intra-articular injection of IMRCs is a safe and effective therapy by providing a permissive niche for cartilage regeneration.
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Affiliation(s)
- Liangjiang Huang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Zhang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wu
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Baojie Guo
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Tingting Gao
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajie Li
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Stem Cell Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Fan
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Liu Wang
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yani Xiao
- Beijing Key Lab for Pre-clinical Safety Evaluation of Drugs, National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, Beijing, China
| | - Wenjing Liu
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Yao Tian
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Zhengyu Fang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Lv
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingfeng Xie
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Yao
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaotan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Huang
- Beijing Key Lab for Pre-clinical Safety Evaluation of Drugs, National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, Beijing, China
| | - Yujuan Li
- Beijing Zephyrm Biotechnologies Co., Ltd., Beijing, China
| | - Yi Jia
- Beijing Zephyrm Biotechnologies Co., Ltd., Beijing, China
| | - Zhongwen Li
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
| | - Guihai Feng
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yan Huo
- Beijing Key Lab for Pre-clinical Safety Evaluation of Drugs, National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, Beijing, China
| | - Wei Li
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qi Zhou
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jie Hao
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Baoyang Hu
- National Stem Cell Resource Center, State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.
- University of Chinese Academy of Sciences, Beijing, China.
| | - Hong Chen
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Stem Cell Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Vasiliadis AV. Is a Healthy Knee the 1995-1996 Chicago Bulls Team? Arthroscopy 2023; 39:2265-2266. [PMID: 37866865 DOI: 10.1016/j.arthro.2023.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/27/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Angelo V Vasiliadis
- Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece; Research Fellow, Department of Orthopaedic Surgery and Sports Medicine, Lyon, France
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40
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Sinna J, Jeencham R, Mueangkhot P, Sophon S, Noralak P, Raksapakdee R, Numpaisal PO, Ruksakulpiwat Y. Development of Poly(vinyl alcohol) Grafted Glycidyl Methacrylate/Cellulose Nanofiber Injectable Hydrogels for Meniscus Tissue Engineering. Polymers (Basel) 2023; 15:4230. [PMID: 37959910 PMCID: PMC10647663 DOI: 10.3390/polym15214230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to develop poly (vinyl alcohol) grafted glycidyl methacrylate/cellulose nanofiber (PVA-g-GMA/CNF) injectable hydrogels for meniscus tissue engineering. PVA-g-GMA is an interesting polymer for preparing cross-linking injectable hydrogels with UV radiation, but it has poor mechanical properties and low cell proliferation. In this study, CNF as a reinforcing agent was selected to improve mechanical properties and cell proliferation in PVA-g-GMA injectable hydro-gels. The effect of CNF concentration on hydrogel properties was investigated. Both PVA-g-GMA and PVA-g-GMA hydrogels incorporating 0.3, 0.5, and 0.7% (w/v) CNF can be formed by UV curing at a wavelength of 365 nm, 6 mW/cm2 for 10 min. All hydrogels showed substantial microporosity with interconnected tunnels, and a pore size diameter range of 3-68 µm. In addition, all hydrogels also showed high physicochemical properties, a gel fraction of 81-82%, porosity of 83-94%, water content of 73-87%, and water swelling of 272-652%. The water content and swelling of hydrogels were increased when CNF concentration increased. It is worth noting that the reduction of porosity in the hydrogels occurred with increasing CNF concentration. With increasing CNF concentration from 0.3% to 0.7% (w/v), the compressive strength and compressive modulus of the hydrogels significantly increased from 23 kPa to 127 kPa and 27 kPa to 130 kPa, respectively. All of the hydrogels were seeded with human cartilage stem/progenitor cells (CSPCs) and cultured for 14 days. PVA-g-GMA hydrogels incorporating 0.5% and 0.7% (w/v) CNF demonstrated a higher cell proliferation rate than PVA-g-GMA and PVA-g-GMA hydrogels incorporating 0.3% (w/v) CNF, as confirmed by MTT assay. At optimum formulation, 10%PVA-g-GMA/0.7%CNF injectable hydrogel met tissue engineering requirements, which showed excellent properties and significantly promoted cell proliferation, and has a great potential for meniscus tissue engineering application.
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Affiliation(s)
- Jiraporn Sinna
- Research Center for Biocomposite Materials for Medical Industry and Agricultural and Food Industry, Nakhon Ratchasima 30000, Thailand
- School of Polymer Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Rachasit Jeencham
- Research Center for Biocomposite Materials for Medical Industry and Agricultural and Food Industry, Nakhon Ratchasima 30000, Thailand
| | - Priyapat Mueangkhot
- School of Polymer Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Sorasak Sophon
- School of Polymer Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Pornpattara Noralak
- School of Polymer Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Romtira Raksapakdee
- School of Polymer Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Piya-on Numpaisal
- Research Center for Biocomposite Materials for Medical Industry and Agricultural and Food Industry, Nakhon Ratchasima 30000, Thailand
- School of Orthopaedics, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Yupaporn Ruksakulpiwat
- Research Center for Biocomposite Materials for Medical Industry and Agricultural and Food Industry, Nakhon Ratchasima 30000, Thailand
- School of Polymer Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
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41
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Yang J, Wang H, Zhou Y, Duan L, Schneider KH, Zheng Z, Han F, Wang X, Li G. Silk Fibroin/Wool Keratin Composite Scaffold with Hierarchical Fibrous and Porous Structure. Macromol Biosci 2023; 23:e2300105. [PMID: 37247409 DOI: 10.1002/mabi.202300105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Indexed: 05/31/2023]
Abstract
The present study describes a silk microfiber reinforced meniscus scaffold (SMRMS) with hierarchical fibrous and porous structure made from silk fibroin (SF) and wool keratin (WK) using electrospinning and freeze-drying technology. This study focuses on the morphology, secondary structure, mechanical properties, and water absorption properties of the scaffold. The cytotoxicity and biocompatibility of SMRMS are assessed in vivo and in vitro. The scaffold shows hierarchical fibrous and porous structure, hierarchical pore size distribution (ranges from 50 to 650 µm), robust mechanical properties (compression strength can reach at 2.8 MPa), and stable biodegradability. A positive growth condition revealed by in vitro cytotoxicity testing indicates that the scaffold is not hazardous to cells. In vivo assessments of biocompatibility reveal that only a mild inflammatory reaction is present in implanted rat tissue. Meniscal scaffold made of SF/WK composite shows a potential application prospect in the meniscal repair engineering field with its development.
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Affiliation(s)
- Jie Yang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Huan Wang
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yuhang Zhou
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Lirong Duan
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Karl H Schneider
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Waehringer Gurtel 18-20, Vienna, 1090, Austria
| | - Zhaozhu Zheng
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Fengxuan Han
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaoqin Wang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Gang Li
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
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42
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Musbahi O, Waddell L, Shah N, Smith SE, Chen AF, Bisson L, Katz JN. Subchondral Insufficiency Fractures of the Knee: A Clinical Narrative Review. JBJS Rev 2023; 11:01874474-202310000-00005. [PMID: 37812676 DOI: 10.2106/jbjs.rvw.23.00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
» Subchondral insufficiency fractures of the knee (SIFKs) are subchondral plate fractures with a prevalence of 2% to 4% of all knee injuries.» Magnetic resonance imaging is the gold standard for evaluating SIFK, while plain radiographs have limited the use in the diagnosis of SIFK.» Among patients with SIFK, 50% to 100% have meniscal pathology.» Medical therapies and standard treatments traditionally used in the management of knee osteoarthritis differ from recommended management of SIFK patients.» Randomized controlled trials and cohort studies with long-term follow-up are needed to determine the optimal rehabilitation protocol, interventional therapy, and prognosis of SIFK patients.
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Affiliation(s)
- Omar Musbahi
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Imperial College London, London, United Kingdom
| | - Lily Waddell
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nehal Shah
- Harvard Medical School, Boston, Massachusetts
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stacy E Smith
- Harvard Medical School, Boston, Massachusetts
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Leslie Bisson
- Department of Orthopedic Surgery, University of Buffalo, Buffalo, New York
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts
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43
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Jang S, Lee J, Jeong JG, Oh TI, Lee E. Reconstruction of Fibrocartilage with Fibrous Alignment of Type I Collagen in Scaffold-Free Manner. Tissue Eng Part A 2023; 29:529-540. [PMID: 37382424 DOI: 10.1089/ten.tea.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
For functional reconstruction of fibrocartilage, it is necessary to reproduce the essential mechanical property exhibited by natural fibrocartilage. The distinctive mechanical property of fibrocartilage is originated from the specific histological features of fibrocartilage composed of highly aligned type I collagen (Col I) and an abundant cartilaginous matrix. While the application of tensile stimulation induces highly aligned Col I, our study reveals that it also exerts an antichondrogenic effect on scaffold-free tissues constructed with meniscal chondrocytes (MCs) and induces downregulation of Sox-9 expression and attenuated glycosaminoglycan production. Modulation of mechanotransduction by blocking nuclear translocation of Yes-associated protein (YAP) ameliorated the antichondrogenic effect in the presence of tensile stimulation. Since MCs subjected to mechanical doses either by surface stiffness or tensile stimulation showed reversibility of YAP status even after a long-term exposure to mechanotransduction, fibrocartilage tissue was constructed by sequentially inducing tissue alignment by tensile stimulation followed by inducing cartilaginous matrix production in a tension-released state. The minimal tensile dose to constitute durable tissue alignment was screened by investigating the alignment of cytoskeleton and Col I after culturing the scaffold-free tissue constructs with various tensile doses (10% static tension for 1, 3, 7, and 10 days) followed by maintaining in a released state for 5 days. Fluorescence-conjugated phalloidin binding and immunofluorescence of Col I indicated that the duration of static tension for more than 7 days resulted in durable tissue alignment for at least 5 days in the tension-released state. The tissues subjected to tensile stimulation for 7 days followed by 14 days in a released state in chondrogenic media resulted in abundant cartilaginous matrix as well as uniaxial anisotropic alignment. Our results show that the optimized tensile dose can facilitate the successful reconstruction of fibrocartilage by modulating the characteristics of matrix production by MCs.
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Affiliation(s)
- Seoyoung Jang
- Department of Medical Engineering, Graduate School, Kyung Hee University, Seoul, South Korea
- R&D Institute, Akrocell Biosciences, Inc., Seoul, South Korea
| | - Jisoo Lee
- Department of Medical Engineering, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jin Gil Jeong
- Department of Medical Engineering, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Tong In Oh
- Department of Biomedical Engineering, School of Medicine, Kyung Hee University, Seoul, South Korea
- Impedance Imaging Research Center, Kyung Hee University, Seoul, South Korea
| | - EunAh Lee
- Impedance Imaging Research Center, Kyung Hee University, Seoul, South Korea
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Oladeji LO, Reynolds G, Nuelle CW, DeFroda SF. Securing the Root: Meniscus Root Repair with Rip Stop and Cannulated Drilling. Arthrosc Tech 2023; 12:e1665-e1672. [PMID: 37942109 PMCID: PMC10627872 DOI: 10.1016/j.eats.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Meniscal root pathology has garnered increased attention over the past decade. Meniscal root tears are considered to essentially represent a meniscus-deficient state, which has led to a rise in the surgical fixation of this pathology. Meniscus root tears are classified as either radial tears within 1 cm of the root insertion, or a direct avulsion of meniscal root. These injuries are important to recognize because they contribute to impaired joint mechanics and rapid articular cartilage degeneration. Given this, there remains significant interest in identifying novel surgical techniques that may facilitate better surgical repair and enhance patient outcomes. The purpose of this technical note is to describe a surgical technique for a medial meniscus root ripstop repair with cannulated drilling. This technique is simple and reproducible, while also allowing for the augmentation of potentially poor tissue quality.
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Affiliation(s)
- Lasun O. Oladeji
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Grace Reynolds
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
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Erard J, Cance N, Shatrov J, Fournier G, Gunst S, Ciolli G, Porcelli P, Lustig S, Servien E. Delaying ACL reconstruction is associated with increased rates of medial meniscal tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4458-4466. [PMID: 37486367 DOI: 10.1007/s00167-023-07516-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. METHODS Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 [16-60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%). RESULTS Delaying ACLR > 12 months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). CONCLUSION Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Julien Erard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
| | - Nicolas Cance
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Stanislas Gunst
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Gianluca Ciolli
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Via Della Pineta Sacchetti, 217, 00168, Rome, Italy
| | - Pasquale Porcelli
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Orthopaedic and Traumatology Department, Centro Traumatologico Ortopedico, Via Gianfranco Zuretti, 29, 10126, Turin, TO, Italy
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- IFSTTAR, Univ Lyon, Claude Bernard Lyon 1 University, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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Doan K, Dey Hazra ME, Brown JR, Hollenbeck JFM, Dey Hazra RO, Johnson D, Fossum B, Vidal A. Biomechanical Analysis of Meniscotibial Ligament Tenodesis to Treat Meniscal Extrusion in the Setting of Posterior Medial Meniscus Root Repair. Am J Sports Med 2023; 51:3204-3210. [PMID: 37681550 DOI: 10.1177/03635465231193961] [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] [Indexed: 09/09/2023]
Abstract
BACKGROUND Meniscal extrusion often persists after a medial meniscus root repair. If the meniscus is extruded, the function of the meniscus as a load-sharing device and secondary knee stabilizer is compromised. HYPOTHESIS It was hypothesized that repairing the meniscotibial ligament (MTL) would decrease meniscal extrusion in the settings of both an isolated MTL tear and a repaired medial meniscus root while also improving medial compartment contact mechanics. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen cadaveric knees (mean age, 50.5 years) were tested in 5 conditions: intact, MTL deficiency, MTL deficiency + posterior medial meniscus root deficiency, MTL deficiency + posterior medial meniscus root repair, and MTL tenodesis + posterior medial meniscus root repair. Specimens were mounted to a load frame that applied a 1000-N axial load. Joint contact pressures were measured using thin pressure sensors, and the peak and mean pressures were analyzed. Ultrasound was used to measure meniscal extrusion. RESULTS The MTL tear in isolation resulted in significant meniscal extrusion compared with the intact state (P = 0.035) without a detectable difference in medial compartment pressures. The addition of a root tear to the MTL tear state resulted in significantly more extrusion (P = 0.001) and significant increases in medial compartment pressure (P = .030) compared to the MTL tear state. Root repair alone restored extrusion, mean contact pressure, and peak contact pressure back to the intact state (P > .05). CONCLUSION This study showed that MTL disruption led to increased meniscal extrusion in a cadaveric model. Unlike the root tear state, MTL disruption did not change contact mechanics. Furthermore, root repair alone was sufficient in restoring intact biomechanics and extrusion. CLINICAL RELEVANCE This study may help clinicians understand the origin of medial meniscus root tears and aid in the decision-making process for whether to add an MTL tenodesis in the setting of root repair.
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Affiliation(s)
- Kent Doan
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Maria Else Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Private Practice Dr Ulf Kuhlee
| | - Justin R Brown
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charite-University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Donovan Johnson
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Bradley Fossum
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Armando Vidal
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Rohde MS, Trivedi S, Randhawa S, Wright CE, Vuong BB, Pham N, Stavinoha T, Ellis HB, Ganley TJ, Green DW, Fabricant PD, Tompkins M, Shea KG. Pediatric meniscus morphology varies with age: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4179-4186. [PMID: 37178242 DOI: 10.1007/s00167-023-07447-3] [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: 01/12/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE In adolescent patients, meniscal tear injury can occur either in isolation (e.g., discoid lateral meniscus tears) or in association with other traumatic injuries including tibial eminence fracture or ACL tear. Damage to meniscal integrity has been shown to increase contact pressure in articular cartilage, increasing risk of early onset osteoarthritis. In symptomatic patients failing conservative management, surgical intervention via meniscus repair or meniscus transplant is indicated. The purpose of this study was to evaluate the radial dimensions of pediatric menisci throughout development. The hypothesis was that the average radial meniscus dimensions will increase as specimen age increases, and mean medial and lateral region measurements will increase at a linear rate. METHODS Seventy-eight skeletally immature knee cadaver specimens under age 12 years were included in this study. The meniscal specimens were photographed in the axial view with ruler in the plane of the tibial plateau and analyzed using computer-aided design (CAD) software (Autodesk Fusion 360). Measurements were taken from inner to outer meniscus rims at five 45 degree intervals using the clockface as a reference (12:00, 1:30, 3:00, 4:30, 6:00), and total area of meniscus and tibial plateau was recorded. Generalized linear models were used to evaluate the associations of radial width measurements with age, tibial coverage, and lateral vs. medial meniscus widths. RESULTS All radial width measurements increased significantly with specimen age (p ≤ 0.002), and all lateral-medial meniscal widths increased (p < 0.001). The anterior zones of the meniscus were found to increase at the slowest rate compared to other regions. Tibial plateau coverage was found to not significantly vary with age. CONCLUSIONS Meniscus radial width and lateral-medial meniscus width are related to age. The anterior width of the meniscus varied least with age. Improved anatomic understanding may help surgeons more effectively plan for meniscus repair, discoid resection/saucerization/repair, and also support appropriate selection of meniscus allograft for transplantation.
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Affiliation(s)
- Matthew S Rohde
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA.
| | - Sunny Trivedi
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Sahej Randhawa
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Christian E Wright
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Brian B Vuong
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Nicole Pham
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | | | | | | | | | | | - Marc Tompkins
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kevin G Shea
- Department of Orthopedic Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
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Modina SC, Aidos L, Millar VRH, Pallaoro M, Polito U, Veronesi MC, Peretti GM, Mangiavini L, Carnevale L, Boschetti F, Abbate F, Di Giancamillo A. Postnatal morpho-functional development of a dog's meniscus. Ann Anat 2023; 250:152141. [PMID: 37499701 DOI: 10.1016/j.aanat.2023.152141] [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: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential structures for the knee joint, poor information is available about their morphogenesis, in particular in dog models. Menisci from a group of Dobermann Pinchers aged 0, 10, 30 days, and 4 years (T0, T10, T30, adult, respectively) were analyzed by SEM, histochemistry (Safranin O and Picro Sirius Red Staining analyzed under a polarized light microscope), immunofluorescences (collagen type I and II), biomechanical (compression) and biochemical analyses (glycosaminoglycans, GAGs, and DNA content). SEM analyses revealed that the T0 meniscus is a bulgy structure that during growth tends to flatten, firstly in the inner zone (T10) and then even in the outer zone (T30), until the achievement of the completely smooth adult final shape. These results were further supported by the histochemistry analyses in which the deposition of GAGs started from T30, and the presence of type I birefringent collagen fibers was observed from T0 to T30, while poorly refringent type III collagen fibers were observed in the adult dogs. Double immunofluorescence analyses also evidenced that the neonatal meniscus contains mainly type I collagen fibers, as well as the T10 meniscus, and demonstrated a more evident regionalization and crimping in the T30 and adult meniscus. Young's elastic modulus of the meniscus in T0 and T10 animals was lower than the T30 animals, and this last group was also lower than adult ones (T0-T10 vs T30 vs adult). Biochemical analysis confirmed that cellularity decreases over time from neonatal to adult (p < 0.01). The same decreasing trend was observed in GAGs deposition. These results may suggest that the postnatal development of canine meniscus may be related to the progressive functional locomotory development: after birth, the meniscus acquires its functionality over time, through movement, load, and growth itself.
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Affiliation(s)
- Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | | | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Umberto Polito
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Maria Cristina Veronesi
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Liliana Carnevale
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Federica Boschetti
- IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Polytechnic University of Milan, 20133 Milan, Italy
| | - Francesco Abbate
- Department of Veterinary Sciences, University of Messina, Polo Universitario S.S. Annunziata, 98168 Messina, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy.
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49
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Kakoulidis P, Panagiotidou S, Profitiliotis G, Papavasiliou K, Tsiridis E, Topalis C. Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:3684-3700. [PMID: 36522493 DOI: 10.1007/s00167-022-07238-2] [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: 08/12/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters. METHODS A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. RESULTS Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical difference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05). DISCUSSION The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Panagiotis Kakoulidis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece.
| | - Sousana Panagiotidou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | | | - Kyriakos Papavasiliou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Christos Topalis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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50
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Lemmon EA, Bonnevie ED, Patel JM, Miller LM, Mauck RL. Transient inhibition of meniscus cell migration following acute inflammatory challenge. J Orthop Res 2023; 41:2055-2064. [PMID: 36866823 PMCID: PMC10750267 DOI: 10.1002/jor.25545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Meniscus tears represent a common orthopedic injury that often requires surgery to restore pain-free function. The need for surgical intervention is due, in part, to the inflammatory and catabolic environment that inhibits meniscus healing after injury. In other organ systems, healing is dependent on the migration of cells to the site of injury; however, in the meniscus, it is currently unknown how the microenvironment dictates cell migration in the postinjury inflamed setting. Here, we investigated how inflammatory cytokines alter meniscal fibrochondrocyte (MFC) migration and sensation of microenvironmental stiffness. We further tested whether an FDA approved interleukin-1 receptor antagonist (IL-1Ra; Anakinra) could rescue migratory deficits caused by inflammatory challenge. When cultured in the presence of inflammatory cytokines (tumor necrosis factor-α [TNF-α] or interleukin-1β [IL-1β]) for 1 day, MFC migration was inhibited for 3 days before returning to control levels at Day 7. This migratory deficit was clear in three-dimensional as well, where fewer MFCs exposed to inflammatory cytokines migrated from a living meniscal explant compared with control. Notably, addition of IL-1Ra to MFCs previously exposed to IL-1β restored migration to baseline levels. This study demonstrates that joint inflammation can have negative impacts on meniscus cell migration and mechanosensation, affecting their potential for repair, and that resolution of this inflammation with concurrent anti-inflammatories can reverse these deficits. Future work will apply these findings to mitigate the negative consequences of joint inflammation and promote repair in a clinically relevant meniscus injury model.
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Affiliation(s)
- Elisabeth A. Lemmon
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Edward D. Bonnevie
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Jay M. Patel
- Department of Orthopaedics, Emory University, Decatur, Georgia, USA
| | - Liane M. Miller
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- University of Pennsylvania Perelman School of Medicine, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
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