Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application

Short-Term but Not Long-Term Knee Symptoms and Functional Improvements of Tissue Engineering Strategy for Meniscus Defects: A Systematic Review of Clinical Studies

PURPOSE

To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects.

METHODS

A search was performed by 3 independent reviewers on PubMed, MEDLINE, EMBASE, and Cochrane from 2016 to June 18, 2023, with the term "meniscus" with all the following terms: "scaffolds," "constructs," "implant," and "tissue engineering." Inclusion criteria included "Clinical trials" and "English language articles" that involved isolated meniscus tissue engineering strategies for meniscus injuries. Only Level I to IV clinical studies were considered. The modified Coleman Methodology score was used for quality analysis of included clinical trials. The Methodological Index for Non-Randomized Studies was employed for analysis of the risk of study bias and methodological quality.

RESULTS

The search identified 2,280 articles, and finally 19 original clinical trials meeting the inclusion criteria were included. Three types of tissue-engineered meniscus implants (CMI-Menaflex, Actifit, and NUsurface) have been clinically evaluated for meniscus reconstruction. Lack of standardized outcome measures and imaging protocols limits comparison between studies.

CONCLUSIONS

Tissue-engineered meniscus implants can provide short-term knee symptom and function improvements, but no implants have been shown to propose significant long-term benefits for meniscus defects.

LEVEL OF EVIDENCE

Level IV, systematic review of Level I to IV studies.

Does laterality matter? a systematic review and meta-analysis of clinical and survival outcomes of medial versus lateral meniscal scaffolds

PURPOSE

Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect of laterality on outcomes is unclear. This study aimsto assess the hypothesis that lateral meniscal scaffold implants have worse clinical or survival outcomes compared with medial scaffold implants.

METHODS

The study was performedaccording to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO. Three databases (PubMed, Embase, Scopus) were searched from date of database establishment to 21 January 2022. Human studies reporting clinical or survival outcomedata specific to the medial or lateral meniscal scaffold implant were included. Random-effects model was used to analyse survival outcome data.

RESULTS

Ten studies comprising 568 patients (mean age 29.2-40 years, follow up duration 1-14 years) were included. There were 483 medial and 85 lateral meniscal scaffold implants. Amongst two studies directly comparing the survival rate of medial and lateral meniscal scaffolds, there was no significant difference in survival rates between medial and lateral meniscus scaffolds (hazard ratio = 1.24, 95 % confidence interval: 0.51-3.03, P = 0.63). There were no consistent statistically significant differences between medial and lateral meniscal scaffolds in terms of postoperative Visual Analog Scale pain,Tegner Activity, Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, and Knee Society Scores.

CONCLUSION

Despite anatomical and biomechanical differences between the medial and lateral meniscus, there are no significant differences in clinical outcomes or survival rates between medial and lateral meniscal scaffold implants for irreparable partial meniscal defects at short- or mid-term follow up. Lateral meniscal scaffold implants are therefore non-inferior to medial meniscal scaffold implants.

No differences in clinical outcome between CMI and Actifit meniscal scaffolds: a systematic review and meta-analysis

PURPOSE

To compare the results of two meniscal scaffolds, CMI and Actifit, for the treatment of partial meniscal lesions.

METHODS

A systematic review was performed on the PubMed, Web of Science, Scopus, Embase, and Cochrane databases in January 2021, including randomized controlled trails (RCTs) and prospective and retrospective observational studies on the clinical results of meniscal scaffolds. A meta-analysis of the clinical results was performed; the rate of failures was recorded, as well as radiological results. The quality of the included studies was assessed with a modified Coleman Methodology Score (CMS).

RESULTS

The search identified 37 studies (31 in the last 10 years): 2 RCTs, 5 comparative studies, 26 prospective and 4 retrospective series on a total of 1276 patients (472 CMI, 804 Actifit). The quality of evidence was generally low. An overall significant improvement in all clinical scores was documented for both scaffolds. The meta-analysis showed no differences between the two scaffolds in terms of patient reported outcome measures and activity level. The meta-analysis on the risk of failures documented a risk of failures of 7% in the CMI and of 9% in the Actifit group.

CONCLUSIONS

There is a growing interest on the results of meniscal scaffolds, with most studies published recently. However, long-term data on the Actifit scaffold and high-level comparative studies are missing. Both CMI and Actifit offered good clinical results with a significant and comparable improvement in symptoms and function, and with a low number of failures over time. Accordingly, with the proper indication, their use may be encouraged in the clinical practice.

LEVEL OF EVIDENCE

Level IV.