1
|
Bian Y, Cai X, Zhou R, Lv Z, Xu Y, Wang Y, Wang H, Zhu W, Sun H, Zhao X, Feng B, Weng X. Advances in meniscus tissue engineering: Towards bridging the gaps from bench to bedside. Biomaterials 2025; 312:122716. [PMID: 39121731 DOI: 10.1016/j.biomaterials.2024.122716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/12/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
Meniscus is vital for maintaining the anatomical and functional integrity of knee. Injuries to meniscus, commonly caused by trauma or degenerative processes, can result in knee joint dysfunction and secondary osteoarthritis, while current conservative and surgical interventions for meniscus injuries bear suboptimal outcomes. In the past decade, there has been a significant focus on advancing meniscus tissue engineering, encompassing isolated scaffold strategies, biological augmentation, physical stimulus, and meniscus organoids, to improve the prognosis of meniscus injuries. Despite noteworthy promising preclinical results, translational gaps and inconsistencies in the therapeutic efficiency between preclinical and clinical studies exist. This review comprehensively outlines the developments in meniscus tissue engineering over the past decade (Scheme 1). Reasons for the discordant results between preclinical and clinical trials, as well as potential strategies to expedite the translation of bench-to-bedside approaches are analyzed and discussed.
Collapse
Affiliation(s)
- Yixin Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xuejie Cai
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Runze Zhou
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yiming Xu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yingjie Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Han Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hanyang Sun
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiuli Zhao
- Department of Medical Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
2
|
Stambaugh JR, Colon-Morillo R, Culebras Almeida LA, Selman F, Perry NPJ. Meniscal Posterior Root to Bone Post-Operative Healing Appears Incomplete at 24 Weeks in a Goat Model. Arthroscopy 2024:S0749-8063(24)00753-9. [PMID: 39326571 DOI: 10.1016/j.arthro.2024.09.036] [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: 09/13/2024] [Accepted: 09/18/2024] [Indexed: 09/28/2024]
Abstract
The goal of many orthopedic surgeries is to mechanically stabilize the tissue long enough for biological healing to occur. The healed tissue should be able to bear the load before the mechanical device (screw, suture, anchor, etc.) eventually fails. Recent research shows that in a goat model, meniscus posterior root repair to bone is not fully healed at 24 weeks post-operative (after the suture is removed and under biomechanical and histological testing). In addition, MRI at 24 months post-operative showed persistent meniscal extrusion, but only under mechanical loading. Of course, in clinical practice, repair sutures are not removed and continue to provide mechanical stability until they either fail, the tissue-suture interface fails, or the meniscus root is healed enough to resist the load. Nevertheless, we need to be mindful of time to healing, weight bearing, and return to activity in human patients.
Collapse
Affiliation(s)
| | | | | | - Farah Selman
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicholas P J Perry
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| |
Collapse
|
3
|
Du M, Liu K, Lai H, Qian J, Ai L, Zhang J, Yin J, Jiang D. Functional meniscus reconstruction with biological and biomechanical heterogeneities through topological self-induction of stem cells. Bioact Mater 2024; 36:358-375. [PMID: 38496031 PMCID: PMC10944202 DOI: 10.1016/j.bioactmat.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Meniscus injury is one of the most common sports injuries within the knee joint, which is also a crucial pathogenic factor for osteoarthritis (OA). The current meniscus substitution products are far from able to restore meniscal biofunctions due to the inability to reconstruct the gradient heterogeneity of natural meniscus from biological and biomechanical perspectives. Here, inspired by the topology self-induced effect and native meniscus microstructure, we present an innovative tissue-engineered meniscus (TEM) with a unique gradient-sized diamond-pored microstructure (GSDP-TEM) through dual-stage temperature control 3D-printing system based on the mechanical/biocompatibility compatible high Mw poly(ε-caprolactone) (PCL). Biologically, the unique gradient microtopology allows the seeded mesenchymal stem cells with spatially heterogeneous differentiation, triggering gradient transition of the extracellular matrix (ECM) from the inside out. Biomechanically, GSDP-TEM presents excellent circumferential tensile modulus and load transmission ability similar to the natural meniscus. After implantation in rabbit knee, GSDP-TEM induces the regeneration of biomimetic heterogeneous neomeniscus and efficiently alleviates joint degeneration. This study provides an innovative strategy for functional meniscus reconstruction. Topological self-induced cell differentiation and biomechanical property also provides a simple and effective solution for other complex heterogeneous structure reconstructions in the human body and possesses high clinical translational potential.
Collapse
Affiliation(s)
- Mingze Du
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Kangze Liu
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 639798, Singapore
| | - Huinan Lai
- Department of Engineering Mechanics, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Zhejiang University, Zhejiang, 310058, China
| | - Jin Qian
- Department of Engineering Mechanics, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Zhejiang University, Zhejiang, 310058, China
| | - Liya Ai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jiying Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jun Yin
- The State Key Laboratory of Fluid Power Transmission and Control Systems, Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Zhejiang, 310058, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| |
Collapse
|
4
|
González-Duque MI, Flórez AM, Torres MA, Fontanilla MR. Composite Zonal Scaffolds of Collagen I/II for Meniscus Regeneration. ACS Biomater Sci Eng 2024; 10:2426-2441. [PMID: 38549452 DOI: 10.1021/acsbiomaterials.3c01737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The meniscus is divided into three zones according to its vascularity: an external vascularized red-red zone mainly comprising collagen I, a red-white interphase zone mainly comprising collagens I and II, and an internal white-white zone rich in collagen II. Known scaffolds used to treat meniscal injuries do not reflect the chemical composition of the vascular areas of the meniscus. Therefore, in this study, four composite zonal scaffolds (named A, B, C, and D) were developed and characterized; the developed scaffolds exhibited the main chemical components of the external (collagen I), interphase (collagens I/II), and internal (collagen II) zones of the meniscus. Noncomposite scaffolds were also produced (named E), which had the same shape as the composite scaffolds but were entirely made of collagen I. The composite zonal scaffolds were prepared using different concentrations of collagen I and the same concentration of collagen II and were either cross-linked with genipin or not cross-linked. Porous, biodegradable, and hydrophilic scaffolds with an expected chemical composition were obtained. Their pore size was smaller than the size reported for the meniscus substitutes; however, all scaffolds allowed the adhesion and proliferation of human adipose-derived stem cells (hADSCs) and were not cytotoxic. Data from enzymatic degradation and hADSC proliferation assays were considered for choosing the cross-linked composite scaffolds along with the collagen I scaffold and to test if composite zonal scaffolds seeded with hADSC and cultured with differentiation medium produced fibrocartilage-like tissue different from that formed in noncomposite scaffolds. After 21 days of culture, hADSCs seeded on composite scaffolds afforded an extracellular matrix with aggrecan, whereas hADSCs seeded on noncomposite collagen I scaffolds formed a matrix-like fibrocartilage without aggrecan.
Collapse
Affiliation(s)
- Martha Isabel González-Duque
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| | - Adriana Matilde Flórez
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| | - María Alejandra Torres
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| | - Marta Raquel Fontanilla
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| |
Collapse
|
5
|
Morgan C, Bell R, Burland JP, Edgar CM. Meniscus Allograft Transplantation Augmented With Autologous Bone Marrow Aspirate Concentrate. Arthrosc Tech 2023; 12:e1021-e1026. [PMID: 37533910 PMCID: PMC10390746 DOI: 10.1016/j.eats.2023.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 08/04/2023] Open
Abstract
Meniscus allograft transplantation (MAT) has been shown to be a feasible surgical option for younger patients, below 50 years of age who have meniscal insufficiency and have failed conservative treatment measures. In this technical note, we describe a procedure of harvesting and injecting bone marrow aspirate concentrate in a meniscus allograft during a MAT procedure, which may allow for longer lasting transplants and improve patient outcomes. In this technical note, bone marrow aspirate concentrate is harvested arthroscopically from the intercondylar notch at the surgical site, which prevents additional donor site morbidity, as seen with harvesting from other locations, such as the iliac crest. This also reduces operating time, since harvesting from the iliac crest requires different patient positioning and usually additional anesthesia. The authors of this surgical technique believe that biological augmentation during MATs will assist surgeons in maximizing graft survivorship and, ultimately, lead to better patient outcomes.
Collapse
Affiliation(s)
- Courtney Morgan
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Julie P. Burland
- UConn Institute for Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- UConn Institute for Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
| |
Collapse
|
6
|
Wang B, Barceló X, Von Euw S, Kelly DJ. 3D printing of mechanically functional meniscal tissue equivalents using high concentration extracellular matrix inks. Mater Today Bio 2023; 20:100624. [PMID: 37122835 PMCID: PMC10130628 DOI: 10.1016/j.mtbio.2023.100624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Decellularized extracellular matrix (dECM) has emerged as a promising biomaterial in the fields of tissue engineering and regenerative medicine due to its ability to provide specific biochemical and biophysical cues supportive of the regeneration of diverse tissue types. Such biomaterials have also been used to produce tissue-specific inks and bioinks for 3D printing applications. However, a major limitation associated with the use of such dECM materials is their poor mechanical properties, which limits their use in load-bearing applications such as meniscus regeneration. In this study, native porcine menisci were solubilized and decellularized using different methods to produce highly concentrated dECM inks of differing biochemical content and printability. All dECM inks displayed shear thinning and thixotropic properties, with increased viscosity and improved printability observed at higher pH levels, enabling the 3D printing of anatomically defined meniscal implants. With additional crosslinking of the dECM inks following thermal gelation at pH 11, it was possible to fabricate highly elastic meniscal tissue equivalents with compressive mechanical properties similar to the native tissue. These improved mechanical properties at higher pH correlated with the development of a denser network of smaller diameter collagen fibers. These constructs also displayed repeatable loading and unloading curves when subjected to long-term cyclic compression tests. Moreover, the printing of dECM inks at the appropriate pH promoted a preferential alignment of the collagen fibers. Altogether, these findings demonstrate the potential of 3D printing of highly concentrated meniscus dECM inks to produce mechanically functional and biocompatible implants for meniscal tissue regeneration. This approach could be applied to a wide variety of different biological tissues, enabling the 3D printing of tissue mimics with diverse applications from tissue engineering to surgical planning.
Collapse
Affiliation(s)
- Bin Wang
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), SFI Research Centre for Advanced Materials and BioEngineering Research, Ireland
| | - Xavier Barceló
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), SFI Research Centre for Advanced Materials and BioEngineering Research, Ireland
| | - Stanislas Von Euw
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Daniel J. Kelly
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
- Department of Anatomy and Regenarative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), SFI Research Centre for Advanced Materials and BioEngineering Research, Ireland
- Corresponding author. Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
7
|
Rai RS, P GJ, Bajpai V, Khan MI, Elboughdiri N, Shanableh A, Luque R. An eco-friendly approach on green synthesis, bio-engineering applications, and future outlook of ZnO nanomaterial: A critical review. ENVIRONMENTAL RESEARCH 2023; 221:114807. [PMID: 36455633 DOI: 10.1016/j.envres.2022.114807] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Synthesizing ZnO nanostructures ranging from 1 nm to 4 nm confines the electron cloud and exhibits a quantum effect generally called as quantum confinement effect attracting many researchers in the field of electronics and optics. ZnO nanostructures are used in medical applications to formulate antioxidant, antibacterial, antifungal, anti-inflammatory, wound healing, and anti-diabetic medications. This work is a comprehensive study of green synthesis of ZnO nanomaterials using different biological sources and highlights different processes able to produce nanostructures including nanowires, nanorods, nanotubes and other nano shapes of ZnO nanostructures. Different properties of ZnO nanostructures and their targeted bioengineering applications are also described. The strategies and challenges of the eco-friendly approach to enhance the application span of ZnO nanomaterials are also summarized, with future prospects for greener design of ZnO nanomaterials are also suggested.
Collapse
Affiliation(s)
- Ravi Shankar Rai
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, Jharkhand, India.
| | - Girish J P
- Department of Mechanical Engineering with Specialization in Design and Manufacturing, Indian Institute of Information Technology Design and Manufacturing, Kurnool, A.P, India.
| | - Vivek Bajpai
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, Jharkhand, India
| | - Muhammad Imran Khan
- Research Institute of Sciences and Engineering (RISE), University of Sharjah, Sharjah, 27272, United Arab Emirates.
| | - Noureddine Elboughdiri
- Chemical Engineering Department, College of Engineering, University of Ha'il, Ha'il, 81441, Saudi Arabia; Chemical Engineering Process Department, National School of Engineers Gabes, University of Gabes, Gabes, 6029, Tunisia.
| | - Abdallah Shanableh
- Research Institute of Sciences and Engineering (RISE), University of Sharjah, Sharjah, 27272, United Arab Emirates.
| | - Rafael Luque
- Peoples Friendship University of Russia (RUDN University), 6 Miklukho Maklaya Str., 117198, Moscow, Russian Federation; Universidad ECOTEC, Km 13.5 Samborondón, Samborondón, EC092302, Ecuador
| |
Collapse
|
8
|
Bone Marrow-Derived Fibrin Clots Stimulate Healing of a Meniscal Defect in a Rabbit Model. Arthroscopy 2022:S0749-8063(22)00838-6. [PMID: 36574822 DOI: 10.1016/j.arthro.2022.12.013] [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: 07/05/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the in vivo effectiveness of bone marrow aspirate-derived (BMA) fibrin clots for avascular meniscal defect healing in a rabbit model. METHODS In 42 Japanese white rabbits, a 2.0-mm cylindrical defect was introduced into the avascular zone of the anterior part of the medial meniscus in the bilateral knees. The rabbits were grouped according to implantation of a BMA fibrin clot (BMA group) or a peripheral blood (PB)-derived clot (PB group) into the defect and nonimplantation (control group). Macroscopic and histological assessments were performed using a scoring system at 4 and 12 weeks after surgery. At 12 weeks after surgery, compressive stress was analyzed biomechanically. RESULTS The meniscal score in the BMA group (12.1) was greater than that in the PB group (5.5; P = .031) and control group (4.4; P = .013) at 4 weeks. The meniscal score in the BMA group (13.1) was greater than that in the control group (6.4; BMA = 13.1; P = .0046) at 12 weeks. In the biomechanical analysis, the BMA group demonstrated significantly higher compressive strength than the PB group (6.6 MPa) (BMA = 15.4 MPa; P = .0201) and control group (3.6 MPa; BMA = 15.4 MPa; P = .007). CONCLUSIONS Implantation of BMA fibrin clots into the meniscal defect of the avascular zone in a rabbit model improved the meniscal score at 4 weeks and strengthened the reparative meniscal tissue at 12 weeks compared with the implantation of PB fibrin clots. CLINICAL RELEVANCE Healing in the avascular zone of the meniscus can be problematic. Approaches to improving this healing response have had variable results. This study provides additional information that may help improve the outcomes in patients with these injuries.
Collapse
|
9
|
Wang M, Li Y, Feng L, Zhang X, Wang H, Zhang N, Viohl I, Li G. Pulsed Electromagnetic Field Enhances Healing of a Meniscal Tear and Mitigates Posttraumatic Osteoarthritis in a Rat Model. Am J Sports Med 2022; 50:2722-2732. [PMID: 35834942 DOI: 10.1177/03635465221105874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal tears in the avascular region are thought to rarely heal and are a considerable challenge to treat. Although the therapeutic effects of a pulsed electromagnetic field (PEMF) have been extensively studied in a variety of orthopaedic disorders, the effect of a PEMF on meniscal healing has not been reported. HYPOTHESIS PEMF treatment would promote meniscal healing and prevent osteoarthritis progression. STUDY DESIGN Controlled laboratory study. METHODS A total of 72 twelve-week-old male Sprague-Dawley rats with full-thickness longitudinal medial meniscal tears in the avascular region were divided into 3 groups: control (Gcon), treatment with a classic signal PEMF (Gclassic), and treatment with a high-slew rate signal PEMF (GHSR). Macroscopic observation and histological analysis of the meniscus and articular cartilage were performed to evaluate the meniscal healing and progression of osteoarthritis. The synovium was harvested for histological and immunofluorescent analysis to evaluate the intra-articular inflammation. Meniscal healing, articular cartilage degeneration, and synovitis were quantitatively evaluated according to their scoring systems. RESULTS Dramatic degenerative changes of the meniscus and articular cartilage were noticed during gross observation and histological evaluation in Gcon at 8 weeks. However, the menisci in the 2 treatment groups were restored to normal morphology, with a smooth surface and shiny white color. Particularly, the HSR signal remarkably enhanced the fibrochondrogenesis and accelerated the remodeling process of the regenerated tissue. The meniscal healing scores of the PEMF treatment groups were significantly higher than those in Gcon at 8 weeks. Specifically, the HSR signal showed a significantly higher meniscal repair score than did the classic signal at week 8 (P < .01). Additionally, the HSR signal significantly downregulated the secretion levels of interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the meniscus and synovium as compared with the control group. When compared with the 2 treatment groups, Gcon had significantly higher degeneration scores (Gcon vs Gclassic, P < .0001; Gcon vs GHSR, P < .0001). The HSR signal also exhibited significantly lower synovitis scores compared with the other two groups (Gcon vs Gclassic, P < .0001; Gclassic vs GHSR, P = .0002). CONCLUSION A PEMF promoted the healing of meniscal tears in the avascular region and restored the injured meniscus to its structural integrity in a rat model. As compared with the classic signal, the HSR signal showed increased capability to promote fibrocartilaginous tissue formation and modulate the inflammatory environment, therefore protecting the knee joint from posttraumatic osteoarthritis development. CLINICAL RELEVANCE Adjuvant PEMF therapy may offer a new approach for the treatment of meniscal tears attributed to the enhanced meniscal repair and ameliorated osteoarthritis progression.
Collapse
Affiliation(s)
- Ming Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yucong Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Lu Feng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Xiaoting Zhang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Haixing Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Nianli Zhang
- Research and Clinical Affairs, Orthofix Medical Inc, Lewisville, Texas, USA
| | - Ingmar Viohl
- Research and Clinical Affairs, Orthofix Medical Inc, Lewisville, Texas, USA
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| |
Collapse
|
10
|
Sekiya I, Koga H, Katano H, Mizuno M, Kohno Y, Otabe K, Ozeki N. Second-look arthroscopy after meniscus repair and synovial mesenchymal stem cell transplantation to treat degenerative flaps and radial tears of the medial meniscus: A case report. J Orthop Sci 2022; 27:821-834. [PMID: 34120825 DOI: 10.1016/j.jos.2021.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this study was to compare arthroscopic findings of a degenerative flap and radial tear of the medial meniscus (MM) before and one year after treatment by meniscus repair and synovial mesenchymal stem cell (MSC) transplantation. METHODS Patients with a degenerative flap and radial MM tear that would generally be treated by meniscectomy were included. The patients ranged in age from 45 to 62 years and all underwent meniscus repair and synovium harvest at time 0. The digested synovium was cultured with autologous serum for 12 days, and an average of 4 × 107 MSCs were transplanted at two weeks. A second-look arthroscopy was performed at 52 weeks (n = 6). The average duration of symptoms was 24 months. For flap tears, arthroscopic findings were quantified in terms of the presence, stability, and smoothness of the meniscus at each zone and area. The Lysholm score was evaluated throughout the 52 week follow-up. RESULTS Four patients with MM flap tears showed deficiencies in the central area at the posterior junctional zone before treatment, but this zone was completely restored to a stable and smooth condition in two patients and partially restored in the other two patients. The arthroscopy score for a flap tear at the central area of the posterior junctional zone was 0.3 ± 0.5 before treatment and 4.3 ± 2.1 after treatment. The score was significantly higher after treatment (p < 0.05, n = 4). The original radial MM tears in two patients were healed one year after treatment. Lysholm scores were significantly higher at 4 and 52 weeks after treatment than before treatment (n = 6). CONCLUSIONS Arthroscopic findings for a degenerative flap and radial tear of the MM were improved at the central area of the posterior junctional zone one year after meniscus repair and MSC transplantation.
Collapse
Affiliation(s)
- Ichiro Sekiya
- Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Japan.
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hisako Katano
- Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Mitsuru Mizuno
- Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Yuji Kohno
- Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Koji Otabe
- Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Nobutake Ozeki
- Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| |
Collapse
|
11
|
Li M, Yin H, Yan Z, Li H, Wu J, Wang Y, Wei F, Tian G, Ning C, Li H, Gao C, Fu L, Jiang S, Chen M, Sui X, Liu S, Chen Z, Guo Q. The immune microenvironment in cartilage injury and repair. Acta Biomater 2022; 140:23-42. [PMID: 34896634 DOI: 10.1016/j.actbio.2021.12.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 02/07/2023]
Abstract
The ability of articular cartilage to repair itself is limited because it lacks blood vessels, nerves, and lymph tissue. Once damaged, it can lead to joint swelling and pain, accelerating the progression of osteoarthritis. To date, complete regeneration of hyaline cartilage exhibiting mechanical properties remains an elusive goal, despite the many available technologies. The inflammatory milieu created by cartilage damage is critical for chondrocyte death and hypertrophy, extracellular matrix breakdown, ectopic bone formation, and progression of cartilage injury to osteoarthritis. In the inflammatory microenvironment, mesenchymal stem cells (MSCs) undergo aberrant differentiation, and chondrocytes begin to convert or dedifferentiate into cells with a fibroblast phenotype, thereby resulting in fibrocartilage with poor mechanical qualities. All these factors suggest that inflammatory problems may be a major stumbling block to cartilage repair. To produce a milieu conducive to cartilage repair, multi-dimensional management of the joint inflammatory microenvironment in place and time is required. Therefore, this calls for elucidation of the immune microenvironment of cartilage repair after injury. This review provides a brief overview of: (1) the pathogenesis of cartilage injury; (2) immune cells in cartilage injury and repair; (3) effects of inflammatory cytokines on cartilage repair; (4) clinical strategies for treating cartilage defects; and (5) strategies for targeted immunoregulation in cartilage repair. STATEMENT OF SIGNIFICANCE: Immune response is increasingly considered the key factor affecting cartilage repair. It has both negative and positive regulatory effects on the process of regeneration and repair. Proinflammatory factors are secreted in large numbers, and necrotic cartilage is removed. During the repair period, immune cells can secrete anti-inflammatory factors and chondrogenic cytokines, which can inhibit inflammation and promote cartilage repair. However, inflammatory factors persist, which accelerate the degradation of the cartilage matrix. Furthermore, in an inflammatory microenvironment, MSCs undergo abnormal differentiation, and chondrocytes begin to transform or dedifferentiate into fibroblast-like cells, forming fibrocartilage with poor mechanical properties. Consequently, cartilage regeneration requires multi-dimensional regulation of the joint inflammatory microenvironment in space and time to make it conducive to cartilage regeneration.
Collapse
|
12
|
Fan B, Ye J, Xu B, Sun Z, Zhang J, Song S, Wang X, Song Y, Zhang Z, Jiang D, Yu J. Study on feasibility of the partial meniscal allograft transplantation. Clin Transl Med 2022; 12:e701. [PMID: 35088938 PMCID: PMC8796274 DOI: 10.1002/ctm2.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/02/2022] Open
Abstract
Since the meniscus is an important stabilizing structure of the knee joint and has a significant role in load-bearing and shock absorption, so the complete structural and functional reconstructions of the teared menisci should be done not only after partial meniscectomy but also post total meniscectomy. So far, animal experiments and good clinical practice have showed that TMAT after total meniscectomy has partially solved the problem of structural and functional reconstructions after total meniscectomy. However, partial meniscectomy will also lead to accelerated knee degeneration, and its proportion is much higher than that of patients with total meniscectomy. Herein, the feasibility of PMAT after partial meniscectomy was investigated for the first time by using the 40% posterior horn meniscectomy model of the medial meniscus in Beagle dogs, and also for the first time, TMAT group and the total meniscectomy group were used as control groups. Compared with the TMAT, the transcriptomics evaluation, scanning electron microscope observation, histological regeneration and structure, biomechanical property, inflammation environment, and the knee function post PMAT were more similar to that of normal meniscus was first reported. This study provides a PMAT scheme with clinical translational value for the complete structural and functional reconstruction of the patients with partial meniscectomy and fills the gap in the field of teared meniscus therapy on the basis of quite well clinical applications of the meniscus repair and the TMAT.
Collapse
Affiliation(s)
- Bao‐Shi Fan
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Jing Ye
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Bing‐Bing Xu
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Ze‐Wen Sun
- Department of Sports MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Ji‐Ying Zhang
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Shi‐Tang Song
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Xin‐Jie Wang
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Yi‐Fan Song
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Zheng‐Zheng Zhang
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Dong Jiang
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Jia‐Kuo Yu
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| |
Collapse
|
13
|
Blough CL, Bobba CM, DiBartola AC, Everhart JS, Magnussen RA, Kaeding C, Flanigan DC. Biologic Augmentation during Meniscal Repair. J Knee Surg 2021; 36:498-506. [PMID: 34781393 DOI: 10.1055/s-0041-1739198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal repair improves postoperative knee function and reduces risk of repair failure. PubMed and Embase databases were systematically searched. Included studies were clinical studies in humans, published in English, and reported use of biologic augmentation techniques in addition to meniscal repair (including platelet-rich plasma [PRP], fibrin clot, bone marrow stimulation, meniscal wrapping, and bioscaffolds) for treatment of knee meniscal tears. Outcome measures included repair failure, repeat knee arthroscopic surgery, and magnetic resonance imaging), visual analog scale for pain, the International Knee Documentation Committee questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index Lysholm's Knee Scoring Scale, and the Knee Injury and Osteoarthritis Outcome Score. Study quality was assessed using the modified Coleman methodology score. Nineteen studies reported repair of 1,092 menisci including six studies that investigated fibrin clot augmentation, five studies that investigated PRP augmentation, three studies that investigated bone marrow stimulation augmentation, two studies that used meniscal wrapping augmentation, and three studies that used other techniques. The level of evidence ranged from I to IV and mean modified Coleman methodology score was 43 (range: 17-69), with higher scores noted in studies completed in recent years. PRP and bone marrow stimulation augmentation appear to decrease risk of failure in patients undergoing isolated meniscal repair but do not improve knee symptom scores. Fibrin clot and trephination augmentation techniques do not have sufficient evidence to support decreased failure risk at this time. Meniscal wrapping augmentation and scaffold implantation augmentation appear to be an attractive option to meniscectomy in complicated tears that are not candidates for repair alone, but further confirmatory studies are needed to support initial data. Evidence supporting augmentation of meniscal repair is limited at this time but suggests that the highest likelihood for effectiveness of augmentation is in the settings of isolated meniscal repair or meniscal repairs that would normally not be amenable to repair.
Collapse
Affiliation(s)
- Christian L Blough
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Alex C DiBartola
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joshua S Everhart
- Sports Medicine, Department of Orthopaedic Surgery, Indiana University, Indianapolis, Indiana
| | - Robert A Magnussen
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio.,Sports Medicine, The Ohio State University, Columbus, Ohio
| | - Christopher Kaeding
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio.,Sports Medicine, The Ohio State University, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, Ohio.,Sports Medicine, The Ohio State University, Columbus, Ohio.,Cartilage Restoration Program, The Ohio State University, Columbus, Ohio
| |
Collapse
|
14
|
Prabhath S, Alappatt K, Shetty A, Sumalatha S. An exploratory study of the histomorphogenesis and zonal vascular changes in the human fetal medial meniscus. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
15
|
Rhim HC, Jeon OH, Han SB, Bae JH, Suh DW, Jang KM. Mesenchymal stem cells for enhancing biological healing after meniscal injuries. World J Stem Cells 2021; 13:1005-1029. [PMID: 34567422 PMCID: PMC8422933 DOI: 10.4252/wjsc.v13.i8.1005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/02/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
The meniscus is a semilunar fibrocartilage structure that plays important roles in maintaining normal knee biomechanics and function. The roles of the meniscus, including load distribution, force transmission, shock absorption, joint stability, lubrication, and proprioception, have been well established. Injury to the meniscus can disrupt overall joint stability and cause various symptoms including pain, swelling, giving-way, and locking. Unless treated properly, it can lead to early degeneration of the knee joint. Because meniscal injuries remain a significant challenge due to its low intrinsic healing potential, most notably in avascular and aneural inner two-thirds of the area, more efficient repair methods are needed. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential in vitro and in vivo. Thus far, the application of MSCs, including bone marrow-derived, synovium-derived, and adipose-derived MSCs, has shown promising results in preclinical studies in different animal models. These preclinical studies could be categorized into intra-articular injection and tissue-engineered construct application according to delivery method. Despite promising results in preclinical studies, there is still a lack of clinical evidence. This review describes the basic knowledge, current treatment, and recent studies regarding the application of MSCs in treating meniscal injuries. Future directions for MSC-based approaches to enhance meniscal healing are suggested.
Collapse
Affiliation(s)
- Hye Chang Rhim
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, United States
| | - Ok Hee Jeon
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Seoul, South Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam 13497, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| |
Collapse
|
16
|
DePhillipo NN, LaPrade RF, Zaffagnini S, Mouton C, Seil R, Beaufils P. The future of meniscus science: international expert consensus. J Exp Orthop 2021; 8:24. [PMID: 33791890 PMCID: PMC8012449 DOI: 10.1186/s40634-021-00345-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the main focus areas for research and development for furthering the state of meniscus science in 2021. Methods An electronic survey including 10 questions was sent in a blind fashion to the faculty members of the 5th International Conference on Meniscus Science and Surgery. These faculty served as an expert consensus on the future of research and development areas of meniscus science. Survey responses were analyzed using descriptive statistics and ranking weighted averages were calculated to score survey questions. Results Of the 82 faculty, 76 (93%) from 18 different countries completed the survey (84% male, 16% female). The highest ranked future research and development focus areas were meniscus repair, biologics, osteotomy procedures, addressing meniscus extrusion, and the development of new therapies for the prevention of posttraumatic osteoarthritis. Currently, the most ‘valuable’ type of biologic reported for meniscus treatment was platelet-rich plasma. The main reported global research limitation was a lack of long-term clinical outcomes data. The most promising emerging medical technologies for improving meniscus science were 3-D printing, personalized medicine, and artificial implants. Conclusions This survey suggests that the future of meniscus science should be focused on meniscal preservation techniques through meniscus repair, addressing meniscal extrusion, and the use of orthobiologics. The lack of long-term clinical outcomes was the main reported research limitation globally for meniscus treatment. Future product development utilizing emerging medical technologies suggest the use of 3-D printing for meniscal transplants/scaffolds, personalized treatment, and bioengineering for artificial implants. Level of Evidence Level V. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00345-y.
Collapse
Affiliation(s)
| | | | | | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, Clinique d'Eich, Luxembourg city, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg city, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, Clinique d'Eich, Luxembourg city, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg city, Luxembourg.,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg city, Luxembourg
| | | |
Collapse
|
17
|
Recent advances in bioprinting technologies for engineering different cartilage-based tissues. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:112005. [PMID: 33812625 DOI: 10.1016/j.msec.2021.112005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
Inadequate self-repair and regenerative efficiency of the cartilage tissues has motivated the researchers to devise advanced and effective strategies to resolve this issue. Introduction of bioprinting to tissue engineering has paved the way for fabricating complex biomimetic engineered constructs. In this context, the current review gears off with the discussion of standard and advanced 3D/4D printing technologies and their implications for the repair of different cartilage tissues, namely, articular, meniscal, nasoseptal, auricular, costal, and tracheal cartilage. The review is then directed towards highlighting the current stem cell opportunities. On a concluding note, associated critical issues and prospects for future developments, particularly in this sphere of personalized medicines have been discussed.
Collapse
|
18
|
3D cell-printing of biocompatible and functional meniscus constructs using meniscus-derived bioink. Biomaterials 2020; 267:120466. [PMID: 33130320 DOI: 10.1016/j.biomaterials.2020.120466] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/26/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023]
Abstract
Meniscus injuries are prevalent in orthopedic diagnosis. The reconstruction of the structural inhomogeneity and anisotropy of the meniscus is a major challenge in clinical practice. Meniscal tissue engineering has emerged as a potential alternative for the treatment of various meniscal diseases and injuries. In this study, we developed three-dimensional (3D) cell-printed meniscus constructs using a mixture of polyurethane and polycaprolactone polymers and cell-laden decellularized meniscal extracellular matrix (me-dECM) bioink with high controllability and durable architectural integrity. The me-dECM bioink provided 3D cell-printed meniscus constructs with a conducive biochemical environment that supported growth and promoted the proliferation and differentiation of encapsulated stem cells toward fibrochondrogenic commitment. In addition, we investigated the in vivo performance of the 3D cell-printed meniscus constructs, which exhibited biocompatibility, excellent mechanical properties, and improved biological functionality. These attributes were similar to those of the native meniscus. Collectively, the 3D cell-printing technology and me-dECM bioink facilitate the recapitulation of meniscus tissue specificity in the aspect of the shape and microenvironment for meniscus regeneration. Further, the developed constructs can potentially be applied in clinical practice.
Collapse
|
19
|
Smoak JB, Matthews JR, Vinod AV, Kluczynski MA, Bisson LJ. An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses. Orthop J Sports Med 2020; 8:2325967120950306. [PMID: 32953923 PMCID: PMC7485005 DOI: 10.1177/2325967120950306] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: A large number of systematic reviews and meta-analyses regarding the meniscus
have been published. Purpose: To provide a qualitative summary of the published systematic reviews and
meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the
meniscus and published between July 2009 and July 2019 was performed with
PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts,
narrative reviews, articles not written in English, commentaries, study
protocols, and topics that were not focused on the meniscus were excluded.
The most pertinent results were extracted and summarized from each
study. Results: A total of 332 articles were found, of which 142 were included. Included
articles were summarized and divided into 16 topics: epidemiology,
diagnosis, histology, biomechanics, comorbid pathology, animal models,
arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root
repairs, meniscal allograft transplantation (MAT), meniscal implants and
scaffolds, mesenchymal stem cells and growth factors, postoperative
rehabilitation, postoperative imaging assessment, patient-reported outcome
measures, and cost-effectiveness. The majority of articles focused on APM
(20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a
single source of the current evidence regarding the meniscus.
Collapse
Affiliation(s)
- Jason B Smoak
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - John R Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
20
|
Carlson Strother CR, Saris DBF, Verdonk P, Nakamura N, Krych AJ. Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
21
|
Zhou ZX, Chen YR, Zhang JY, Jiang D, Yuan FZ, Mao ZM, Yang F, Jiang WB, Wang X, Yu JK. Facile Strategy on Hydrophilic Modification of Poly(ε-caprolactone) Scaffolds for Assisting Tissue-Engineered Meniscus Constructs In Vitro. Front Pharmacol 2020; 11:471. [PMID: 32431606 PMCID: PMC7216581 DOI: 10.3389/fphar.2020.00471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/25/2020] [Indexed: 12/22/2022] Open
Abstract
Poly(ε-caprolactone) (PCL) derived scaffolds have been extensively explored in the field of tissue-engineered meniscus (TEM) originating from their good biosafety and biomechanical properties. However, the poor intrinsic hydrophobicity severely hindered their wide applications for the scaffold-assisted tissue regeneration. Herein, we developed a simple strategy on surface modification of three-dimensional (3D) PCL scaffolds via a simply soaking treatment of sodium hydroxide (NaOH) solutions to increase the hydrophilicity and roughness of scaffolds' surfaces. We investigated the effect of hydrolysis degree mediated by NaOH solutions on mechanical properties of 3D scaffolds, considering the importance of scaffolds' resistance to internal force. We also investigated and analyzed the biological performances of mesenchymal stromal cells (MSCs) and meniscal fibrocartilage cells (MFCs) onto the scaffolds treated or untreated by NaOH solutions. The results indicated that hydrophilic modification could improve the proliferation and attachment of cells on the scaffolds. After careful screening process condition, structural fabrication, and performance optimization, these modified PCL scaffolds possessed roughened surfaces with inherent hierarchical pores, enhanced hydrophilicity and preferable biological performances, thus exhibiting the favorable advantages on the proliferation and adhesion of seeded cells for TEM. Therefore, this feasible hydrophilic modification method is not only beneficial to promote smarter biomedical scaffold materials but also show great application prospect in tissue engineering meniscus with tunable architectures and desired functionalities.
Collapse
Affiliation(s)
- Zhu-Xing Zhou
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - You-Rong Chen
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Ji-Ying Zhang
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Dong Jiang
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Fu-Zhen Yuan
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zi-Mu Mao
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Fei Yang
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics & Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Wen-Bo Jiang
- Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics & Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jia-Kuo Yu
- Knee Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| |
Collapse
|
22
|
Janarthanan G, Pillai MM, Kulasekaran SS, Rajendran S, Bhattacharyya A. Engineered knee meniscus construct: understanding the structure and impact of functionalization in 3D environment. Polym Bull (Berl) 2020. [DOI: 10.1007/s00289-019-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Li Z, Wu N, Cheng J, Sun M, Yang P, Zhao F, Zhang J, Duan X, Fu X, Zhang J, Hu X, Chen H, Ao Y. Biomechanically, structurally and functionally meticulously tailored polycaprolactone/silk fibroin scaffold for meniscus regeneration. Am J Cancer Res 2020; 10:5090-5106. [PMID: 32308770 PMCID: PMC7163455 DOI: 10.7150/thno.44270] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/24/2020] [Indexed: 12/23/2022] Open
Abstract
Meniscus deficiency, the most common and refractory disease in human knee joints, often progresses to osteoarthritis (OA) due to abnormal biomechanical distribution and articular cartilage abrasion. However, due to its anisotropic spatial architecture, complex biomechanical microenvironment, and limited vascularity, meniscus repair remains a challenge for clinicians and researchers worldwide. In this study, we developed a 3D printing-based biomimetic and composite tissue-engineered meniscus scaffold consisting of polycaprolactone (PCL)/silk fibroin (SF) with extraordinary biomechanical properties and biocompatibility. We hypothesized that the meticulously tailored composite scaffold could enhance meniscus regeneration and cartilage protection. Methods: The physical property of the scaffold was characterized by scanning electron microscopy (SEM) observation, degradation test, frictional force of interface assessment, biomechanical testing, and fourier transform infrared (FTIR) spectroscopy analysis. To verify the biocompatibility of the scaffold, the viability, morphology, proliferation, differentiation, and extracellular matrix (ECM) production of synovium-derived mesenchymal stem cell (SMSC) on the scaffolds were assessed by LIVE/DEAD staining, alamarBlue assay, ELISA analysis, and qRT-PCR. The recruitment ability of SMSC was tested by dual labeling with CD29 and CD90 by confocal microscope at 1 week after implantation. The functionalized hybrid scaffold was then implanted into the meniscus defects on rabbit knee joint for meniscus regeneration, comparing with the Blank group (no scaffold) and PS group. The regenerated meniscus tissue was evaluated by histological and immunohistochemistry staining, and biomechanical test. Macroscopic and histological scoring was performed to assess the outcome of meniscus regeneration and cartilage protection in vivo. Results: The combination of SF and PCL could greatly balance the biomechanical properties and degradation rate to match the native meniscus. SF sponge, characterized by fine elasticity and low interfacial shear force, enhanced energy absorption capacity of the meniscus and improved chondroprotection. The SMSC-specific affinity peptide (LTHPRWP; L7) was conjugated to the scaffold to further increase the recruitment and retention of endogenous SMSCs. This meticulously tailored scaffold displayed superior biomechanics, structure, and function, creating a favorable microenvironment for SMSC proliferation, differentiation, and extracellular matrix (ECM) production. After 24 weeks of implantation, the histological assessment, biochemical contents, and biomechanical properties demonstrated that the polycaprolactone/silk fibroin-L7 (PS-L7) group was close to the native meniscus group, showing significantly better cartilage protection than the PS group. Conclusion: This tissue engineering scaffold could greatly strengthen meniscus regeneration and chondroprotection. Compared with traditional cell-based therapies, the meniscus tissue engineering approach with advantages of one-step operation and reduced cost has a promising potential for future clinical and translational studies.
Collapse
|
24
|
de Caro F, Perdisa F, Dhollander A, Verdonk R, Verdonk P. Meniscus Scaffolds for Partial Meniscus Defects. Clin Sports Med 2020; 39:83-92. [DOI: 10.1016/j.csm.2019.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
25
|
Kwon H, Brown WE, Lee CA, Wang D, Paschos N, Hu JC, Athanasiou KA. Surgical and tissue engineering strategies for articular cartilage and meniscus repair. Nat Rev Rheumatol 2019; 15:550-570. [PMID: 31296933 PMCID: PMC7192556 DOI: 10.1038/s41584-019-0255-1] [Citation(s) in RCA: 350] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/30/2022]
Abstract
Injuries to articular cartilage and menisci can lead to cartilage degeneration that ultimately results in arthritis. Different forms of arthritis affect ~50 million people in the USA alone, and it is therefore crucial to identify methods that will halt or slow the progression to arthritis, starting with the initiating events of cartilage and meniscus defects. The surgical approaches in current use have a limited capacity for tissue regeneration and yield only short-term relief of symptoms. Tissue engineering approaches are emerging as alternatives to current surgical methods for cartilage and meniscus repair. Several cell-based and tissue-engineered products are currently in clinical trials for cartilage lesions and meniscal tears, opening new avenues for cartilage and meniscus regeneration. This Review provides a summary of surgical techniques, including tissue-engineered products, that are currently in clinical use, as well as a discussion of state-of-the-art tissue engineering strategies and technologies that are being developed for use in articular cartilage and meniscus repair and regeneration. The obstacles to clinical translation of these strategies are also included to inform the development of innovative tissue engineering approaches.
Collapse
Affiliation(s)
- Heenam Kwon
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Cassandra A Lee
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Nikolaos Paschos
- Division of Sports Medicine, Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
| |
Collapse
|
26
|
Otsuki S, Nakagawa K, Murakami T, Sezaki S, Sato H, Suzuki M, Okuno N, Wakama H, Kaihatsu K, Neo M. Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold. Am J Sports Med 2019; 47:1804-1815. [PMID: 31172797 DOI: 10.1177/0363546519850578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. PURPOSE To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. STUDY DESIGN Controlled laboratory study. METHODS The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. RESULTS Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. CONCLUSION Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. CLINICAL RELEVANCE This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.
Collapse
Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Hideki Sato
- Gunze Limited, QOL Research Laboratory, Kyoto, Japan
| | | | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| |
Collapse
|
27
|
Zhang ZZ, Chen YR, Wang SJ, Zhao F, Wang XG, Yang F, Shi JJ, Ge ZG, Ding WY, Yang YC, Zou TQ, Zhang JY, Yu JK, Jiang D. Orchestrated biomechanical, structural, and biochemical stimuli for engineering anisotropic meniscus. Sci Transl Med 2019; 11:11/487/eaao0750. [PMID: 30971451 DOI: 10.1126/scitranslmed.aao0750] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/12/2018] [Accepted: 03/21/2019] [Indexed: 12/31/2022]
Abstract
Reconstruction of the anisotropic structure and proper function of the knee meniscus remains an important challenge to overcome, because the complexity of the zonal tissue organization in the meniscus has important roles in load bearing and shock absorption. Current tissue engineering solutions for meniscus reconstruction have failed to achieve and maintain the proper function in vivo because they have generated homogeneous tissues, leading to long-term joint degeneration. To address this challenge, we applied biomechanical and biochemical stimuli to mesenchymal stem cells seeded into a biomimetic scaffold to induce spatial regulation of fibrochondrocyte differentiation, resulting in physiological anisotropy in the engineered meniscus. Using a customized dynamic tension-compression loading system in conjunction with two growth factors, we induced zonal, layer-specific expression of type I and type II collagens with similar structure and function to those present in the native meniscus tissue. Engineered meniscus demonstrated long-term chondroprotection of the knee joint in a rabbit model. This study simultaneously applied biomechanical, biochemical, and structural cues to achieve anisotropic reconstruction of the meniscus, demonstrating the utility of anisotropic engineered meniscus for long-term knee chondroprotection in vivo.
Collapse
Affiliation(s)
- Zheng-Zheng Zhang
- Knee Surgery Department of the Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, P.R. China
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, P.R. China
| | - You-Rong Chen
- Knee Surgery Department of the Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shao-Jie Wang
- Knee Surgery Department of the Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, P.R. China
- Department of Joint Surgery, Zhongshan Hospital of Xiamen University, Xiamen 361004, P.R. China
| | - Feng Zhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P.R. China
| | - Xiao-Gang Wang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100083, P.R. China
| | - Fei Yang
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, P.R. China
| | - Jin-Jun Shi
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Zi-Gang Ge
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, P.R. China
| | - Wen-Yu Ding
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P.R. China
| | - Yu-Chen Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P.R. China
| | - Tong-Qiang Zou
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P.R. China
| | - Ji-Ying Zhang
- Knee Surgery Department of the Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Jia-Kuo Yu
- Knee Surgery Department of the Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, P.R. China.
| | - Dong Jiang
- Knee Surgery Department of the Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, P.R. China.
| |
Collapse
|
28
|
Zhang ZZ, Zhou YF, Li WP, Jiang C, Chen Z, Luo H, Song B. Local Administration of Magnesium Promotes Meniscal Healing Through Homing of Endogenous Stem Cells: A Proof-of-Concept Study. Am J Sports Med 2019; 47:954-967. [PMID: 30786213 DOI: 10.1177/0363546518820076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many strategies have been developed to modify the biological and biomechanical environment of the meniscal suture repair to improve the chances of healing, the failure rates remain high. Thus, new methods to promote meniscal regeneration and repair are needed. HYPOTHESIS Administration of magnesium (via a repair using magnesium stitches) might enhance recruitment and adherence of endogenous stem cells to the site of the lesion, thereby promoting in situ meniscal regeneration and chondroprotective functions. STUDY DESIGN Controlled laboratory study. METHODS Synovial fluid-derived mesenchymal stem cells (SMSCs) were identified and isolated from the knees of rabbits with a meniscal injury of 4 weeks' duration. An in vitro analysis of adherence and chemotaxis of SMSCs was performed. For the in vivo assay, rabbits (n = 120) with meniscal lesions were divided into 3 groups: repair with high-purity magnesium stitches (Mg group), repair with absorbable sutures (Control group), and no repair (Blank group). Healing of the regenerated tissue and degeneration of the articular cartilage were evaluated by gross and histological analysis at postoperative weeks 1, 3, 6, and 12. The mechanical properties of the repaired meniscus were also analyzed (tensile testing). RESULTS In vitro, magnesium promoted the adhesion and migration of SMSCs, which were identified and increased in the knee joints with meniscal lesions. Moreover, fibrochondrogenesis of SMSCs was stimulated by magnesium. Compared with the other groups, the Mg group had enhanced tissue regeneration, lower cartilage degeneration, and retained mechanical strength at 12 weeks after meniscal repair. CONCLUSION/CLINICAL RELEVANCE Magnesium could be used for in situ meniscal repair due to the potential capacity of magnesium to recruit endogenous stem cells and promote synthesis of fibrocartilaginous matrix.
Collapse
Affiliation(s)
- Zheng-Zheng Zhang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun-Feng Zhou
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei-Ping Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Jiang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Chen
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huan Luo
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Song
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
29
|
Szojka ARA, Lyons BD, Moore CN, Liang Y, Kunze M, Idrees E, Mulet-Sierra A, Jomha NM, Adesida AB. Hypoxia and TGF-β3 Synergistically Mediate Inner Meniscus-Like Matrix Formation by Fibrochondrocytes. Tissue Eng Part A 2019; 25:446-456. [PMID: 30343640 DOI: 10.1089/ten.tea.2018.0211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The interactions of hypoxia and TGF-β3 in aggregates of human meniscus fibrochondrocytes are synergistic in nature, suggesting combinatorial strategies using these factors are promising for tissue engineering the inner meniscus regions. Hypoxia alone in the absence of TGF-β supplementation may be insufficient to initiate an inner meniscus-like extracellular matrix-forming response in this model.
Collapse
Affiliation(s)
- Alexander R A Szojka
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Brayden D Lyons
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Colleen N Moore
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Yan Liang
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- 2 Division of Burn and Reconstructive Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China
| | - Melanie Kunze
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Enaam Idrees
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Aillette Mulet-Sierra
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Nadr M Jomha
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Adetola B Adesida
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
30
|
Vaquero-Picado A, Rodríguez-Merchán EC. Arthroscopic repair of the meniscus: Surgical management and clinical outcomes. EFORT Open Rev 2018; 3:584-594. [PMID: 30595844 PMCID: PMC6275851 DOI: 10.1302/2058-5241.3.170059] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
From the biomechanical and biological points of view, an arthroscopic meniscal repair (AMR) should always be considered as an option. However, AMR has a higher reoperation rate compared with arthroscopic partial meniscectomy, so it should be carefully indicated. Compared with meniscectomy, AMR outcomes are better and the incidence of osteoarthritis is lower when it is well indicated. Factors influencing healing and satisfactory results must be carefully evaluated before indicating an AMR. Tears in the peripheral third are more likely to heal than those in the inner thirds. Vertical peripheral longitudinal tears are the best scenario in terms of success when facing an AMR. ‘Inside-out’ techniques were considered as the gold standard for large repairs on mid-body and posterior parts of the meniscus. However, recent studies do not demonstrate differences regarding failure rate, functional outcomes and complications, when compared with the ‘all-inside’ techniques. Some biological therapies try to enhance meniscal repair success but their efficacy needs further research. These are: mechanical stimulation, supplemental bone marrow stimulation, platelet rich plasma, stem cell therapy, and scaffolds and membranes. Meniscal root tear/avulsion dramatically compromises meniscal stability, accelerating cartilage degeneration. Several options for reattachment have been proposed, but no differences between them have been established. However, repair of these lesions is actually the reference of the treatment. Meniscal ramp lesions consist of disruption of the peripheral attachment of the meniscus. In contrast, with meniscal root tears, the treatment of reference has not yet been well established.
Cite this article: EFORT Open Rev 2018;3:584-594. DOI: 10.1302/2058-5241.3.170059
Collapse
|
31
|
Sasaki H, Rothrauff BB, Alexander PG, Lin H, Gottardi R, Fu FH, Tuan RS. In Vitro Repair of Meniscal Radial Tear With Hydrogels Seeded With Adipose Stem Cells and TGF-β3. Am J Sports Med 2018; 46:2402-2413. [PMID: 30001494 DOI: 10.1177/0363546518782973] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radial tears of the meniscus are a common knee injury, frequently resulting in osteoarthritis. To date, there are no established, effective treatments for radial tears. Adipose-derived stem cells (ASCs) may be an attractive cell source for meniscal regeneration because they can be quickly isolated in large number and are capable of undergoing induced fibrochondrogenic differentiation mediated by transforming growth factor β3 (TGF-β3). However, the use of ASCs for meniscal repair is largely unexplored. HYPOTHESIS ASC-seeded hydrogels with preloaded TGF-β3 will improve meniscal healing of radial tears, as modeled in an explant model. STUDY DESIGN Controlled laboratory study. METHODS With an institutional review board-exempted protocol, human ASCs were isolated from the infrapatellar fat pads of 3 donors, obtained after total knee replacement, and characterized. ASCs were encapsulated in photocrosslinkable methacrylated gelatin hydrogels to form 3-dimensional constructs, which were placed into tissue culture. The effect of TGF-β3-whether preloaded into the hydrogel or added as a soluble medium supplement-on matrix-sulfated proteoglycan deposition in the constructs was evaluated. A meniscal explant culture model was used to simulate meniscal repair. Cylindrical-shaped explants were excised from the inner avascular region of adult bovine menisci, and a radial tear was modeled by cutting perpendicular to the meniscal main fibers to the length of the radius. Six combinations of hydrogels-namely, acellular and ASC-seeded hydrogels supplemented with preloaded TGF-β3 (2 µg/mL) or soluble TGF-β3 (10 ng/mL) and without supplement-were injected into the radial tear and stabilized by photocrosslinking with visible light. At 4 and 8 weeks of culture, healing was assessed through histology, immunofluorescence staining, and mechanical testing. RESULTS ASCs isolated from the 3 donors exhibited colony-forming and multilineage differentiation potential. Hydrogels preloaded with TGF-β3 and those cultured in soluble TGF-β3 showed robust matrix-sulfated proteoglycan deposition. ASC-seeded hydrogels promoted superior healing as compared with acellular hydrogels, with preloaded or soluble TGF-β3 further improving histological scores and mechanical properties. CONCLUSION These findings demonstrated that ASC-seeded hydrogels preloaded with TGF-β3 enhanced healing of radial meniscal tears in an in vitro meniscal repair model. CLINICAL RELEVANCE Injection delivery of ASCs in a TGF-β3-preloaded photocrosslinkable hydrogel represents a novel candidate strategy to repair meniscal radial tears and minimize further osteoarthritic joint degeneration.
Collapse
Affiliation(s)
| | | | | | - Hang Lin
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Freddie H Fu
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
32
|
Vedicherla S, Romanazzo S, Kelly DJ, Buckley CT, Moran CJ. Chondrocyte-based intraoperative processing strategies for the biological augmentation of a polyurethane meniscus replacement. Connect Tissue Res 2018; 59:381-392. [PMID: 29182439 DOI: 10.1080/03008207.2017.1402892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Purpose/aim of study: Menisectomies account for over 1.5 million surgical interventions in Europe annually, and there is a growing interest in regenerative strategies to improve outcomes in meniscal replacement. The overall objective of this study was to evaluate the role of intraoperatively applied fresh chondrocyte (FC) isolates compared to minced cartilage (MC) fragments, used without cell isolation, to improve bioactivity and tissue integration when combined with a polyurethane replacement. MATERIALS AND METHODS First, to optimize the intraoperative cell isolation protocol, caprine articular cartilage biopsies were digested with 750 U/ml or 3000 U/ml collagenase type II (ratio of 10 ml per g of tissue) for 30 min, 1 h or 12 h with constant agitation and compared to culture-expanded chondrocytes in terms of matrix deposition when cultured on polyurethane scaffolds. Finally, FCs and MC-augmented polyurethane scaffolds were evaluated in a caprine meniscal explant model to assess the potential enhancements on tissue integration strength. RESULTS Adequate numbers of FCs were harvested using a 30 min chondrocyte isolation protocol and were found to demonstrate improved matrix deposition compared to standard culture-expanded cells in vitro. Upon evaluation in a meniscus explant defect model, both FCs and MC showed improved matrix deposition at the tissue-scaffold interface and enhanced push-out strength, fourfold and 2.5-fold, respectively, compared with the acellular implant. CONCLUSIONS Herein, we have demonstrated a novel approach that could be applied intraoperatively, using FCs or MC for improved tissue integration with a polyurethane meniscal replacement.
Collapse
Affiliation(s)
- Srujana Vedicherla
- a Orthopaedics and Sports Medicine , School of Medicine, Trinity College , Dublin , Ireland.,c Trinity Centre for Bioengineering , Trinity Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Sara Romanazzo
- a Orthopaedics and Sports Medicine , School of Medicine, Trinity College , Dublin , Ireland.,c Trinity Centre for Bioengineering , Trinity Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Daniel J Kelly
- b Department of Mechanical & Manufacturing Engineering , School of Engineering, Trinity College , Dublin , Ireland.,c Trinity Centre for Bioengineering , Trinity Biomedical Sciences Institute, Trinity College , Dublin , Ireland.,d Advanced Materials and Bioengineering Research (AMBER) Centre , Royal College of Surgeons in Ireland & Trinity College , Dublin , Ireland
| | - Conor T Buckley
- b Department of Mechanical & Manufacturing Engineering , School of Engineering, Trinity College , Dublin , Ireland.,c Trinity Centre for Bioengineering , Trinity Biomedical Sciences Institute, Trinity College , Dublin , Ireland.,d Advanced Materials and Bioengineering Research (AMBER) Centre , Royal College of Surgeons in Ireland & Trinity College , Dublin , Ireland
| | - Cathal J Moran
- a Orthopaedics and Sports Medicine , School of Medicine, Trinity College , Dublin , Ireland.,c Trinity Centre for Bioengineering , Trinity Biomedical Sciences Institute, Trinity College , Dublin , Ireland.,d Advanced Materials and Bioengineering Research (AMBER) Centre , Royal College of Surgeons in Ireland & Trinity College , Dublin , Ireland.,e Sports Surgery Clinic , Santry , Dublin , Ireland
| |
Collapse
|
33
|
Gao S, Chen M, Wang P, Li Y, Yuan Z, Guo W, Zhang Z, Zhang X, Jing X, Li X, Liu S, Sui X, Xi T, Guo Q. An electrospun fiber reinforced scaffold promotes total meniscus regeneration in rabbit meniscectomy model. Acta Biomater 2018; 73:127-140. [PMID: 29654991 DOI: 10.1016/j.actbio.2018.04.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 12/28/2022]
Abstract
Low vascularization in meniscus limits its regeneration ability after injury, and tissue engineering is the most promising method to achieve meniscus regeneration. In this study, we fabricated a kind of composite scaffold by decellularized meniscus extracellular matrix/polycaprolactone (DMECM/PCL) electrospinning fibers and porous DMECM, in which DMECM/PCL fibers were used as reinforcing component. The tensile modulus of the composite scaffold in longitudinal and crosswise directions were 8.5 ± 1.9 and 2.3 ± 0.3 MPa, respectively. Besides that, the DMECM/PCL electrospinning fibers enhanced suture resistance of the composite scaffold more than 5 times than DMECM scaffold effectively. In vitro cytocompatibility showed that the porous structure provided by DMECM component facilitated meniscus cells' proliferation. DMECM was also the main component to regulate cell behaviors, which promoted meniscus cells expressing extracellular matrix related genes such as COL I, COL II, SOX9 and AGG. Rabbits with total meniscectomy were used as animal model to evaluated the composited scaffolds performance in vivo at 3 and 6 months. Results showed that rabbits with scaffold implanting could regenerate neo-menisci in both time points. The neo-menisci had similar histology structure and biochemical content with native menisci. Although neo-menisci had inferior tensile modulus than native ones, its modulus was improved with implanting time prolonging. MRI imaging showed the signal of neo-meniscus in the body is clear, and X-ray imaging of knee joints demonstrated the implantation of scaffolds could relief joint space narrowing. Moreover, rabbits with neo-menisci had better cartilage condition in femoral condyle and tibial plateau compared than meniscectomy group. STATEMENT OF SIGNIFICANCE We fabricated the meniscus scaffold by combining porous decellularized meniscus extracellular matrix (DMECM) and DMECM/PCL electrospinning fibers together, which used the porous structure of DMECM, and the good tensile property of electrospinning fibers. We believe single material cannot satisfy increasing needs of scaffold. Therefore, we combined not only materials but also fabrication methods together to develop scaffold to make good use of each part. DMECM in electrospinning fibers also made these two components possible to be integrated through crosslinking. Compared to existing meniscus scaffold, the composite scaffold had (1) soft structure and extrusion would not happen after implantation, (2) ability to be trimmed to suitable shape during surgery, and (3) good resistance to suture.
Collapse
Affiliation(s)
- Shuang Gao
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Mingxue Chen
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Pei Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Yan Li
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Zhiguo Yuan
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Weimin Guo
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Zengzeng Zhang
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Xueliang Zhang
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoguang Jing
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Xu Li
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuyun Liu
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiang Sui
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Tingfei Xi
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; Shenzhen Institute, Peking University, Shenzhen 518057, China.
| | - Quanyi Guo
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China.
| |
Collapse
|
34
|
Abstract
The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. It is the orthopaedic surgeon’s responsibility to combine clinical information, radiological images, and clinical experience in an effort to individualize management of meniscal tears, taking into account factors related to the patient and lesion. Surgeons should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. Meniscus surgery has come a long way from the old slogan, “If it is torn, take it out!” to the currently accepted slogan, “Save the meniscus!” which has guided evolving modern treatment methods for meniscal tears. This last slogan will probably constitute the basis for newer alternative biological treatment methods in the future.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170067.
Collapse
Affiliation(s)
- Mahmut Nedim Doral
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Ankara, Turkey
| | - Onur Bilge
- Konya N.E. University, Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Konya, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - René Verdonk
- Ghent University, Faculty of Medicine, Department of Orthopaedics and Traumatology, De Pintelaan, Ghent, Belgium
| |
Collapse
|
35
|
Trad Z, Barkaoui A, Chafra M, Tavares JMR. Finite element analysis of the effect of high tibial osteotomy correction angle on articular cartilage loading. Proc Inst Mech Eng H 2018; 232:553-564. [PMID: 29683374 DOI: 10.1177/0954411918770706] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteoarthritis is a globally common disease that imposes a considerable ongoing health and economic burden on the socioeconomic system. As more and more biomechanical factors have been explored, malalignment of the lower limb has been found to influence the load distribution across the articular surface of the knee joint substantially. In this work, a three-dimensional finite element analysis was carried out to investigate the effect of varying the high tibial osteotomy correction angle on the stress distribution in both compartments of the human knee joint. Thereafter, determine the optimal correction angle to achieve a balanced loading between these two compartments. The developed finite element model was validated against experimental and numerical results. The findings of this work suggest that by changing the correction angle from 0° to 10° valgus, high tibial osteotomy shifted the mechanical load from the affected medial compartment to the lateral compartment with intact cartilage. The Von Mises and the shear stresses decreased in the medial compartment and increased in the lateral compartment. Moreover, a balanced stress distribution between the two compartments as well as the desired alignment were achieved under a valgus hypercorrection of 4.5° that significantly unloads the medial compartment, loads the lateral compartment and arrests the progression of osteoarthritis. After comparing the achieved results against the ones of previous studies that explored the effects of the high tibial osteotomy correction angle on either clinical outcomes or biomechanical outcomes, one can conclude that the findings of this study agree well with the related clinical data and recommendations found in the literature.
Collapse
Affiliation(s)
- Zahra Trad
- 1 LR-11-ES19 Laboratoire de Mécanique Appliquée et Ingénierie (LR-MAI), Ecole Nationale d'Ingénieurs de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Abdelwahed Barkaoui
- 1 LR-11-ES19 Laboratoire de Mécanique Appliquée et Ingénierie (LR-MAI), Ecole Nationale d'Ingénieurs de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Moez Chafra
- 2 Laboratoire de Systèmes et de Mécanique Appliquée (LASMAP-EPT), Ecole Polytechnique de Tunisie, Université de Carthage, La Marsa, Tunisie
| | - João Manuel Rs Tavares
- 3 Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| |
Collapse
|
36
|
Shimomura K, Hamamoto S, Hart DA, Yoshikawa H, Nakamura N. Meniscal repair and regeneration: Current strategies and future perspectives. J Clin Orthop Trauma 2018; 9:247-253. [PMID: 30202157 PMCID: PMC6128795 DOI: 10.1016/j.jcot.2018.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/30/2018] [Accepted: 07/14/2018] [Indexed: 01/01/2023] Open
Abstract
The management of meniscal injuries remains difficult and challenging. Although several clinical options exist for the treatment of such injuries, complete regeneration of the damaged meniscus has proved difficult due to the limited healing capacity of the tissue. With the advancements in tissue engineering and cell-based technologies, new therapeutic options for patients with currently incurable meniscal lesions now potentially exist. This review will discuss basic anatomy, current repair techniques and treatment options for loss of meniscal integrity. Specifically, we focus on the possibility and feasibility of the latest tissue engineering approaches, including 3D printing technologies. Therefore, this discussion will facilitate a better understanding of the latest trends in meniscal repair and regeneration, and contribute to the future application of such clinical therapies for patients with meniscal injuries.
Collapse
Affiliation(s)
- Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Shuichi Hamamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - David A. Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta, T2N 4N1, Canada
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan,Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka City, Osaka, 530-0043, Japan,Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan,Corresponding author. Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27, Tenma, Kita-ku, Osaka City, Osaka, 530-0043, Japan.
| |
Collapse
|
37
|
Romanazzo S, Vedicherla S, Moran C, Kelly DJ. Meniscus ECM-functionalised hydrogels containing infrapatellar fat pad-derived stem cells for bioprinting of regionally defined meniscal tissue. J Tissue Eng Regen Med 2017; 12:e1826-e1835. [PMID: 29105354 DOI: 10.1002/term.2602] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 09/23/2017] [Accepted: 10/19/2017] [Indexed: 01/22/2023]
Abstract
Injuries to the meniscus of the knee commonly lead to osteoarthritis. Current therapies for meniscus regeneration, including meniscectomies and scaffold implantation, fail to achieve complete functional regeneration of the tissue. This has led to increased interest in cell and gene therapies and tissue engineering approaches to meniscus regeneration. The implantation of a biomimetic implant, incorporating cells, growth factors, and extracellular matrix (ECM)-derived proteins, represents a promising approach to functional meniscus regeneration. The objective of this study was to develop a range of ECM-functionalised bioinks suitable for 3D bioprinting of meniscal tissue. To this end, alginate hydrogels were functionalised with ECM derived from the inner and outer regions of the meniscus and loaded with infrapatellar fat pad-derived stem cells. In the absence of exogenously supplied growth factors, inner meniscus ECM promoted chondrogenesis of fat pad-derived stem cells, whereas outer meniscus ECM promoted a more elongated cell morphology and the development of a more fibroblastic phenotype. With exogenous growth factors supplementation, a more fibrogenic phenotype was observed in outer ECM-functionalised hydrogels supplemented with connective tissue growth factor, whereas inner ECM-functionalised hydrogels supplemented with TGFβ3 supported the highest levels of Sox-9 and type II collagen gene expression and sulfated glycosaminoglycans (sGAG) deposition. The final phase of the study demonstrated the printability of these ECM-functionalised hydrogels, demonstrating that their codeposition with polycaprolactone microfibres dramatically improved the mechanical properties of the 3D bioprinted constructs with no noticeable loss in cell viability. These bioprinted constructs represent an exciting new approach to tissue engineering of functional meniscal grafts.
Collapse
Affiliation(s)
- S Romanazzo
- Trinity Centre for Bioengineering, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research (AMBER), Trinity College Dublin, Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - S Vedicherla
- Trinity Centre for Bioengineering, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland.,Sports Surgery Clinic Dublin, Orthopaedics and Sports Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - C Moran
- Trinity Centre for Bioengineering, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research (AMBER), Trinity College Dublin, Dublin, Ireland.,Sports Surgery Clinic Dublin, Orthopaedics and Sports Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - D J Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research (AMBER), Trinity College Dublin, Dublin, Ireland.,Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
38
|
Zellner J, Pattappa G, Koch M, Lang S, Weber J, Pfeifer CG, Mueller MB, Kujat R, Nerlich M, Angele P. Autologous mesenchymal stem cells or meniscal cells: what is the best cell source for regenerative meniscus treatment in an early osteoarthritis situation? Stem Cell Res Ther 2017; 8:225. [PMID: 29017608 PMCID: PMC5634903 DOI: 10.1186/s13287-017-0678-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 01/05/2023] Open
Abstract
Background Treatment of meniscus tears within the avascular region represents a significant challenge, particularly in a situation of early osteoarthritis. Cell-based tissue engineering approaches have shown promising results. However, studies have not found a consensus on the appropriate autologous cell source in a clinical situation, specifically in a challenging degenerative environment. The present study sought to evaluate the appropriate cell source for autologous meniscal repair in a demanding setting of early osteoarthritis. Methods A rabbit model was used to test autologous meniscal repair. Bone marrow and medial menisci were harvested 4 weeks prior to surgery. Bone marrow-derived mesenchymal stem cells (MSCs) and meniscal cells were isolated, expanded, and seeded onto collagen-hyaluronan scaffolds before implantation. A punch defect model was performed on the lateral meniscus and then a cell-seeded scaffold was press-fit into the defect. Following 6 or 12 weeks, gross joint morphology and OARSI grade were assessed, and menisci were harvested for macroscopic, histological, and immunohistochemical evaluation using a validated meniscus scoring system. In conjunction, human meniscal cells isolated from non-repairable bucket handle tears and human MSCs were expanded and, using the pellet culture model, assessed for their meniscus-like potential in a translational setting through collagen type I and II immunostaining, collagen type II enzyme-linked immunosorbent assay (ELISA), and gene expression analysis. Results After resections of the medial menisci, all knees showed early osteoarthritic changes (average OARSI grade 3.1). However, successful repair of meniscus punch defects was performed using either meniscal cells or MSCs. Gross joint assessment demonstrated donor site morbidity for meniscal cell treatment. Furthermore, human MSCs had significantly increased collagen type II gene expression and production compared to meniscal cells (p < 0.05). Conclusions The regenerative potential of the meniscus by an autologous cell-based tissue engineering approach was shown even in a challenging setting of early osteoarthritis. Autologous MSCs and meniscal cells were found to have improved meniscal healing in an animal model, thus demonstrating their feasibility in a clinical setting. However, donor site morbidity, reduced availability, and reduced chondrogenic differentiation of human meniscal cells from debris of meniscal tears favors autologous MSCs for clinical use for cell-based meniscus regeneration.
Collapse
Affiliation(s)
- Johannes Zellner
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany.
| | - Girish Pattappa
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Matthias Koch
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Siegmund Lang
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Johannes Weber
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Christian G Pfeifer
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Michael B Mueller
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Richard Kujat
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Michael Nerlich
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Peter Angele
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany.,Sporthopaedicum Regensburg, Hildegard von Bingen Strasse 1, 93053, Regensburg, Germany
| |
Collapse
|
39
|
Strümper R. Intra-Articular Injections of Autologous Conditioned Serum to Treat Pain from Meniscal Lesions. Sports Med Int Open 2017; 1:E200-E205. [PMID: 30539108 PMCID: PMC6259459 DOI: 10.1055/s-0043-118625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Routine use of biological therapies is in its early stages. Techniques involve stem cells, platelet preparations, recombinant growth factors and autologous conditioned serum, often combined with surgery. The objective of this case analysis was to document effects of intra-articular autologous conditioned serum injections in outpatients with knee pain associated with meniscal defects. Autologous conditioned serum was prepared from patients’ blood by centrifugal separation from cellular components using a specialized device (EOT
®
II, Orthokine). Outpatients (n=47) with heterogeneous knee meniscus lesions (76.6% traumatic knee injury) were injected once weekly (average 5.2 applications). Average age was 48.6 years (range 21–79). Oxford Knee Score and structural changes with the MRI Boston Leeds Osteoarthritis Knee Score were documented at baseline and 6 months. All analyses were performed retrospectively.
In 83% patients, surgery was avoided during the 6-month observation period. Oxford Knee Score improved significantly from 29.1–44.3 (p<0.001; best possible score=48). Structural findings on MRI, measured by Boston Leeds Osteoarthritis Knee Score, showed significant improvement at 6 months (0.82–0.71, p<0.001). This retrospective study implies that intra-articular autologous conditioned serum injection may be an effective treatment option for knee pain associated with meniscal lesions. Controlled studies of autologous conditioned serum treatment for meniscal lesions are advocated.
Collapse
|
40
|
Abstract
Native joint preservation has gained importance in recent years. This is mostly to find solutions for limitations of arthroplasty. In the knee joint, the menisci perform critical functions, adding stability during range of motion and efficiently transferring load across the tibiofemoral articulation while protecting the cartilage. The menisci are the most common injury seen by orthopedicians, especially in the younger active patients. Advances in technology and our knowledge on functioning of the knee joint have made meniscus repair an important mode of treatment. This review summarizes the various techniques of meniscus tear repair and also describes biological enhancements of healing.
Collapse
Affiliation(s)
- Shantanu Sudhakar Patil
- Department of Translational Medicine and Research, SRM Medical College and Hospitals, SRM University, Chennai, Tamil Nadu, India
| | - Anshu Shekhar
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | | |
Collapse
|
41
|
Woodmass JM, LaPrade RF, Sgaglione NA, Nakamura N, Krych AJ. Meniscal Repair: Reconsidering Indications, Techniques, and Biologic Augmentation. J Bone Joint Surg Am 2017; 99:1222-1231. [PMID: 28719562 DOI: 10.2106/jbjs.17.00297] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jarret M Woodmass
- 1Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota 2The Steadman Clinic, Steadman Philippon Research Institute, Vail, Colorado 3Department of Orthopedics, Northwell Health System, Great Neck, New York 4Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | | | | | | | | |
Collapse
|
42
|
Zhang ZZ, Wang SJ, Zhang JY, Jiang WB, Huang AB, Qi YS, Ding JX, Chen XS, Jiang D, Yu JK. 3D-Printed Poly(ε-caprolactone) Scaffold Augmented With Mesenchymal Stem Cells for Total Meniscal Substitution: A 12- and 24-Week Animal Study in a Rabbit Model. Am J Sports Med 2017; 45:1497-1511. [PMID: 28278383 DOI: 10.1177/0363546517691513] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total meniscectomy leads to knee osteoarthritis in the long term. The poly(ε-caprolactone) (PCL) scaffold is a promising material for meniscal tissue regeneration, but cell-free scaffolds result in relatively poor tissue regeneration and lead to joint degeneration. HYPOTHESIS A novel, 3-dimensional (3D)-printed PCL scaffold augmented with mesenchymal stem cells (MSCs) would offer benefits in meniscal regeneration and cartilage protection. STUDY DESIGN Controlled laboratory study. METHODS PCL meniscal scaffolds were 3D printed and seeded with bone marrow-derived MSCs. Seventy-two New Zealand White rabbits were included and were divided into 4 groups: cell-seeded scaffold, cell-free scaffold, sham operation, and total meniscectomy alone. The regeneration of the implanted tissue and the degeneration of articular cartilage were assessed by gross and microscopic (histological and scanning electron microscope) analysis at 12 and 24 weeks postoperatively. The mechanical properties of implants were also evaluated (tensile and compressive testing). RESULTS Compared with the cell-free group, the cell-seeded scaffold showed notably better gross appearance, with a shiny white color and a smooth surface. Fibrochondrocytes with extracellular collagen type I, II, and III and proteoglycans were found in both seeded and cell-free scaffold implants at 12 and 24 weeks, while the results were significantly better for the cell-seeded group at week 24. Furthermore, the cell-seeded group presented notably lower cartilage degeneration in both femur and tibia compared with the cell-free or meniscectomy group. Both the tensile and compressive properties of the implants in the cell-seeded group were significantly increased compared with those of the cell-free group. CONCLUSION Seeding MSCs in the PCL scaffold increased its fibrocartilaginous tissue regeneration and mechanical strength, providing a functional replacement to protect articular cartilage from damage after total meniscectomy. CLINICAL RELEVANCE The study suggests the potential of the novel 3D PCL scaffold augmented with MSCs as an alternative meniscal substitution, although this approach requires further improvement before being used in clinical practice.
Collapse
Affiliation(s)
- Zheng-Zheng Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China
| | - Shao-Jie Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China.,Department of Joint Surgery, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, P.R. China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China
| | - Wen-Bo Jiang
- Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Ai-Bing Huang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China
| | - Yan-Song Qi
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China
| | - Jian-Xun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, P.R. China
| | - Xue-Si Chen
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, P.R. China
| | - Dong Jiang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P.R. China
| |
Collapse
|
43
|
Kremer A, Ribitsch I, Reboredo J, Dürr J, Egerbacher M, Jenner F, Walles H. Three-Dimensional Coculture of Meniscal Cells and Mesenchymal Stem Cells in Collagen Type I Hydrogel on a Small Intestinal Matrix—A Pilot Study Toward Equine Meniscus Tissue Engineering. Tissue Eng Part A 2017; 23:390-402. [DOI: 10.1089/ten.tea.2016.0317] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Antje Kremer
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center Wuerzburg ‘Regenerative therapies,’ Wuerzburg Branch of the Fraunhofer IGB, Wuerzburg, Germany
| | - Iris Ribitsch
- Vienna Equine Tissue Engineering and Regenerative Medicine, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Jenny Reboredo
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center Wuerzburg ‘Regenerative therapies,’ Wuerzburg Branch of the Fraunhofer IGB, Wuerzburg, Germany
| | - Julia Dürr
- Department of Pathobiology, Institute of Histology & Embryology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Monika Egerbacher
- Department of Pathobiology, Institute of Histology & Embryology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Florien Jenner
- Vienna Equine Tissue Engineering and Regenerative Medicine, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Heike Walles
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center Wuerzburg ‘Regenerative therapies,’ Wuerzburg Branch of the Fraunhofer IGB, Wuerzburg, Germany
| |
Collapse
|
44
|
De Coninck T, Vanrietvelde F, Seynaeve P, Verdonk P, Verstraete K. MR imaging of the anatomy of the anterior horn of the medial meniscus. Acta Radiol 2017; 58:464-471. [PMID: 27552979 DOI: 10.1177/0284185116661880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background In cadaveric and arthroscopic studies different insertion locations of the anterior horn of the medial meniscus (AHMM) have been described. Purpose To investigate if the different insertion locations of the AHMM, as described in cadaveric studies, can be determined on magnetic resonance imaging (MRI). Material and Methods MR images of 100 patients without meniscal tears on MRI were retrospectively evaluated. Two observers classified the AHMM insertion based on its position relative to the anterior tibial edge and the medial tibial spine. The association between AHMM insertion and tibial plateau slope, meniscal radial displacement, and anterior intermeniscal ligament (AIL) presence was investigated. Results The AHMM inserted posterior to the anterior tibial edge in 93 knees and anterior to the tibial edge in seven knees (= type III). Of the 93 knees with AHMM insertion posterior to the anterior tibial edge, 63 inserted lateral to the medial tibial spine (= type I) and 30 medial (= type II). The AHMMs inserting anterior to the tibial edge had a significantly ( P < 0.05) steeper anterior tibial plateau slope and a significantly ( P < 0.05) higher presence of the AIL. No significant difference in radial displacement was observed between the three insertion types ( P > 0.05). A strong inter- and intra-observer agreement was observed. Conclusion Three different bony insertion locations of the AHMM, as described in cadaveric studies, could be identified on MRI. All AHMMs inserting anterior to the tibial edge displayed an AIL. Whether there is a clinical correlation with these insertion patterns remains unclear.
Collapse
Affiliation(s)
| | | | | | - Peter Verdonk
- Faculty of Medicine Ghent University, Ghent, Belgium
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | | |
Collapse
|
45
|
Rossi MJ. Editorial Commentary: Thinking "Inside the Box" Yields the Possibility of Harvesting Stem Cells From "Inside the Injured Knee". Arthroscopy 2017; 33:798-799. [PMID: 28372703 DOI: 10.1016/j.arthro.2017.01.014] [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: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 02/02/2023]
Abstract
Looking to the injured knee for potential stem cell harvesting has attractive benefits. Stem cells can be successfully harvested but the concentrations with the current technology are lower than bone marrow or lipoaspirate sites. The technique of utilizing the knee effusion and tissue by-products after cruciate ligament injury shows future promise.
Collapse
|
46
|
Shimomura K, Rothrauff BB, Tuan RS. Region-Specific Effect of the Decellularized Meniscus Extracellular Matrix on Mesenchymal Stem Cell-Based Meniscus Tissue Engineering. Am J Sports Med 2017; 45:604-611. [PMID: 27895039 DOI: 10.1177/0363546516674184] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The meniscus is the most commonly injured knee structure, and surgical repair is often ineffective. Tissue engineering-based repair or regeneration may provide a needed solution. Decellularized, tissue-derived extracellular matrices (ECMs) have received attention for their potential use as tissue-engineered scaffolds. In considering meniscus-derived ECMs (mECMs) for meniscus tissue engineering, it is noteworthy that the inner and outer regions of the meniscus have different structural and biochemical features, potentially directing the differentiation of cells toward region-specific phenotypes. PURPOSE To investigate the applicability of mECMs for meniscus tissue engineering by specifically comparing region-dependent effects of mECMs on 3-dimensional constructs seeded with human bone marrow mesenchymal stem cells (hBMSCs). STUDY DESIGN Controlled laboratory study. METHODS Bovine menisci were divided into inner and outer halves and were minced, treated with Triton X-100 and DNase, and extracted with urea. Then, hBMSCs (1 × 106 cells/mL) were encapsulated in a photo-cross-linked 10% polyethylene glycol diacrylate scaffold containing mECMs (60 μg/mL) derived from either the inner or outer meniscus, with an ECM-free scaffold as a control. The cell-seeded constructs were cultured with chondrogenic medium containing recombinant human transforming growth factor β3 (TGF-β3) and were analyzed for expression of meniscus-associated genes as well as for the collagen (hydroxyproline) and glycosaminoglycan content as a function of time. RESULTS Decellularization was verified by the absence of 4',6-diamidino-2-phenylindole (DAPI)-stained cell nuclei and a reduction in the DNA content. Quantitative real-time polymerase chain reaction showed that collagen type I expression was significantly higher in the outer mECM group than in the other groups, while collagen type II and aggrecan expression was highest in the inner mECM group. The collagen (hydroxyproline) content was highest in the outer mECM group, while the glycosaminoglycan content was higher in both the inner and outer mECM groups compared with the control group. CONCLUSION These results showed that the inner mECM enhances the fibrocartilaginous differentiation of hBMSCs, while the outer mECM promotes a more fibroblastic phenotype. Our findings support the feasibility of fabricating bioactive scaffolds using region-specific mECM preparations for meniscus tissue engineering. CLINICAL RELEVANCE This is the first report to demonstrate the feasibility of applying region-specific mECMs for the engineering of meniscus implants capable of reproducing the biphasic, anatomic, and biochemical characteristics of the meniscus, features that should contribute to the feasibility of their clinical application.
Collapse
Affiliation(s)
- Kazunori Shimomura
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan.,Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
47
|
Gao S, Yuan Z, Guo W, Chen M, Liu S, Xi T, Guo Q. Comparison of glutaraldehyde and carbodiimides to crosslink tissue engineering scaffolds fabricated by decellularized porcine menisci. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 71:891-900. [DOI: 10.1016/j.msec.2016.10.074] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/06/2016] [Accepted: 10/30/2016] [Indexed: 02/06/2023]
|
48
|
Vedicherla S, Buckley CT. Cell-based therapies for intervertebral disc and cartilage regeneration- Current concepts, parallels, and perspectives. J Orthop Res 2017; 35:8-22. [PMID: 27104885 DOI: 10.1002/jor.23268] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
Lower back pain from degenerative disc disease represents a global health burden, and presents a prominent opportunity for regenerative therapeutics. While current regenerative therapies such as autologous disc chondrocyte transplantation (ADCT), allogeneic juvenile chondrocyte implantation (NuQu®), and immunoselected allogeneic adipose derived precursor cells (Mesoblast) show exciting clinical potential, limitations remain. The heterogeneity of preclinical approaches and the paucity of clinical guidance have limited translational outcomes in disc repair, lagging almost a decade behind cartilage repair. Advances in cartilage repair have evolved to single step approaches with improved orthopedic repair and regeneration. Elements from cartilage regeneration endeavors could be adopted and applied to harness translatable approaches and deliver a clinically and economically feasible regenerative surgery for back pain. In this article, we trace the developments behind the translational success of cartilage repair, examine elements to consider in achieving disc regeneration, and the need for surgical redesign. We further discuss clinical parameters, objectives, and coordination required to deliver improved regenerative surgery. Cell source, processing, and delivery modalities are key issues to be addressed in considering surgical redesign. Advances in biomanufacturing, tissue cryobanking, and point of care cell processing technology may enable intraoperative solutions for single step procedures. To maximize translational success a triad partnership between clinicians, industry, and researchers will be critical in providing instructive clinical guidelines for design as well as practical and economic considerations. This will allow a consensus in research ventures and add regenerative surgery into the algorithm in managing and treating a debilitating condition such as back pain. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:8-22, 2017.
Collapse
Affiliation(s)
- Srujana Vedicherla
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Conor T Buckley
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Ireland
| |
Collapse
|
49
|
Gao S, Guo W, Chen M, Yuan Z, Wang M, Zhang Y, Liu S, Xi T, Guo Q. Fabrication and characterization of electrospun nanofibers composed of decellularized meniscus extracellular matrix and polycaprolactone for meniscus tissue engineering. J Mater Chem B 2017; 5:2273-2285. [DOI: 10.1039/c6tb03299k] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Decellularized meniscus extracellular matrix (DMECM) and polycaprolactone (PCL) were electrospun into nanofibers to make meniscus scaffolds with good mechanical properties.
Collapse
Affiliation(s)
- Shuang Gao
- Center for Biomedical Material and Tissue Engineering
- Academy for Advanced Interdisciplinary Studies
- Peking University
- Beijing 100871
- China
| | - Weimin Guo
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| | - Mingxue Chen
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| | - Zhiguo Yuan
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| | - Mingjie Wang
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| | - Yu Zhang
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| | - Shuyun Liu
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| | - Tingfei Xi
- Center for Biomedical Material and Tissue Engineering
- Academy for Advanced Interdisciplinary Studies
- Peking University
- Beijing 100871
- China
| | - Quanyi Guo
- Key Lab of Musculoskeletal Trauma & War Injuries
- PLA
- Beijing Key Lab of Regenerative Medicine in Orthopedics
- Chinese PLA General Hospital
- Beijing
| |
Collapse
|
50
|
Numpaisal PO, Rothrauff BB, Gottardi R, Chien CL, Tuan RS. Rapidly dissociated autologous meniscus tissue enhances meniscus healing: An in vitro study. Connect Tissue Res 2016; 58:355-365. [PMID: 27726454 DOI: 10.1080/03008207.2016.1245727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Treatment of meniscus tears is a persistent challenge in orthopedics. Although cell therapies have shown promise in promoting fibrocartilage formation in in vitro and preclinical studies, clinical application has been limited by the paucity of autologous tissue and the need for ex vivo cell expansion. Rapid dissociation of the free edges of the anterior and posterior meniscus with subsequent implantation in a meniscus lesion may overcome these limitations. The purpose of this study was to explore the effect of rapidly dissociated meniscus tissue in enhancing neotissue formation in a radial meniscus tear, as simulated in an in vitro explant model. MATERIALS AND METHODS All experiments in this study, performed at minimum with biological triplicates, utilized meniscal tissues from hind limbs of young cows. The effect of varying collagenase concentration (0.1%, 0.2% and 0.5% w/v) and treatment duration (overnight and 30 minutes) on meniscus cell viability, organization of the extracellular matrix (ECM), and gene expression was assessed through a cell metabolism assay, microscopic examination, and quantitative real-time reverse transcription polymerase chain reaction analysis, respectively. Thereafter, an explant model of a radial meniscus tear was used to evaluate the effect of a fibrin gel seeded with one of the following: (1) fibrin alone, (2) isolated and passaged (P2) meniscus cells, (3) overnight digested tissue, and (4) rapidly dissociated tissue. The quality of in vitro healing was determined through histological analysis and derivation of an adhesion index. RESULTS Rapid dissociation in 0.2% collagenase yielded cells with higher levels of metabolism than either 0.1% or 0.5% collagenase. When seeded in a three-dimensional fibrin hydrogel, both overnight digested and rapidly dissociated cells expressed greater levels of collagens type I and II than P2 meniscal cells at 1 week. At 4 and 8 weeks, collagen type II expression remained elevated only in the rapid dissociation group. Histological examination revealed enhanced healing in all cell-seeded treatment groups over cell-free fibrin controls at weeks 1, 4, and 8, but there were no significant differences across the treatment groups. CONCLUSIONS Rapid dissociation of meniscus tissue may provide a single-step approach to augment regenerative healing of meniscus repairs.
Collapse
Affiliation(s)
- Piya-On Numpaisal
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,b Department of Anatomy and Cell Biology , College of Medicine, National Taiwan University , Taipei , Taiwan.,c Institute of Medicine, Suranaree University of Technology , Nakhon Ratchasima , Thailand
| | - Benjamin B Rothrauff
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,d McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh , PA , USA
| | - Riccardo Gottardi
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,e Ri.MED Foundation , Palermo , Italy
| | - Chung-Liang Chien
- b Department of Anatomy and Cell Biology , College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Rocky S Tuan
- a Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,d McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh , PA , USA
| |
Collapse
|