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
|
Yang J, Wang H, Zhou Y, Duan L, Schneider KH, Zheng Z, Han F, Wang X, Li G. Silk Fibroin/Wool Keratin Composite Scaffold with Hierarchical Fibrous and Porous Structure. Macromol Biosci 2023; 23:e2300105. [PMID: 37247409 DOI: 10.1002/mabi.202300105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Indexed: 05/31/2023]
Abstract
The present study describes a silk microfiber reinforced meniscus scaffold (SMRMS) with hierarchical fibrous and porous structure made from silk fibroin (SF) and wool keratin (WK) using electrospinning and freeze-drying technology. This study focuses on the morphology, secondary structure, mechanical properties, and water absorption properties of the scaffold. The cytotoxicity and biocompatibility of SMRMS are assessed in vivo and in vitro. The scaffold shows hierarchical fibrous and porous structure, hierarchical pore size distribution (ranges from 50 to 650 µm), robust mechanical properties (compression strength can reach at 2.8 MPa), and stable biodegradability. A positive growth condition revealed by in vitro cytotoxicity testing indicates that the scaffold is not hazardous to cells. In vivo assessments of biocompatibility reveal that only a mild inflammatory reaction is present in implanted rat tissue. Meniscal scaffold made of SF/WK composite shows a potential application prospect in the meniscal repair engineering field with its development.
Collapse
Affiliation(s)
- Jie Yang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Huan Wang
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yuhang Zhou
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Lirong Duan
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Karl H Schneider
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Waehringer Gurtel 18-20, Vienna, 1090, Austria
| | - Zhaozhu Zheng
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Fengxuan Han
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaoqin Wang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Gang Li
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| |
Collapse
|
3
|
Pereira H, Cengiz IF, Silva-Correia J, Oliveira JM, Vasconcelos JC, Gomes S, Ripoll PL, Karlsson J, Reis RL, Espregueira-Mendes J. Integration of polyurethane meniscus scaffold during ACL revision is not reliable at 5 years despite favourable clinical outcome. Knee Surg Sports Traumatol Arthrosc 2022; 30:3422-3427. [PMID: 35338384 DOI: 10.1007/s00167-022-06946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical outcome at 5-year follow-up of a one-step procedure combining anterior cruciate ligament (ACL) reconstruction and partial meniscus replacement using a polyurethane scaffold for the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy. Moreover, the implanted scaffolds have been evaluated by MRI protocol in terms of morphology, volume, and signal intensity. METHODS Twenty patients with symptomatic knee laxity after failed ACL reconstruction and partial medial meniscectomy underwent ACL revision combined with polyurethane-based meniscal scaffold implant. Clinical assessment at 2- and 5-year follow-ups included VAS, Tegner Activity Score, International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lysholm Score. MRI evaluation of the scaffold was performed according to the Genovese scale with quantification of the scaffold's volume at 1- and 5-year follow-ups. RESULTS All scores revealed clinical improvement as compared with the preoperative values at the 2- and 5-year follow-ups. However, a slight, but significant reduction of scores was observed between 2 and 5 years. Concerning the MRI assessment, a significant reduction of the scaffold's volume was observed between 1 and 5 years. Genovese Morphology classification at 5 years included two complete resorptions (Type 3) and all the remaining patients had irregular morphology (Type 2). With regard to the Genovese Signal at the 5-year follow-up, three were classified as markedly hyperintense (Type 1), 15 as slightly hyperintense (Type 2), and two as isointense (Type 1). CONCLUSION Simultaneous ACL reconstruction and partial meniscus replacement using a polyurethane scaffold provides favourable clinical outcomes in the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy at 5 years. However, MRI evaluation suggests that integration of the scaffold is not consistent. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Hélder Pereira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. .,Orthopedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal. .,Ripoll y de Prado Sports Clinic-FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.
| | - Ibrahim Fatih Cengiz
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joana Silva-Correia
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joaquim M Oliveira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Sérgio Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
| | - Pedro L Ripoll
- Ripoll y de Prado Sports Clinic-FIFA Medical Centre of Excellence, Murcia-Madrid, Spain
| | - Jón Karlsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Rui L Reis
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João Espregueira-Mendes
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
| |
Collapse
|
4
|
Stocco E, Porzionato A, De Rose E, Barbon S, Caro RD, Macchi V. Meniscus regeneration by 3D printing technologies: Current advances and future perspectives. J Tissue Eng 2022; 13:20417314211065860. [PMID: 35096363 PMCID: PMC8793124 DOI: 10.1177/20417314211065860] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/24/2021] [Indexed: 01/10/2023] Open
Abstract
Meniscal tears are a frequent orthopedic injury commonly managed by conservative
strategies to avoid osteoarthritis development descending from altered
biomechanics. Among cutting-edge approaches in tissue engineering, 3D printing
technologies are extremely promising guaranteeing for complex biomimetic
architectures mimicking native tissues. Considering the anisotropic
characteristics of the menisci, and the ability of printing over structural
control, it descends the intriguing potential of such vanguard techniques to
meet individual joints’ requirements within personalized medicine. This
literature review provides a state-of-the-art on 3D printing for meniscus
reconstruction. Experiences in printing materials/technologies, scaffold types,
augmentation strategies, cellular conditioning have been compared/discussed;
outcomes of pre-clinical studies allowed for further considerations. To date,
translation to clinic of 3D printed meniscal devices is still a challenge:
meniscus reconstruction is once again clear expression of how the integration of
different expertise (e.g., anatomy, engineering, biomaterials science, cell
biology, and medicine) is required to successfully address native tissues
complexities.
Collapse
Affiliation(s)
- Elena Stocco
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, Padova, Italy
| | - Andrea Porzionato
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, Padova, Italy
| | - Enrico De Rose
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Silvia Barbon
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, Padova, Italy
| | - Raffaele De Caro
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, Padova, Italy
| | - Veronica Macchi
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, Padova, Italy
| |
Collapse
|
5
|
Figueroa D, Figueroa F, Calvo R, Gomez C, Vaisman A. Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up. J Clin Orthop Trauma 2021; 15:16-21. [PMID: 33717911 PMCID: PMC7920011 DOI: 10.1016/j.jcot.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. METHODS Prospective study in patients with PU meniscal scaffolds implanted during 2014-2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Post-operative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. RESULTS Fourteen patients with an average age of 25.8 years (range: 17-47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39-66) months. Post-operative mean clinical outcomes scores showed significantly improved results compared to the pre-operative scores. Lysholm scores increased from 62.4 to 80.2 (P = 0.0023), KOOS from 68.9 to 80 (P = 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P = 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3-6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. CONCLUSION The use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. LEVEL OF EVIDENCE IV. Case series.
Collapse
Affiliation(s)
| | - Francisco Figueroa
- Clínica Alemana-Universidad del Desarrollo, Chile
- Hospital Sótero del Río, Chile
| | - Rafael Calvo
- Clínica Alemana-Universidad del Desarrollo, Chile
| | - Carlos Gomez
- Hospital Padre Hurtado, Chile
- Hospital del Trabajador, Chile
| | - Alex Vaisman
- Clínica Alemana-Universidad del Desarrollo, Chile
- Hospital Padre Hurtado, Chile
| |
Collapse
|
6
|
Demirkıran ND, Havıtçıoğlu H, Ziylan A, Cankurt Ü, Hüsemoğlu B. Novel multilayer meniscal scaffold provides biomechanical and histological results comparable to polyurethane scaffolds: An 8 week rabbit study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:120-128. [PMID: 30826138 PMCID: PMC6506817 DOI: 10.1016/j.aott.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/11/2018] [Accepted: 02/05/2019] [Indexed: 12/11/2022]
Abstract
Objective The aim of this study was to evaluate the meniscal regeneration and arthritic changes after partial meniscectomy and application of either polyurethane scaffold or novel multilayer meniscal scaffold in a rabbit model. Methods Sixteen NewZealand rabbits were randomly divided into three groups. A reproducible 1.5-mm cylindrical defect was created in the avascular zone of the anterior horn of the medial meniscus bilaterally. Defects were filled with the polyurethane scaffold in Group 1 (n:6) and with novel multilayer scaffold in Group 2 (n:6). Rabbits in Group 3 (n:4) did not receive any treatment and defects were left empty. All animals were sacrificed after 8 weeks and bilateral knee joints were taken for macroscopic, biomechanical, and histological analysis. After excision of menisci, inked condylar surfaces and tibial plateaus were evaluated for arthritic changes. Digital photographs of excised menisci were also obtained and surface areas were measured by a computer software. Indentation testing of the tibial condyles and compression tests for the relevant meniscal areas was also performed in all groups. Histological analysis was made and all specimens were scored according to Rodeo scoring system. Results No signs of inflammation or infection were observed in any animals. A significant difference was observed between meniscus surface areas of the multilayer scaffold group (20.13 ± 1.91 mm2) and the group with empty meniscus defects (15.62 ± 2.04 mm2) (p = 0.047). The results of biomechanical compression tests revealed a significant difference between the Hayes scores of the second group (1.728) and the empty defect group (0,467) (p = 0.029). Intact meniscal tissue showed higher mechanical properties than all the defected samples. Multilayer scaffold group demonstrated the closest results compared to healthy meniscus tissue. Tibia indentation tests and histological evaluation showed no significant differences between groups (p = 0.401 and p = 0.186 respectively). Conclusions In this study, the initial evaluation of novel multilayer meniscal scaffold prevented the shrinkage that may occur in the meniscus area and demonstrated superior biomechanical results compared to empty defects. No adverse events related to scaffold material was observed. Besides, promising biomechanical and histological results, comparable to polyurethane scaffold, were obtained.
Collapse
|