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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.
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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
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Ronca A, D'Amora U, Capuana E, Zihlmann C, Stiefel N, Pattappa G, Schewior R, Docheva D, Angele P, Ambrosio L. Development of a highly concentrated collagen ink for the creation of a 3D printed meniscus. Heliyon 2023; 9:e23107. [PMID: 38144315 PMCID: PMC10746456 DOI: 10.1016/j.heliyon.2023.e23107] [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: 10/04/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
The most prevalent extracellular matrix (ECM) protein in the meniscus is collagen, which controls cell activity and aids in preserving the biological and structural integrity of the ECM. To create stable and high-precision 3D printed collagen scaffolds, ink formulations must possess good printability and cytocompatibility. This study aims to overlap the limitation in the 3D printing of pure collagen, and to develop a highly concentrated collagen ink for meniscus fabrication. The extrusion test revealed that 12.5 % collagen ink had the best combination of high collagen concentration and printability. The ink was specifically designed to have load-bearing capacity upon printing and characterized with respect to rheological and extrusion properties. Following printing of structures with different infill, a series of post-processing steps, including salt stabilization, pH shifting, washing, freeze-drying, crosslinking and sterilization were performed, and optimised to maintain the stability of the engineered construct. Mechanical testing highlighted a storage modulus of 70 kPa for the lower porous structure while swelling properties showed swelling ratio between 9 and 11 after 15 min of soaking. Moreover, human avascular and vascular meniscus cells cultured on the scaffolds deposited a meniscus-like matrix containing collagen I, II and glycosaminoglycans after 28 days of culture. Finally, as proof-of-concept, human size 3D printed meniscus scaffold were created.
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Affiliation(s)
- Alfredo Ronca
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Ugo D'Amora
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Elisa Capuana
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Carla Zihlmann
- Geistlich Pharma AG (Geistlich), Bahnhofstrasse 40, CH-6110 Wolhusen, Switzerland
| | - Niklaus Stiefel
- Geistlich Pharma AG (Geistlich), Bahnhofstrasse 40, CH-6110 Wolhusen, Switzerland
| | - Girish Pattappa
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Ruth Schewior
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
- Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Wurzburg, Germany
| | - Peter Angele
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
- Sporthopaedicum Regensburg, Hildegard von Bingen Strasse 1, 93053 Regensburg, Germany
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
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Li X, Li D, Li J, Wang G, Yan L, Liu H, Jiu J, Li JJ, Wang B. Preclinical Studies and Clinical Trials on Cell-Based Treatments for Meniscus Regeneration. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:634-670. [PMID: 37212339 DOI: 10.1089/ten.teb.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study aims at performing a thorough review of cell-based treatment strategies for meniscus regeneration in preclinical and clinical studies. The PubMed, Embase, and Web of Science databases were searched for relevant studies (both preclinical and clinical) published from the time of database construction to December 2022. Data related to cell-based therapies for in situ regeneration of the meniscus were extracted independently by two researchers. Assessment of risk of bias was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Statistical analyses based on the classification of different treatment strategies were performed. A total of 5730 articles were retrieved, of which 72 preclinical studies and 6 clinical studies were included in this review. Mesenchymal stem cells (MSCs), especially bone marrow MSCs (BMSCs), were the most commonly used cell type. Among preclinical studies, rabbit was the most commonly used animal species, partial meniscectomy was the most commonly adopted injury pattern, and 12 weeks was the most frequently chosen final time point for assessing repair outcomes. A range of natural and synthetic materials were used to aid cell delivery as scaffolds, hydrogels, or other morphologies. In clinical trials, there was large variation in the dose of cells, ranging from 16 × 106 to 150 × 106 cells with an average of 41.52 × 106 cells. The selection of treatment strategy for meniscus repair should be based on the nature of the injury. Cell-based therapies incorporating various "combination" strategies such as co-culture, composite materials, and extra stimulation may offer greater promise than single strategies for effective meniscal tissue regeneration, restoring natural meniscal anisotropy, and eventually achieving clinical translation. Impact Statement This review provides an up-to-date and comprehensive overview of preclinical and clinical studies that tested cell-based treatments for meniscus regeneration. It presents novel perspectives on studies published in the past 30 years, giving consideration to the cell sources and dose selection, delivery methods, extra stimulation, animal models and injury patterns, timing of outcome assessment, and histological and biomechanical outcomes, as well as a summary of findings for individual studies. These unique insights will help to shape future research on the repair of meniscus lesions and inform the clinical translation of new cell-based tissue engineering strategies.
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Affiliation(s)
- Xiaoke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Dijun Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Jiarong Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Guishan Wang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, China
| | - Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Jingwei Jiu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Bin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Jin P, Liu L, Chen X, Cheng L, Zhang W, Zhong G. Applications and prospects of different functional hydrogels in meniscus repair. Front Bioeng Biotechnol 2022; 10:1082499. [PMID: 36568293 PMCID: PMC9773848 DOI: 10.3389/fbioe.2022.1082499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
The meniscus is a kind of fibrous cartilage structure that serves as a cushion in the knee joint to alleviate the mechanical load. It is commonly injured, but it cannot heal spontaneously. Traditional meniscectomy is not currently recommended as this treatment tends to cause osteoarthritis. Due to their good biocompatibility and versatile regulation, hydrogels are emerging biomaterials in tissue engineering. Hydrogels are excellent candidates in meniscus rehabilitation and regeneration because they are fine-tunable, easily modified, and capable of delivering exogenous drugs, cells, proteins, and cytokines. Various hydrogels have been reported to work well in meniscus-damaged animals, but few hydrogels are effective in the clinic, indicating that hydrogels possess many overlooked problems. In this review, we summarize the applications and problems of hydrogels in extrinsic substance delivery, meniscus rehabilitation, and meniscus regeneration. This study will provide theoretical guidance for new therapeutic strategies for meniscus repair.
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Affiliation(s)
- Pan Jin
- Health Science Center, Yangtze University, Jingzhou, China,Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China,*Correspondence: Pan Jin, ; Gang Zhong,
| | - Lei Liu
- Articular Surgery, The Second Nanning People’s Hospital (Third Affiliated Hospital of Guangxi Medical University), Nanning, China
| | - Xichi Chen
- Health Science Center, Yangtze University, Jingzhou, China
| | - Lin Cheng
- Health Science Center, Yangtze University, Jingzhou, China
| | - Weining Zhang
- Health Science Center, Yangtze University, Jingzhou, China
| | - Gang Zhong
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,*Correspondence: Pan Jin, ; Gang Zhong,
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Mahmoud EE, Mawas AS, Mohamed AA, Noby MA, Abdel-Hady ANA, Zayed M. Treatment strategies for meniscal lesions: from past to prospective therapeutics. Regen Med 2022; 17:547-560. [PMID: 35638397 DOI: 10.2217/rme-2021-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Menisci play an important role in the biomechanics of knee joint function, including loading transmission, joint lubrication, prevention of soft tissue impingement during motion and joint stability. Meniscal repair presents a challenge due to a lack of vascularization that limits the healing capacity of meniscal tissue. In this review, the authors aimed to untangle the available treatment options for repairing meniscal tears. Various surgical procedures have been developed to treat meniscal tears; however, clinical outcomes are limited. Consequently, numerous researchers have focused on different treatments such as the application of exogenous and/or autologous growth factors, scaffolds including tissue-derived matrix, cell-based therapy and miRNA-210. The authors present current and prospective treatment strategies for meniscal lesions.
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Affiliation(s)
- Elhussein E Mahmoud
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Amany S Mawas
- Department of Pathology & Clinical Pathology, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Alsayed A Mohamed
- Department of Anatomy & Embryology, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Mohammed A Noby
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | | | - Mohammed Zayed
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
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Implantation of autogenous meniscal fragments wrapped with a fascia sheath induces fibrocartilage regeneration in a large meniscal defect in sheep: A histological and biomechanical study. Orthop Traumatol Surg Res 2022; 108:103225. [PMID: 35104627 DOI: 10.1016/j.otsr.2022.103225] [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] [Received: 11/10/2020] [Revised: 04/12/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Currently, various studies have been reported to regenerate the meniscus tissue in a large defect after partial meniscectomy using biological or synthetic scaffolds with or without fibrochondrocytes. However, the clinical utility of those treatments has not been established as of yet. HYPOTHESIS Purposes of this study were to develop a sheep model to evaluate feasibility of this new surgical strategy to treat the irreparable meniscus injury, and to test the hypothesis that implantation of autogenous meniscal fragments wrapped with a fascia sheath may significantly induce fibrocartilage regeneration in a large meniscal defect in the sheep model. METHODS AND METHODS Twenty Suffolk sheep were used. In each animal, an anterior 10-mm width of the right medial meniscus was resected. Then, the animals were divided into the following 2 groups. In Group I, the defect was enveloped with a fascia from the left thigh. In Group II, the resected meniscus fragmented into small pieces was grafted into the defect. Then the defect was enveloped with a fascia. In each group, 5 of 10 sheep were used for histological and biomechanical evaluations, respectively, at 12 weeks after surgery. RESULTS In Group I, the defect was incompletely filled with thin fibrous tissues, while fibrocartilage tissues rarely regenerated in the tissue. In Group II, all defects were completely filled with thick fibrocartilage tissues, which were richly stained with the safranin O staining. Both the gross and histological observation score of Group II was significantly (p=0.0005, p=0.0005) greater than that of Group I. Concerning the cross-sectional area of the regenerated tissue, Group II was significantly (p=0.0002) greater than Group I. In the biomechanical evaluation, the maximal load and the linear stiffness of the meniscus-tibia complex were significantly (p=0.0015, p=0.0283) greater in Group II than in Group I. DISCUSSION Implantation of autogenous meniscal fragments wrapped with a fascia sheath significantly induces fibrocartilage regeneration into a large meniscal defect in the sheep model. LEVEL OF EVIDENCE Not applicable; Controlled Laboratory Study, Experimental in vivo study.
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A Comparison Between Polyurethane and Collagen Meniscal Scaffold for Partial Meniscal Defects: Similar Positive Clinical Results at a Mean of 10 Years of Follow-Up. Arthroscopy 2022; 38:1279-1287. [PMID: 34571182 DOI: 10.1016/j.arthro.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare, at long-term follow-up, the clinical outcomes and failures of collagen and polyurethane meniscal scaffolds for the treatment of partial meniscal defects. METHODS Patients affected by partial meniscal defect with intact anterior and posterior meniscal attachments and an intact rim at the circumference of the missing meniscus were included, treated with a collagen meniscal implant or with polyurethane scaffold, and clinically evaluated by analysis of the subjective International Knee Documentation Committee score, the visual analog scale score for the evaluation of knee function and symptoms, and the Tegner score to assess the activity level. RESULTS After 3 patients dropped out, a total of 47 patients, comprising 31 men and 16 women, with a mean age of 43 ± 14.1 years and mean body mass index of 25 ± 1.4, were clinically evaluated up to a mean of 10 years' follow-up. The International Knee Documentation Committee score improved from 42.9 ± 15.9 to 67.4 ± 12.4 (P < .0005) in the polyurethane implant group and from 46.8 ± 16.7 to 62.1 ± 22.6 (P < .0005) in the collagen meniscal implant group. The visual analog scale score decreased significantly from baseline values of 5.4 ± 2.3 and 4.4 ± 1.7, to 3.4 ± 2.5 and 2.7 ± 2.4, respectively, at final follow-up in the polyurethane implant (P = .002) and collagen meniscal implant (P < .0005) groups. The Tegner score improved in both groups without reaching the preinjury activity level. No significant differences in the scores were found between the polyurethane and collagen scaffold groups. A total of 10 implants failed, 5 per group, for a cumulative failure rate of 21.3%, with no differences between the 2 scaffolds. CONCLUSIONS The long-term comparison showed positive and similar results for both polyurethane- and collagen-based meniscal scaffolds, with an implant survival rate of about 80% at 10 years of follow-up and no differences in terms of pain, function, and activity level. LEVEL OF EVIDENCE Level IV, case-control comparative study.
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No differences in clinical outcome between CMI and Actifit meniscal scaffolds: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:328-348. [PMID: 33864114 DOI: 10.1007/s00167-021-06548-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the results of two meniscal scaffolds, CMI and Actifit, for the treatment of partial meniscal lesions. METHODS A systematic review was performed on the PubMed, Web of Science, Scopus, Embase, and Cochrane databases in January 2021, including randomized controlled trails (RCTs) and prospective and retrospective observational studies on the clinical results of meniscal scaffolds. A meta-analysis of the clinical results was performed; the rate of failures was recorded, as well as radiological results. The quality of the included studies was assessed with a modified Coleman Methodology Score (CMS). RESULTS The search identified 37 studies (31 in the last 10 years): 2 RCTs, 5 comparative studies, 26 prospective and 4 retrospective series on a total of 1276 patients (472 CMI, 804 Actifit). The quality of evidence was generally low. An overall significant improvement in all clinical scores was documented for both scaffolds. The meta-analysis showed no differences between the two scaffolds in terms of patient reported outcome measures and activity level. The meta-analysis on the risk of failures documented a risk of failures of 7% in the CMI and of 9% in the Actifit group. CONCLUSIONS There is a growing interest on the results of meniscal scaffolds, with most studies published recently. However, long-term data on the Actifit scaffold and high-level comparative studies are missing. Both CMI and Actifit offered good clinical results with a significant and comparable improvement in symptoms and function, and with a low number of failures over time. Accordingly, with the proper indication, their use may be encouraged in the clinical practice. LEVEL OF EVIDENCE Level IV.
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Wu J, Xu J, Huang Y, Tang L, Hong Y. Regional-specific meniscal extracellular matrix hydrogels and their effects on cell-matrix interactions of fibrochondrocytes. Biomed Mater 2021; 17. [PMID: 34883474 DOI: 10.1088/1748-605x/ac4178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023]
Abstract
Decellularized meniscal extracellular matrix (ECM) material holds great potential for meniscus repair and regeneration. Particularly, injectable ECM hydrogel is highly desirable for the minimally invasive treatment of irregularly shaped defects. Although regional-specific variations of the meniscus are well documented, no ECM hydrogel has been reported to simulate zonally specific microenvironments of the native meniscus. To fill the gap, different (outer, middle, and inner) zones of porcine menisci were separately decellularized. Then the regionally decellularized meniscal ECMs were solubilized by pepsin digestion, neutralized, and then form injectable hydrogels. The hydrogels were characterized in gelation behaviors and mechanical properties and seeded with bovine fibrochondrocytes to evaluate the regionally biochemical effects on the cell-matrix interactions. Our results showed that the decellularized inner meniscal ECM (IM) contained the greatest glycosaminoglycan (GAG) content and the least collagen content compared with the decellularized outer meniscal ECM (OM) and middle meniscal ECM (MM). The IM hydrogel showed lower compressive strength than the OM hydrogel. When encapsulated with fibrochondrocytes, the IM hydrogel accumulated more GAG, contracted to a greater extent and reached higher compressive strength than that of the OM hydrogel at 28 days. Our findings demonstrate that the regionally specific meniscal ECMs present biochemical variation and show various effects on the cell behaviors, thus providing information on how meniscal ECM hydrogels may be utilized to reconstruct the microenvironments of the native meniscus.
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Affiliation(s)
- Jinglei Wu
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, United States of America
| | - Jiazhu Xu
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, United States of America
| | - Yihui Huang
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, United States of America
| | - Liping Tang
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, United States of America
| | - Yi Hong
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, United States of America
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Nakagawa K, Otsuki S, Murakami T, Okamoto Y, Okuno N, Wakama H, Sezaki S, Ikeda K, Okayoshi T, Neo M. Histological Analysis of the Wrapping Treatment for Meniscal Horizontal Tears in Rabbits. Cartilage 2021; 13:1551S-1561S. [PMID: 31466462 PMCID: PMC8804842 DOI: 10.1177/1947603519870838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate meniscal regeneration and prevent cartilage degeneration using wrapping treatment for meniscal horizontal tears that have been difficult to repair in rabbits. DESIGN Thirty knees from 15 Japanese white rabbits were divided into the horizontal (horizontal tears) or wrapping (horizontal tears with wrapping treatment) groups. Horizontal tears were created and wrapped with a sheet scaffold containing polyglycolic acid, polylactic acid, and polycaprolactone. The meniscus was stained with Safranin-O/Fast Green and evaluated with modified Pauli scores at 8, 12, and 16 weeks after implantation (n = 5). Cell morphology was determined with hematoxylin and eosin staining. Mature collagen was confirmed with Picrosirius Red staining. Furthermore, immunohistochemical analysis of inducible nitric oxide synthase (iNOS) for inflammation, Ki-67 for proliferation, and type II collagen for regeneration was performed. Medial femoral cartilage was stained with Safranin-O/Fast Green and evaluated with the Osteoarthritis Research Society International score at 8 and 16 weeks. RESULTS The wrapping group had significantly better regeneration than the horizontal group, especially at 16 weeks (P < 0.05). Wrapping treatment induced fibrochondrocyte-like cells at 16 weeks. After wrapping treatment, iNOS was overexpressed at 8 weeks, Ki-67 at 8 and 12 weeks, and type II collagen at 16 weeks. Cartilage degeneration in the wrapping group did not progress significantly compared with that in the horizontal group at 16 weeks (P < 0.05). CONCLUSIONS Wrapping treatment for meniscal horizontal tears induced meniscal regeneration as the sheet scaffold might induce intrinsic and extrinsic repair. Regaining the meniscal function by the wrapping treatment prevented cartilage degeneration.
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Affiliation(s)
- Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan,Shuhei Otsuki, Department of Orthopedic
Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-city, Osaka
569-8686, Japan.
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shunsuke Sezaki
- Department of QOL Research Center
Laboratory, Gunze Limited, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
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Veronesi F, Di Matteo B, Vitale N, Filardo G, Visani A, Kon E, Fini M. Biosynthetic scaffolds for partial meniscal loss: A systematic review from animal models to clinical practice. Bioact Mater 2021; 6:3782-3800. [PMID: 33898878 PMCID: PMC8044909 DOI: 10.1016/j.bioactmat.2021.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Acute or degenerative meniscus tears are the most common knee lesions. Meniscectomy provides symptomatic relief and functional recovery only in the short- to mid-term follow-up but significantly increases the risk of osteoarthritis. For this reason, preserving the meniscus is key, although it remains a challenge. Allograft transplants present many disadvantages, so during the last 20 years preclinical and clinical research focused on developing and investigating meniscal scaffolds. The aim of this systematic review was to collect and evaluate all the available evidence on biosynthetic scaffolds for meniscus regeneration both in vivo and in clinical studies. Three databases were searched: 46 in vivo preclinical studies and 30 clinical ones were found. Sixteen natural, 15 synthetic, and 15 hybrid scaffolds were studied in vivo. Among them, only 2 were translated into clinic: the Collagen Meniscus Implant, used in 11 studies, and the polyurethane-based scaffold Actifit®, applied in 19 studies. Although positive outcomes were described in the short- to mid-term, the number of concurrent procedures and the lack of randomized trials are the major limitations of the available clinical literature. Few in vivo studies also combined the use of cells or growth factors, but these augmentation strategies have not been applied in the clinical practice yet. Current solutions offer a significant but incomplete clinical improvement, and the regeneration potential is still unsatisfactory. Building upon the overall positive results of these "old" technologies to address partial meniscal loss, further innovation is urgently needed in this field to provide patients better joint sparing treatment options.
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Affiliation(s)
- F. Veronesi
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - B. Di Matteo
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- First Moscow State Medical University - Sechenov University, Bol'shaya Pirogovskaya Ulitsa, 19c1, 119146, Moscow, Russia
| | - N.D. Vitale
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - G. Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - A. Visani
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E. Kon
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M. Fini
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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12
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Abstract
The menisci are fibrocartilaginous semilunar structures in the knee that provide load support. Injury to the meniscus alters its load sharing and biomechanical profile. Knee arthroscopy with meniscus débridement is the most common orthopaedic surgical procedure done in the United States. The current goals of meniscal surgery are to preserve native meniscal tissue and maintain structural integrity. Meniscal preservation is critical to maintain the normal mechanics and homeostasis of the knee; however, it is not always feasible because of the structure's poor blood supply and often requires removal of irreparable tissue with meniscectomy. Efforts have increasingly focused on the promotion of meniscal healing and the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. The purpose of this article was to review current and future meniscal salvage treatments such as meniscus transplant, synthetic arthroplasty, and possible bioprinted meniscus to allow patients to maintain quality of life, limit pain, and delay osteoarthritis.
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13
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Matsubara N, Nakasa T, Ishikawa M, Tamura T, Adachi N. Autologous meniscus fragments embedded in atelocollagen gel enhance meniscus repair in a rabbit model. Bone Joint Res 2021; 10:269-276. [PMID: 33827268 PMCID: PMC8076997 DOI: 10.1302/2046-3758.104.bjr-2019-0359.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aims Meniscal injuries are common and often induce knee pain requiring surgical intervention. To develop effective strategies for meniscus regeneration, we hypothesized that a minced meniscus embedded in an atelocollagen gel, a firm gel-like material, may enhance meniscus regeneration through cell migration and proliferation in the gel. Hence, the objective of this study was to investigate cell migration and proliferation in atelocollagen gels seeded with autologous meniscus fragments in vitro and examine the therapeutic potential of this combination in an in vivo rabbit model of massive meniscus defect. Methods A total of 34 Japanese white rabbits (divided into defect and atelocollagen groups) were used to produce the massive meniscus defect model through a medial patellar approach. Cell migration and proliferation were evaluated using immunohistochemistry. Furthermore, histological evaluation of the sections was performed, and a modified Pauli’s scoring system was used for the quantitative evaluation of the regenerated meniscus. Results In vitro immunohistochemistry revealed that the meniscus cells migrated from the minced meniscus and proliferated in the gel. Furthermore, histological analysis suggested that the minced meniscus embedded in the atelocollagen gel produced tissue resembling the native meniscus in vivo. The minced meniscus group also had a higher Pauli’s score compared to the defect and atelocollagen groups. Conclusion Our data show that cells in minced meniscus can proliferate, and that implantation of the minced meniscus within atelocollagen induces meniscus regeneration, thus suggesting a novel therapeutic alternative for meniscus tears. Cite this article: Bone Joint Res 2021;10(4):269–276.
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Affiliation(s)
- Norimasa Matsubara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Artifical Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takayuki Tamura
- Department of Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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14
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Elkhenany HA, Szojka ARA, Mulet-Sierra A, Liang Y, Kunze M, Lan X, Sommerfeldt M, Jomha NM, Adesida AB. Bone Marrow Mesenchymal Stem Cell-Derived Tissues are Mechanically Superior to Meniscus Cells. Tissue Eng Part A 2020; 27:914-928. [PMID: 32940137 DOI: 10.1089/ten.tea.2020.0183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bone marrow-derived mesenchymal stem cells (BMSCs) have the potential to form the mechanically responsive matrices of joint tissues, including the menisci of the knee joint. The purpose of this study is to assess BMSC's potential to engineer meniscus-like tissue relative to meniscus fibrochondrocytes (MFCs). MFCs were isolated from castoffs of partial meniscectomy from nonosteoarthritic knees. BMSCs were developed from bone marrow aspirates of the iliac crest. All cells were of human origin. Cells were cultured in type I collagen scaffolds under normoxia (21% O2) for 2 weeks followed by hypoxia (3% O2) for 3 weeks. The structural and functional assessment of the generated meniscus constructs were based on glycosaminoglycan (GAG) content, histological appearance, gene expression, and mechanical properties. The tissues formed by both cell types were histologically positive for Safranin O stain and appeared more intense in the BMSC constructs. This observation was confirmed by a 2.7-fold higher GAG content. However, there was no significant difference in collagen I (COL1A2) expression in BMSC- and MFC-based constructs (p = 0.17). The expression of collagen II (COL2A1) and aggrecan (ACAN) were significantly higher in BMSCs than MFC (p ≤ 0.05). Also, the gene expression of the hypertrophic marker collagen X (COL10A1) was 199-fold higher in BMSCs than MFC (p < 0.001). Moreover, relaxation moduli were significantly higher in BMSC-based constructs at 10-20% strain step than MFC-based constructs. BMSC-based constructs expressed higher COL2A1, ACAN, COL10A1, contained higher GAG content, and exhibited higher relaxation moduli at 10-20% strain than MFC-based construct. Impact statement Cell-based tissue engineering (TE) has the potential to produce functional tissue replacements for irreparably damaged knee meniscus. But the source of cells for the fabrication of the tissue replacements is currently unknown and of research interest in orthopedic TE. In this study, we fabricated tissue-engineered constructs using type I collagen scaffolds and two candidate cell sources in meniscus TE. We compared the mechanical properties of the tissues formed from human meniscus fibrochondrocytes and bone marrow-derived mesenchymal stem cells (BMSCs). Our data show that the tissues engineered from the BMSC are mechanically superior in relaxation modulus.
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Affiliation(s)
- Hoda A Elkhenany
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Surgery, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt
| | - Alexander R A Szojka
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aillette Mulet-Sierra
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Yan Liang
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Kunze
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Xiaoyi Lan
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Mark Sommerfeldt
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| | - Nadr M Jomha
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Adetola B Adesida
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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15
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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: 52] [Impact Index Per Article: 13.0] [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.
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16
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Grogan SP, Baek J, D'Lima DD. Meniscal tissue repair with nanofibers: future perspectives. Nanomedicine (Lond) 2020; 15:2517-2538. [PMID: 32975146 DOI: 10.2217/nnm-2020-0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The knee menisci are critical to the long-term health of the knee joint. Because of the high incidence of injury and degeneration, replacing damaged or lost meniscal tissue is extremely clinically relevant. The multiscale architecture of the meniscus results in unique biomechanical properties. Nanofibrous scaffolds are extremely attractive to replicate the biochemical composition and ultrastructural features in engineered meniscus tissue. We review recent advances in electrospinning to generate nanofibrous scaffolds and the current state-of-the-art of electrospun materials for meniscal regeneration. We discuss the importance of cellular function for meniscal tissue engineering and the application of cells derived from multiple sources. We compare experimental models necessary for proof of concept and to support translation. Finally, we discuss future directions and potential for technological innovations.
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Affiliation(s)
- Shawn P Grogan
- Shiley Center for Orthopedic Research & Education at Scripps Clinic 10666 North Torrey Pines Road, MS126, La Jolla, CA 92037, USA.,Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
| | - Jihye Baek
- Shiley Center for Orthopedic Research & Education at Scripps Clinic 10666 North Torrey Pines Road, MS126, La Jolla, CA 92037, USA.,Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
| | - Darryl D D'Lima
- Shiley Center for Orthopedic Research & Education at Scripps Clinic 10666 North Torrey Pines Road, MS126, La Jolla, CA 92037, USA.,Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
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17
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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]
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18
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Inyang AO, Vaughan CL. Functional Characteristics and Mechanical Performance of PCU Composites for Knee Meniscus Replacement. MATERIALS 2020; 13:ma13081886. [PMID: 32316407 PMCID: PMC7215399 DOI: 10.3390/ma13081886] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/14/2022]
Abstract
The potential use of fiber-reinforced based polycarbonate-urethanes (PCUs) as candidate meniscal substitutes was investigated in this study. Mechanical test pieces were designed and fabricated using a compression molding technique. Ultra-High Molecular Weight Polyethylene (UHMWPE) fibers were impregnated into PCU matrices, and their mechanical and microstructural properties evaluated. In particular, the tensile moduli of the PCUs were found unsuitable, since they were comparatively lower than that of the meniscus, and may not be able to replicate the inherent role of the meniscus effectively. However, the inclusion of fibers produced a substantial increment in the tensile modulus, to a value within a close range measured for meniscus tissues. Increments of up to 227% were calculated with a PCU fiber reinforcement composite. The embedded fibers in the PCU composites enhanced the fracture mechanisms by preventing the brittle failure and plastic deformation exhibited in fractured PCUs. The behavior of the composites in compression varied with respect to the PCU matrix materials. The mechanical characteristics demonstrated by the developed PCU composites suggest that fiber reinforcements have a considerable potential to duplicate the distinct and multifaceted biomechanical roles of the meniscus.
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19
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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: 51] [Impact Index Per Article: 12.8] [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.
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20
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Cengiz IF, Maia FR, da Silva Morais A, Silva-Correia J, Pereira H, Canadas RF, Espregueira-Mendes J, Kwon IK, Reis RL, Oliveira JM. Entrapped in cage (EiC) scaffolds of 3D-printed polycaprolactone and porous silk fibroin for meniscus tissue engineering. Biofabrication 2020; 12:025028. [PMID: 32069441 DOI: 10.1088/1758-5090/ab779f] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The meniscus has critical functions in the knee joint kinematics and homeostasis. Injuries of the meniscus are frequent, and the lack of a functional meniscus between the femur and tibial plateau can cause articular cartilage degeneration leading to osteoarthritis development and progression. Regeneration of meniscus tissue has outstanding challenges to be addressed. In the current study, novel Entrapped in cage (EiC) scaffolds of 3D-printed polycaprolactone (PCL) and porous silk fibroin were proposed for meniscus tissue engineering. As confirmed by micro-structural analysis the entrapment of silk fibroin was successful, and all scaffolds had excellent interconnectivity (≥99%). The EiC scaffolds had more favorable micro-structure compared with the PCL cage scaffolds by improving the pore size while keeping the interconnectivity almost the same. When compared with the PCL cage, the entrapment of porous silk fibroin into the PCL cage decreased the high compressive modulus in a favorable matter in the wet state thanks to the silk fibroin's high swelling properties. The in vitro studies with human stem cells or meniscocytes seeded constructs, demonstrated that the EiC scaffolds had superior cell adhesion, metabolic activity, and proliferation compared to the PCL cage scaffolds. Upon subcutaneous implantation of scaffolds in nude mice, all groups were free of adverse incidents, and mildly invaded by inflammatory cells with neovascularization, while the EiC scaffolds showed better tissue infiltration. The results of this work indicated that the EiC scaffolds of PCL and silk fibroin are favorable for meniscus tissue engineering, and the findings are encouraging for further studies using a larger animal model.
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Affiliation(s)
- 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, 4805-017 Barco, Guimarães, Portugal. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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21
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Anderson-Baron M, Kunze M, Mulet-Sierra A, Adesida AB. Effect of cell seeding density on matrix-forming capacity of meniscus fibrochondrocytes and nasal chondrocytes in meniscus tissue engineering. FASEB J 2020; 34:5538-5551. [PMID: 32090374 DOI: 10.1096/fj.201902559r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022]
Abstract
The presence of intact menisci is imperative for the proper function of the knee joint. Meniscus injuries are often treated by the surgical removal of the damaged tissue, which increases the likelihood of post-traumatic osteoarthritis. Tissue engineering holds great promise in producing viable engineered meniscal tissue for implantation using the patient's own cells; however, the cell source for producing the engineered tissue is unclear. Nasal chondrocytes (NC) possess many attractive features for engineering meniscus. However, in order to validate the use of NC for engineering meniscus fibrocartilage, a thorough comparison of NC and meniscus fibrochondrocytes (MFC) must be considered. Our study presents an analysis of the relative features of NC and MFC and their respective chondrogenic potential in a pellet culture model. We showed considerable differences in the cartilage tissue formed by the two different cell types. Our data showed that NC were more proliferative in culture, deposited more extracellular matrix, and showed higher expression of chondrogenic genes than MFC. Overall, our data suggest that NC produce superior cartilage tissue to MFC in a pellet culture model. In addition, NCs produce higher quality cartilage tissue at higher cell seeding densities during cell expansion.
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Affiliation(s)
- Matthew Anderson-Baron
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
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22
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Veronesi F, Vandenbulcke F, Ashmore K, Di Matteo B, Nicoli Aldini N, Martini L, Fini M, Kon E. Meniscectomy-induced osteoarthritis in the sheep model for the investigation of therapeutic strategies: a systematic review. INTERNATIONAL ORTHOPAEDICS 2020; 44:779-793. [PMID: 32025798 DOI: 10.1007/s00264-020-04493-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE One of the major risk factors for OA is meniscectomy (Mx) that causes a rapid and progressive OA. Mx has been employed in various animal models, especially in large ones, to study preclinical safety and strategy effectiveness to counteract OA. The aim of the present study is to review in vivo studies, performed in sheep and published in the last ten years. METHODS The search strategy was performed in three websites: www.scopus.com, www.pubmed.com, and www.webofknowledge.com, using "Meniscectomy and osteoarthritis in sheep" keywords. RESULTS The 25 included studies performed unilateral total medial Mx (MMx), unilateral partial MMx, bilateral MMx, unilateral total lateral Mx (LMx), unilateral partial LMx, and bilateral LMx and MMx combined with anterior cruciate ligament transaction. The most frequently performed is the unilateral total MMx that increases changes in cartilage and subchondral bone more than the other techniques. Gross evaluations, histology, radiography, and biochemical tests are used to assess the degree of OA. The most widely tested treatments are related to scaffolds with or without mesenchymal stem cells. CONCLUSION OA therapeutic strategies require the use of large animal models due to similarities with human joint anatomy. A protocol for future in vivo studies on post-traumatic OA is clarified.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy.
| | - Filippo Vandenbulcke
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Kevin Ashmore
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Nicolò Nicoli Aldini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy
| | - Lucia Martini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy
| | - Elizaveta Kon
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano - Milan, Italy
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23
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Chen M, Feng Z, Guo W, Yang D, Gao S, Li Y, Shen S, Yuan Z, Huang B, Zhang Y, Wang M, Li X, Hao L, Peng J, Liu S, Zhou Y, Guo Q. PCL-MECM-Based Hydrogel Hybrid Scaffolds and Meniscal Fibrochondrocytes Promote Whole Meniscus Regeneration in a Rabbit Meniscectomy Model. ACS APPLIED MATERIALS & INTERFACES 2019; 11:41626-41639. [PMID: 31596568 DOI: 10.1021/acsami.9b13611] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Regeneration of an injured meniscus continues to be a scientific challenge due to its poor self-healing potential. Tissue engineering provides an avenue for regenerating a severely damaged meniscus. In this study, we first investigated the superiority of five concentrations (0%, 0.5%, 1%, 2%, and 4%) of meniscus extracellular matrix (MECM)-based hydrogel in promoting cell proliferation and the matrix-forming phenotype of meniscal fibrochondrocytes (MFCs). We found that the 2% group strongly enhanced chondrogenic marker mRNA expression and cell proliferation compared to the other groups. Moreover, the 2% group showed the highest glycosaminoglycan (GAG) and collagen production by day 14. We then constructed a hybrid scaffold by 3D printing a wedge-shaped poly(ε-caprolactone) (PCL) scaffold as a backbone, followed by injection with the optimized MECM-based hydrogel (2%), which served as a cell delivery system. The hybrid scaffold (PCL-hydrogel) clearly yielded favorable biomechanical properties close to those of the native meniscus. Finally, PCL scaffold, PCL-hydrogel, and MFCs-loaded hybrid scaffold (PCL-hydrogel-MFCs) were implanted into the knee joints of New Zealand rabbits that underwent total medial meniscectomy. Six months postimplantation we found that the PCL-hydrogel-MFCs group exhibited markedly better gross appearance and cartilage protection than the PCL scaffold and PCL-hydrogel groups. Moreover, the regenerated menisci in the PCL-hydrogel-MFCs group had similar histological structures, biochemical contents, and biomechanical properties as the native menisci in the sham operation group. In conclusion, PCL-MECM-based hydrogel hybrid scaffold seeded with MFCs can successfully promote whole meniscus regeneration, and cell-loaded PCL-MECM-based hydrogel hybrid scaffold may be a promising strategy for meniscus regeneration in the future.
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Affiliation(s)
- Mingxue Chen
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital , Peking University Fourth School of Clinical Medicine , No. 31 Xinjiekou East Street, Xicheng District , Beijing 100035 , People's Republic of China
| | - Zhaoxuan Feng
- School of Material Science and Engineering , University of Science and Technology Beijing , No. 30 Xueyuan Road, Haidian District , Beijing 100083 , People's Republic of China
| | - Weimin Guo
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Orthopaedic Surgery, First Affiliated Hospital , Sun Yat-sen University , No. 58 Zhongshan Second Road, Yuexiu District , Guangzhou , Guangdong 510080 , People's Republic of China
| | - Dejin Yang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital , Peking University Fourth School of Clinical Medicine , No. 31 Xinjiekou East Street, Xicheng District , Beijing 100035 , People's Republic of China
| | - Shuang Gao
- Academy for Advanced Interdisciplinary Studies , Peking University , No. 5 Yiheyuan Road, Haidian District , Beijing 100871 , People's Republic of China
| | - Yangyang Li
- Academy for Advanced Interdisciplinary Studies , Peking University , No. 5 Yiheyuan Road, Haidian District , Beijing 100871 , People's Republic of China
| | - Shi Shen
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Bone and Joint Surgery , The Affiliated Hospital of Southwest Medical University , No. 25 Taiping Road , Luzhou 646000 , People's Republic of China
| | - Zhiguo Yuan
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Bo Huang
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Bone and Joint Surgery , The Affiliated Hospital of Southwest Medical University , No. 25 Taiping Road , Luzhou 646000 , People's Republic of China
| | - Yu Zhang
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Mingjie Wang
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Xu Li
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Libo Hao
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Jiang Peng
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Shuyun Liu
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital , Peking University Fourth School of Clinical Medicine , No. 31 Xinjiekou East Street, Xicheng District , Beijing 100035 , People's Republic of China
| | - Quanyi Guo
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
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Nakagawa Y, Fortier LA, Mao JJ, Lee CH, Goodale MB, Koff MF, Uppstrom TJ, Croen B, Wada S, Carballo CB, Potter HG, Rodeo SA. Long-term Evaluation of Meniscal Tissue Formation in 3-dimensional-Printed Scaffolds With Sequential Release of Connective Tissue Growth Factor and TGF-β3 in an Ovine Model. Am J Sports Med 2019; 47:2596-2607. [PMID: 31386550 PMCID: PMC7422478 DOI: 10.1177/0363546519865513] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Artificial meniscal scaffolds are being developed to prevent development of osteoarthritis after meniscectomy. Previously, it was reported that 3-dimensional (3D) anatomic scaffolds loaded with connective tissue growth factor (CTGF) and transforming growth factor β3 (TGF-β3) achieved meniscal regeneration in an ovine model. This was a relatively short-term study (3 months postoperative), and outcome analyses did not include magnetic resonance imaging (MRI). PURPOSE To evaluate long-term outcome of meniscal replacement with growth factor-laden poly-ε-caprolactone (PCL) scaffolds. STUDY DESIGN Controlled laboratory study. METHODS Anatomically shaped ovine meniscal scaffolds were fabricated from PCL with a 3D printer based on MRI data. Skeletally mature sheep (N = 34) were randomly allocated to 3 groups: scaffold without growth factor (0-µg group), scaffold with CTGF microspheres (µS) (5 µg) + TGF-β3 µS (5 µg) (5-µg group), and scaffold with CTGF µS (10 µg) + TGF-β3 µS (10 µg) (10-µg group). Unilateral medial meniscal replacement was performed. Animals were euthanized at 6 or 12 months. Regenerated meniscus, articular cartilage status, and synovial reaction were evaluated quantitatively with gross inspection, histology, and MRI. Kruskal-Wallis and Dunn tests were used to compare the 3 groups. RESULTS Remnants of the PCL scaffold were evident in the 6-month specimens and were decreased but still present at 12 months in most animals. There were no significant differences among groups in gross inspection, histology, or MRI for either meniscal regeneration or articular cartilage protection. All experimental groups exhibited articular cartilage degeneration as compared with control (nonoperated). In terms of synovitis, there were no clear differences among groups, suggesting that growth factors did not increase inflammation and fibrosis. MRI revealed that meniscal extrusion was observed in most animals (82.7%). CONCLUSION Previously, the combination of CTGF and TGF-β3 was shown to stimulate mesenchymal stem cells into a fibrochondrocyte lineage. CTGF and TGF-β3 did not aggravate synovitis, suggesting no adverse response to the combination of 3D-printed PCL scaffold combined with CTGF and TGF-β3. Further work will be required to improve scaffold fixation to avoid meniscal extrusion. CLINICAL RELEVANCE A significant advantage of this technique is the ability to print custom-fit scaffolds from MRI-generated templates. In addition, average-size menisci could be printed and available for off-the-shelf applications. Based on the 1-year duration of the study, the approach appears to be promising for meniscal regeneration in humans.
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Affiliation(s)
- Yusuke Nakagawa
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA., Department of Cartilage Regeneration, Graduate
School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Lisa A. Fortier
- Department of Clinical Sciences, College of
Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Jeremy J. Mao
- Tissue Engineering and Regenerative Medicine
Laboratory, Columbia University Medical Center, Columbia University, New York, New
York, USA
| | - Chang Hun Lee
- Tissue Engineering and Regenerative Medicine
Laboratory, Columbia University Medical Center, Columbia University, New York, New
York, USA
| | - Margaret B. Goodale
- Department of Clinical Sciences, College of
Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for
Special Surgery, New York, New York, USA
| | - Tyler J. Uppstrom
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Brett Croen
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Susumu Wada
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Camila B. Carballo
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for
Special Surgery, New York, New York, USA
| | - Scott A. Rodeo
- Address correspondence to Scott A. Rodeo, MD,
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA., Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
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25
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Pereira H, Fatih Cengiz I, Gomes S, Espregueira-Mendes J, Ripoll PL, Monllau JC, Reis RL, Oliveira JM. Meniscal allograft transplants and new scaffolding techniques. EFORT Open Rev 2019; 4:279-295. [PMID: 31210969 PMCID: PMC6549113 DOI: 10.1302/2058-5241.4.180103] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical management of meniscal injuries has changed radically in recent years. We have moved from the model of systematic tissue removal (meniscectomy) to understanding the need to preserve the tissue.Based on the increased knowledge of the basic science of meniscal functions and their role in joint homeostasis, meniscus preservation and/or repair, whenever indicated and possible, are currently the guidelines for management.However, when repair is no longer possible or when facing the fact of the previous partial, subtotal or total loss of the meniscus, meniscus replacement has proved its clinical value. Nevertheless, meniscectomy remains amongst the most frequent orthopaedic procedures.Meniscus replacement is currently possible by means of meniscal allograft transplantation (MAT) which provides replacement of the whole meniscus with or without bone plugs/slots. Partial replacement has been achieved by means of meniscal scaffolds (mainly collagen or polyurethane-based). Despite the favourable clinical outcomes, it is still debatable whether MAT is capable of preventing progression to osteoarthritis. Moreover, current scaffolds have shown some fundamental limitations, such as the fact that the newly formed tissue may be different from the native fibrocartilage of the meniscus.Regenerative tissue engineering strategies have been used in an attempt to provide a new generation of meniscal implants, either for partial or total replacement. The goal is to provide biomaterials (acellular or cell-seeded constructs) which provide the biomechanical properties but also the biological features to replace the loss of native tissue. Moreover, these approaches include possibilities for patient-specific implants of correct size and shape, as well as advanced strategies combining cells, bioactive agents, hydrogels or gene therapy.Herein, the clinical evidence and tips concerning MAT, currently available meniscus scaffolds and future perspectives are discussed. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180103.
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Affiliation(s)
- Hélder Pereira
- Orthopedic Department of Póvoa de Varzim - Vila do Conde Hospital Centre, Vila do Conde, Portugal
- Ripoll y De Prado Sports Clinic, Murcia-Madrid, FIFA Medical Centre of Excellence, Madrid, Spain
- International Centre of Sports Traumatology of the Ave, Vila do Conde, Portugal
- 3Bs 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, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ibrahim Fatih Cengiz
- 3Bs 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, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sérgio Gomes
- International Centre of Sports Traumatology of the Ave, Vila do Conde, Portugal
| | - João Espregueira-Mendes
- 3Bs 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, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
- Orthopedic Department, University of Minho, Braga, Portugal
| | - Pedro L. Ripoll
- Ripoll y De Prado Sports Clinic, Murcia-Madrid, FIFA Medical Centre of Excellence, Madrid, Spain
| | - Joan C. Monllau
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rui L. Reis
- 3Bs 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, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal
| | - J. Miguel Oliveira
- 3Bs 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, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal
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Kawaguchi Y, Kondo E, Iwasaki N, Tanaka Y, Yagi T, Yasuda K. Autologous living chondrocytes contained in the meniscal matrix play an important role in in vivo meniscus regeneration induced by in situ meniscus fragment implantation. Orthop Traumatol Surg Res 2019; 105:683-690. [PMID: 31006645 DOI: 10.1016/j.otsr.2018.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Implantation of autogenous meniscal fragments wrapped with a fascia sheath significantly enhances fibrocartilage regeneration in vivo in defect cases at 12 weeks after implantation. The specific effects of the implanted autologous living chondrocytes and meniscal matrix have not been elucidated, however. The aim of this study was to clarify the role of autologous living chondrocytes contained in the meniscal matrix in in vivo meniscus regeneration induced by in situ meniscus fragment implantation. HYPOTHESIS Implantation of meniscus fragments containing autologous living chondrocytes may result in significant in vivo meniscus regeneration. MATERIALS AND METHODS Seventy-five rabbits were used in this study. A partial meniscectomy of the anterior one-third of the medial meniscus including the part of the anterior horn was performed. The rabbits were divided into 3 groups. In Group I, no treatment was applied to the defect. In Group II, the autogenous meniscal fragments devitalized by freeze-thaw treatment were reimplanted into the defect. In Group III, the autogenous meniscal fragments were reimplanted. In each group, the defect was covered with a fascia. Five rabbits from each group were subjected to morphologic and histologic evaluations at 3, 6, and 12 weeks, and 5 rabbits from each group were subjected to biomechanical evaluations at 6 and 12 weeks. RESULTS Histologically, no cells were seen in the grafted meniscal fragments at 3 weeks in Group II, whereas chondrocytes in the grafted meniscal fragments were alive at 3 weeks in Group III. Histologic and biomechanical data for Group II were slightly but significantly better than those of Group I at 12 weeks after implantation (p=0.007 and p=0.002, respectively), whereas the data for Group III were significantly superior to those of Groups I and II at 12 weeks (p<0.0014 and p<0.0029, respectively). DISCUSSIONS Grafted autologous living chondrocytes contained in the meniscal matrix play an important role in in vivo meniscus regeneration induced by in situ meniscus fragment implantation. STUDY DESIGN II, Controlled laboratory study.
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Affiliation(s)
- Yasuyuki Kawaguchi
- Department of Sports Medicine and Joint Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Sports and Arthroscopy Center, Hanna Central Hospital, Ikoma, Nara, Japan
| | - Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tomonori Yagi
- Knee Research Centre, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Kazunori Yasuda
- Department of Sports Medicine and Joint Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Knee Research Centre, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan
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27
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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: 55] [Impact Index Per Article: 11.0] [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.
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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.
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Filardo G, Petretta M, Cavallo C, Roseti L, Durante S, Albisinni U, Grigolo B. Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold. Bone Joint Res 2019; 8:101-106. [PMID: 30915216 PMCID: PMC6397325 DOI: 10.1302/2046-3758.82.bjr-2018-0134.r1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives Meniscal injuries are often associated with an active lifestyle. The damage of meniscal tissue puts young patients at higher risk of undergoing meniscal surgery and, therefore, at higher risk of osteoarthritis. In this study, we undertook proof-of-concept research to develop a cellularized human meniscus by using 3D bioprinting technology. Methods A 3D model of bioengineered medial meniscus tissue was created, based on MRI scans of a human volunteer. The Digital Imaging and Communications in Medicine (DICOM) data from these MRI scans were processed using dedicated software, in order to obtain an STL model of the structure. The chosen 3D Discovery printing tool was a microvalve-based inkjet printhead. Primary mesenchymal stem cells (MSCs) were isolated from bone marrow and embedded in a collagen-based bio-ink before printing. LIVE/DEAD assay was performed on realized cell-laden constructs carrying MSCs in order to evaluate cell distribution and viability. Results This study involved the realization of a human cell-laden collagen meniscus using 3D bioprinting. The meniscus prototype showed the biological potential of this technology to provide an anatomically shaped, patient-specific construct with viable cells on a biocompatible material. Conclusion This paper reports the preliminary findings of the production of a custom-made, cell-laden, collagen-based human meniscus. The prototype described could act as the starting point for future developments of this collagen-based, tissue-engineered structure, which could aid the optimization of implants designed to replace damaged menisci. Cite this article: G. Filardo, M. Petretta, C. Cavallo, L. Roseti, S. Durante, U. Albisinni, B. Grigolo. Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold. Bone Joint Res 2019;8:101–106. DOI: 10.1302/2046-3758.82.BJR-2018-0134.R1.
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Affiliation(s)
- G Filardo
- Applied and Translational Research (ATR) Center, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Petretta
- Laboratory RAMSES, Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; RegenHu Ltd, Villaz-St-Pierre, Switzerland
| | - C Cavallo
- Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Roseti
- Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Durante
- Struttura Complessa Radiologia Diagnostica ed Interventistica, Dipartimento Patologie Ortopediche-Traumatologiche Complesse, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - U Albisinni
- Struttura Complessa Radiologia Diagnostica ed Interventistica, Dipartimento Patologie Ortopediche-Traumatologiche Complesse, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - B Grigolo
- Laboratorio RAMSES, Rizzoli Research, Innovation & Technology Department (RIT), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ghodbane SA, Brzezinski A, Patel JM, Plaff WH, Marzano KN, Gatt CJ, Dunn MG. Partial Meniscus Replacement with a Collagen-Hyaluronan Infused Three-Dimensional Printed Polymeric Scaffold. Tissue Eng Part A 2019; 25:379-389. [PMID: 30351200 PMCID: PMC6916120 DOI: 10.1089/ten.tea.2018.0160] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022] Open
Abstract
IMPACT STATEMENT The only FDA-approved partial meniscus scaffold, the Collagen Meniscus Implant (CMI), is not approved for reimbursement by government and only reimbursable by certain private insurers. Scaffolds with improved mechanical properties and greater efficacy are needed. A previous study (Ghodbane, et al. DOI: 10.1002/jbm.b.34331) demonstrated the ability of our novel acellular, off-the shelf scaffold to restore knee biomechanics following partial meniscectomy, which could potentially decrease the risk of osteoarthritis following partial meniscectomy, providing the motivation for this study. This article presents a first-in-animal feasibility study.
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Affiliation(s)
- Salim A. Ghodbane
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
| | - Jay M. Patel
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - William H. Plaff
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kristen N. Marzano
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
| | - Charles J. Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Michael G. Dunn
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Ghodbane SA, Patel JM, Brzezinski A, Lu TM, Gatt CJ, Dunn MG. Biomechanical characterization of a novel collagen-hyaluronan infused 3D-printed polymeric device for partial meniscus replacement. J Biomed Mater Res B Appl Biomater 2019; 107:2457-2465. [PMID: 30775847 DOI: 10.1002/jbm.b.34336] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/08/2018] [Accepted: 01/26/2019] [Indexed: 12/21/2022]
Abstract
The menisci transmit load by increasing the contact area and decreasing peak contact stresses on the articular surfaces. Meniscal lesions are among the most common orthopedic injuries, and resulting meniscectomies are associated with adverse polycaprolactone contact mechanics changes and, ultimately, an increased likelihood of osteoarthritis. Meniscus scaffolds were fabricated by 3D-printing a network of circumferential and radial filaments of resorbable polymer (poly(desaminotyrosyl-tyrosine dodecyl ester dodecanoate)) and infused with collagen-hyaluronan. The scaffold demonstrated an instantaneous compressive modulus (1.66 ± 0.44 MPa) comparable to native meniscus (1.52 ± 0.59 MPa). The scaffold aggregate modulus (1.33 ± 0.51 MPa) was within 2% of the native value (1.31 ± 0.36 MPa). In tension, the scaffold displayed a comparable stiffness to native tissue (127.6-97.1 N/mm) and an ultimate load of 33% of the native value. Suture pull-out load of scaffolds (83.1 ± 10.0 N) was within 10% of native values (91.5 ± 15.4 N). Contact stress analysis demonstrated the scaffold reduced peak contact stress by 60-67% and increased contact area by 38%, relative to partial meniscectomy. This is the first meniscal scaffold to match both the axial compressive properties and the circumferential tensile stiffness of the native meniscus. The improvement of joint contact mechanics, relative to partial meniscectomy alone, motivates further investigation using a large animal model. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2457-2465, 2019.
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Affiliation(s)
- Salim A Ghodbane
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Jay M Patel
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Tyler M Lu
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Michael G Dunn
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Inyang AO, Abdalrahman T, Bezuidenhout D, Bowen J, Vaughan CL. Suitability of developed composite materials for meniscal replacement: Mechanical, friction and wear evaluation. J Mech Behav Biomed Mater 2018; 89:217-226. [PMID: 30296703 DOI: 10.1016/j.jmbbm.2018.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
The meniscus is a complex and frequently damaged tissue which requires a substitute capable of reproducing similar biomechanical functions. This study aims to develop a synthetic meniscal substitute that can mimic the function of the native meniscus. Medical grade silicones reinforced with nylon were fabricated using compression moulding and evaluated for mechanical and tribological properties. The optimal properties were obtained with tensile modulus increased considerably from 10.7 ± 2.9 MPa to 114.6 ± 20.9 MPa while compressive modulus was found to reduce from 2.5 ± 0.6 MPa to 0.7 ± 0.3 MPa. Using a tribometer, the coefficient of friction of 0.08 ± 0.02 was measured at the end of the 100,000 cycles. The developed composite could be an auspicious substitute for the native meniscus and the knowledge gained from this study is useful as it enhances the understanding of a potentially suitable material for meniscal implants.
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Affiliation(s)
- Adijat Omowumi Inyang
- Division of Biomedical Engineering, Human Biology Department, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
| | - Tamer Abdalrahman
- Division of Biomedical Engineering, Human Biology Department, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
| | - Deon Bezuidenhout
- Cardiovascular Research Unit, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
| | - James Bowen
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Chistopher Leonard Vaughan
- Division of Biomedical Engineering, Human Biology Department, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
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Cell-Free Strategies for Repair and Regeneration of Meniscus Injuries through the Recruitment of Endogenous Stem/Progenitor Cells. Stem Cells Int 2018; 2018:5310471. [PMID: 30123286 PMCID: PMC6079391 DOI: 10.1155/2018/5310471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022] Open
Abstract
The meniscus plays a vital role in protecting the articular cartilage of the knee joint. The inner two-thirds of the meniscus are avascular, and injuries to this region often fail to heal without intervention. The use of tissue engineering and regenerative medicine techniques may offer novel and effective approaches to repairing meniscal injuries. Meniscal tissue engineering and regenerative medicine typically use one of two techniques, cell-based or cell-free. While numerous cell-based strategies have been applied to repair and regenerate meniscal defects, these techniques possess certain limitations including cellular contamination and an increased risk of disease transmission. Cell-free strategies attempt to repair and regenerate the injured tissues by recruiting endogenous stem/progenitor cells. Cell-free strategies avoid several of the disadvantages of cell-based techniques and, therefore, may have a wider clinical application. This review first compares cell-based to cell-free techniques. Next, it summarizes potential sources for endogenous stem/progenitor cells. Finally, it discusses important recruitment factors for meniscal repair and regeneration. In conclusion, cell-free techniques, which focus on the recruitment of endogenous stem and progenitor cells, are growing in efficacy and may play a critical role in the future of meniscal repair and regeneration.
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Patel JM, Ghodbane SA, Brzezinski A, Gatt CJ, Dunn MG. Tissue-Engineered Total Meniscus Replacement With a Fiber-Reinforced Scaffold in a 2-Year Ovine Model. Am J Sports Med 2018; 46:1844-1856. [PMID: 29953287 DOI: 10.1177/0363546517752668] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscus injuries and associated meniscectomies cause patients long-term pain and discomfort and can lead to joint deterioration. PURPOSE To evaluate a collagen-hyaluronan sponge reinforced with synthetic resorbable polymer fiber for total meniscus reconstruction in a long-term ovine model. STUDY DESIGN Controlled laboratory study. METHODS Eleven skeletally mature sheep were implanted with the total meniscus scaffold. At 2 years, explants were evaluated biologically (radial/circumferential histology, immunofluorescence) and mechanically (compression, tension), and articular surfaces were examined for damage. RESULTS The fiber-reinforced scaffold induced formation of functional neomeniscus tissue that was intact in 8 of 11 animals. The implant was remodeled into organized circumferentially aligned collagen bundles to resist meniscus hoop stresses. Moreover, type II collagen and proteoglycan deposition near the inner margin suggested a direct response to compressive stresses and confirmed fibrocartilage formation. Cartilage damage was observed, but end-stage (severe) joint deterioration associated with meniscectomy was avoided, even with limitations regarding the ovine surgical procedure and postoperative care. CONCLUSION A fiber-reinforced total meniscus replacement device induces formation of functional neomeniscus tissue that has the potential to prevent catastrophic joint deterioration associated with meniscectomy. CLINICAL RELEVANCE An off-the-shelf meniscus device that can be remodeled into functional tissue and thus prevent or delay the onset of osteoarthritis could address a widespread clinical need after meniscus injury.
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Affiliation(s)
- Jay M Patel
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA.,McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Salim A Ghodbane
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Michael G Dunn
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
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Patel JM, Brzezinski A, Raole DA, Dunn MG, Gatt CJ. Interference Screw Versus Suture Endobutton Fixation of a Fiber-Reinforced Meniscus Replacement Device in a Human Cadaveric Knee Model. Am J Sports Med 2018; 46:2133-2141. [PMID: 29847143 DOI: 10.1177/0363546518773737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal lesions represent one of the most common intra-articular knee injuries. Meniscus replacement devices are needed to restore load distribution and knee stability after meniscectomy. Fixation of these devices is crucial to the generation of hoop stresses and the distribution of loads in the joint. PURPOSE To evaluate 2 different fixation techniques (suture endobutton and interference screw) for implantation of a novel meniscus device. STUDY DESIGN Controlled laboratory study. METHODS In 7 human cadaveric knees (aged 17-61 years), 1 anterior and 2 potential posterior tunnel locations were investigated, and both fixation techniques were tested in each tunnel. The native meniscus roots, devices fixed with a suture endobutton, and devices fixed with an interference screw were gripped with cryoclamps, and tibias were drilled and loaded into a custom jig. Samples were preloaded, preconditioned, loaded for 500 cycles (50-150 N), and tested in tension until failure. RESULTS For all 3 tunnels, suture fixation resulted in greater elongation (54.1%-150.7% greater; P < .05) during cyclic loading than interference screw fixation, which approximated the native roots. Both fixation techniques displayed ultimate tensile loads in the same range as native roots. However, stiffness of the suture fixation groups (36.5-41.6 N/mm) was only 28% to 37% of that of the interference screw fixation groups (98.7-131.6 N/mm), which had values approaching those of the native roots (anterior: 175.4 ± 24.2 N/mm; posterior: 157.6 ± 22.9 N/mm). CONCLUSION Interference screw fixation was found to be superior to suture fixation with regard to elongation and stiffness, a finding that should be considered in the design and implantation of novel meniscus replacement devices. CLINICAL RELEVANCE With the emergence of various devices for total meniscus replacement, the establishment of fixation strategies is crucial for the generation of tensile hoop stresses and the efficacy of these approaches.
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Affiliation(s)
- Jay M Patel
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA.,McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Deep A Raole
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Michael G Dunn
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
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A Hydrogel Meniscal Replacement: Knee Joint Pressure and Distribution in an Ovine Model Compared to Native Tissue. Ann Biomed Eng 2018; 46:1785-1796. [PMID: 29922953 DOI: 10.1007/s10439-018-2069-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
Pressure distribution of the native ovine knee meniscus was compared to a medial meniscectomy and three treatment conditions including a suture reattachment of the native tissue, an allograft, and a novel thermoplastic elastomer hydrogel (TPE) construct. The objective of this study was to assess the efficacy of a novel TPE hydrogel construct at restoring joint pressure and distribution. Limbs were loaded in uniaxial compression at 45°, 60°, and 75° flexion and from 0 to 181 kg. The medial meniscectomy decreased contact area by approximately 50% and doubled the mean and maximum pressure reading for the medial hemijoint. No treatment condition tested within this study was able to fully restore medial joint contact area and pressures to the native condition. A decrease in lateral contact area and increase in pressures with the meniscectomy was also seen; and to some degree, all reattachment and replacement conditions including the novel TPE hydrogel replacement helped to restore lateral pressures. Although the TPE construct did not perform as well as hoped in the medial compartment, it performed as well as, if not better, than the other reattachment and replacement options in the lateral. Further work is necessary to determine the best anchoring and attachment methods.
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The Radiated Deep-frozen Xenogenic Meniscal Tissue Regenerated the Total Meniscus with Chondroprotection. Sci Rep 2018; 8:9041. [PMID: 29899552 PMCID: PMC5998046 DOI: 10.1038/s41598-018-27016-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 05/14/2018] [Indexed: 12/25/2022] Open
Abstract
Meniscal allograft transplantation yields good and excellent results but is limited by donor availability. The purpose of the study was to evaluate the effectiveness of radiated deep-frozen xenogenic meniscal tissue (RDF-X) as an alternative graft choice in meniscal transplantation. The xenogenic meniscal tissues were harvested from the inner 1/3 part of the porcine meniscus and then irradiated and deeply frozen. The medial menisci of rabbits were replaced by the RDF-X. Meniscal allograft transplantation, meniscectomy and sham operation served as controls. Only a particular kind of rabbit-anti-pig antibody (molecular ranging 60–80 kD) was detected in the blood serum at week 2. The menisci of the group RDF-X grossly resembled the native tissue and the allograft meniscus with fibrocartilage regeneration at postoperative 1 year. Cell incorporation and the extracellular matrix were mostly observed at the surface and the inner 1/3 part of the newly regenerated RDF-X, which was different from the allograft. The biomechanical properties of the group RDF-X were also approximate to those of the native meniscus except for the compressive creep. In addition, chondroprotection was achieved after the RDF-X transplantation although the joint degeneration was not completely prevented. To conclude, the RDF-X could be a promising alternative for meniscal transplantation with similar tissue regeneration capacity to allograft transplantation and superior chondroprotection. The potential minor immunological rejection should be further studied before its clinical application.
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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: 38] [Impact Index Per Article: 6.3] [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.
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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.
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Tarafder S, Gulko J, Sim KH, Yang J, Cook JL, Lee CH. Engineered Healing of Avascular Meniscus Tears by Stem Cell Recruitment. Sci Rep 2018; 8:8150. [PMID: 29802356 PMCID: PMC5970239 DOI: 10.1038/s41598-018-26545-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/09/2018] [Indexed: 12/29/2022] Open
Abstract
Meniscus injuries are extremely common with approximately one million patients undergoing surgical treatment annually in the U.S. alone. Upon injury, the outer zone of the meniscus can be repaired and expected to functionally heal but tears in the inner avascular region are unlikely to heal. To date, no regenerative therapy has been proven successful for consistently promoting healing in inner-zone meniscus tears. Here, we show that controlled applications of connective tissue growth factor (CTGF) and transforming growth factor beta 3 (TGFβ3) can induce seamless healing of avascular meniscus tears by inducing recruitment and step-wise differentiation of synovial mesenchymal stem/progenitor cells (syMSCs). A short-term release of CTGF, a selected chemotactic and profibrogenic cue, successfully recruited syMSCs into the incision site and formed an integrated fibrous matrix. Sustain-released TGFβ3 then led to a remodeling of the intermediate fibrous matrix into fibrocartilaginous matrix, fully integrating incised meniscal tissues with improved functional properties. Our data may represent a novel clinically relevant strategy to improve healing of avascular meniscus tears by recruiting endogenous stem/progenitor cells.
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Affiliation(s)
- Solaiman Tarafder
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA
| | - Joseph Gulko
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA
| | - Kun Hee Sim
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA
| | - Jian Yang
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, Pennsylvania, PA, 16802-4400, USA
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics Missouri Orthopaedic institute, University of Missouri, 1100 Virginia Avenue, Columbia, Missouri, 65212, USA
| | - Chang H Lee
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA.
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Desando G, Giavaresi G, Cavallo C, Bartolotti I, Sartoni F, Nicoli Aldini N, Martini L, Parrilli A, Mariani E, Fini M, Grigolo B. Autologous Bone Marrow Concentrate in a Sheep Model of Osteoarthritis: New Perspectives for Cartilage and Meniscus Repair. Tissue Eng Part C Methods 2017; 22:608-19. [PMID: 27151837 DOI: 10.1089/ten.tec.2016.0033] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cell-based therapies are becoming a valuable tool to treat osteoarthritis (OA). This study investigated and compared the regenerative potential of bone marrow concentrate (BMC) and mesenchymal stem cells (MSC), both engineered with Hyaff(®)-11 (HA) for OA treatment in a sheep model. METHODS OA was induced via unilateral medial meniscectomy. Bone marrow was aspirated from the iliac crest, followed by concentration processes or cell isolation and expansion to obtain BMC and MSC, respectively. Treatments consisted of autologous BMC and MSC seeded onto HA. The regenerative potential of bone, cartilage, menisci, and synovia was monitored using macroscopy, histology, immunohistochemistry, and micro-computed tomography at 12 weeks post-op. Data were analyzed using the general linear model with adjusted Sidak's multiple comparison and Spearman's tests. RESULTS BMC-HA treatment showed a greater repair ability in inhibiting OA progression compared to MSC-HA, leading to a reduction of inflammation in cartilage, meniscus, and synovium. Indeed, the decrease of inflammation positively contributed to counteract the progression of fibrotic and hypertrophic processes, known to be involved in tissue failure. Moreover, the treatment with BMC-HA showed the best results in allowing meniscus regeneration. Minor healing effects were noticed at bone level for both cell strategies; however, a downregulation of subchondral bone thickness (Cs.Th) was found in both cell treatments compared to the OA group in the femur. CONCLUSION The transplantation of BMC-HA provided the best effects in supporting regenerative processes in cartilage, meniscus, and synovium and at less extent in bone. On the whole, both MSC and BMC combined with HA reduced inflammation and contributed to switch off fibrotic and hypertrophic processes. The observed regenerative potential by BMC-HA on meniscus could open new perspectives, suggesting its use not only for OA care but also for the treatment of meniscal lesions, even if further analyses are necessary to confirm its healing potential at long-term follow-up.
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Affiliation(s)
- Giovanna Desando
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Gianluca Giavaresi
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Carola Cavallo
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Isabella Bartolotti
- 4 Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Federica Sartoni
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Nicolò Nicoli Aldini
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Lucia Martini
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | | | - Erminia Mariani
- 4 Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopedic Institute , Bologna, Italy .,5 Department of Medical and Surgical Science, University of Bologna , Bologna, Italy
| | - Milena Fini
- 2 Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute , Bologna, Italy .,3 Laboratory BITTA, Rizzoli Orthopedic Institute , Bologna, Italy
| | - Brunella Grigolo
- 1 Laboratory RAMSES, Rizzoli Orthopedic Institute , Bologna, Italy .,4 Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopedic Institute , Bologna, Italy
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40
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Coculture of meniscus cells and mesenchymal stem cells in simulated microgravity. NPJ Microgravity 2017; 3:28. [PMID: 29147680 PMCID: PMC5681589 DOI: 10.1038/s41526-017-0032-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023] Open
Abstract
Simulated microgravity has been shown to enhance cartilaginous matrix formation by chondrocytes and chondrogenesis of mesenchymal stem cells (MSCs). Similarly, coculture of primary chondrocytes with MSCs has been shown as a strategy to simultaneously retain the differentiated phenotype of chondrocytes and enhance cartilaginous matrix formation. In this study, we investigated the effect of simulated microgravity on cocultures of primary human meniscus cells and adipose-derived MSCs. We used biochemical, qPCR, and immunofluorescence assays to conduct our investigation. Simulated microgravity significantly enhanced cartilaginous matrix formation in cocultures of primary meniscus cells and adipose-derived MSCs. The enhancement was accompanied by increased hypertrophic differentiation markers, COL10A1 and MMP-13, and suppression of hypertrophic differentiation inhibitor, gremlin 1 (GREM1). Co-culture of meniscal cartilage-forming cells with fat-derived stem cells can lead to enhanced cartilage matrix production when cultured under simulated microgravity. Adetola Adesida from the University of Alberta in Edmonton, Canada, and colleagues cultured two types of cells found together in the knee—cartilage-forming chondrocyte cells (taken from the meniscus) and mesenchymal stem cells (isolated from the infrapatellar fat pad)—in a rotary cell culture system designed to model weightlessness on Earth. Simulated microgravity enhanced the synergistic interaction between the two types of cells in culture, resulting in more matrix production, but it also prompted the cartilage-forming cells to differentiate towards bone-forming cells, as evidenced by gene expression analysis. These findings suggest that microgravity and simulated microgravity-based culture technologies could help bioengineers grow knee replacements for people with meniscus tears, but increased bone-directed differentiation could pose a possible problem for astronauts on prolonged missions.
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Fischenich KM, Boncella K, Lewis JT, Bailey TS, Haut Donahue TL. Dynamic compression of human and ovine meniscal tissue compared with a potential thermoplastic elastomer hydrogel replacement. J Biomed Mater Res A 2017; 105:2722-2728. [PMID: 28556414 PMCID: PMC5747566 DOI: 10.1002/jbm.a.36129] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/18/2017] [Accepted: 05/23/2017] [Indexed: 01/19/2023]
Abstract
Understanding how human meniscal tissue responds to loading regimes mimetic of daily life as well as how it compares to larger animal models is critical in the development of a functionally accurate synthetic surrogate. Seven human and eight ovine cadaveric meniscal specimens were regionally sectioned into cylinders 5 mm in diameter and 3 mm thick along with 10 polystyrene-b-polyethylene oxide block copolymer-based thermoplastic elastomer (TPE) hydrogels. Samples were compressed to 12% strain at 1 Hz for 5000 cycles, unloaded for 24 h, and then retested. No differences were found within each group between test one and test two. Human and ovine tissue exhibited no regional dependency (p < 0.05). Human samples relaxed quicker than ovine tissue or the TPE hydrogel with modulus values at cycle 50 not significantly different from cycle 5000. Ovine menisci were found to be similar to human menisci in relaxation profile but had significantly higher modulus values (3.44 MPa instantaneous and 0.61 MPa after 5000 cycles compared with 1.97 and 0.11 MPa found for human tissue) and significantly different power law fit coefficients. The TPE hydrogel had an initial modulus of 0.58 MPa and experienced less than a 20% total relaxation over the 5000. Significant differences in the magnitude of compressive modulus between human and ovine menisci were observed, however the relaxation profiles were similar. Although statistically different than the native tissues, modulus values of the TPE hydrogel material were similar to those of the human and ovine menisci, making it a material worth further investigation for use as a synthetic replacement. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2722-2728, 2017.
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Affiliation(s)
- Kristine M Fischenich
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
| | - Katie Boncella
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, 80523
| | - Jackson T Lewis
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
| | - Travis S Bailey
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
- Department of Chemical and Biological Engineering, Colorado State University, Fort Collins, Colorado, 80523
- Department of Chemistry, Colorado State University, Fort Collins, Colorado, 80523
| | - Tammy L Haut Donahue
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, 80523
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, 80523
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Vrancken ACT, Hannink G, Madej W, Verdonschot N, van Tienen TG, Buma P. In Vivo Performance of a Novel, Anatomically Shaped, Total Meniscal Prosthesis Made of Polycarbonate Urethane: A 12-Month Evaluation in Goats. Am J Sports Med 2017; 45:2824-2834. [PMID: 28719787 DOI: 10.1177/0363546517713687] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injury or loss of the meniscus generally leads to degenerative osteoarthritic changes in the knee joint. However, the treatment options for symptomatic patients with total meniscectomy are limited. Therefore, we developed a novel, anatomically shaped, total meniscal implant made of polycarbonate urethane. PURPOSE To evaluate the in vivo performance of this novel total meniscal implant. The assessment particularly focused on the implant's response to long-term physiological loading in a goat model and its chondroprotective capacity in comparison to clinically relevant controls. STUDY DESIGN Controlled laboratory study. METHODS Surgery was performed to the stifle joint of 26 female Saanen goats, subdivided into 4 groups: implant, allograft, total meniscectomy, and sham surgery. The sham group's contralateral joints served as nonoperated controls. After 12 months of follow-up, investigators evaluated implant wear, deformation, and the histopathological condition of the synovium and cartilage. RESULTS Wear of the implant's articulating surfaces was minimal, which was confirmed by the absence of wear particles in the synovial fluid. Implant deformation was limited. However, one implant failed by complete tearing of the posterior horn extension. No differences in cartilage histopathological condition were observed for the implant, allograft, and meniscectomy groups. However, locally, the cartilage scores for these groups were significantly worse than those of the nonoperated controls. CONCLUSION Whereas this study demonstrated that the novel implant is resistant to wear and that deformation after 12 months of physiological loading is acceptable, reinforcement of the implant horns is necessary to prevent horn failure. Although the implant could not protect the cartilage from developing degenerative changes, the progression of damage was similar in the allograft group. CLINICAL RELEVANCE This novel polycarbonate urethane implant may have the potential to become an alternative treatment for symptomatic patients with total meniscectomy.
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Affiliation(s)
- Anne C T Vrancken
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wojciech Madej
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nico Verdonschot
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands.,Laboratory of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Tony G van Tienen
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Orthopaedic Surgery, Kliniek ViaSana, Mill, the Netherlands
| | - Pieter Buma
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
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Brzezinski A, Ghodbane SA, Patel JM, Perry BA, Gatt CJ, Dunn MG. * The Ovine Model for Meniscus Tissue Engineering: Considerations of Anatomy, Function, Implantation, and Evaluation. Tissue Eng Part C Methods 2017; 23:829-841. [PMID: 28805136 DOI: 10.1089/ten.tec.2017.0192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Meniscus injuries represent one of the most-common intra-articular knee injuries. The current treatment options include meniscectomy and allograft transplantation, both with poor long-term outcomes. Therefore, there is a need for regenerative techniques to restore meniscal function. To preclinically test scaffolds for meniscus replacement, large animal models need to be established and standardized. This review establishes the anatomical and compositional similarities between human and sheep menisci and provides guidance for implantation and evaluation of such devices. The ovine meniscus represents a scaled-down version of the human meniscus, with only slight structural differences that can be addressed during device fabrication. Implantation protocols in sheep remain a challenge, as the meniscus cannot be visualized with the arthroscopic-assisted procedures commonly performed in human patients. Thus, we recommend the appropriate implantation protocols for meniscus visualization, ligamentous restoration, and surgical fixation of both total and partial meniscus replacement devices. Last, due to the lack of standardization in evaluation techniques, we recommend a comprehensive battery of tests to evaluate the efficacy of meniscus replacement implants. We recommend other investigators utilize these surgical and testing techniques to establish the ovine model as the gold standard for preclinical evaluation of meniscus replacement devices.
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Affiliation(s)
- Andrzej Brzezinski
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Salim A Ghodbane
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Jay M Patel
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Barbara A Perry
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Charles J Gatt
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Michael G Dunn
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
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Mechanical function near defects in an aligned nanofiber composite is preserved by inclusion of disorganized layers: Insight into meniscus structure and function. Acta Biomater 2017; 56:102-109. [PMID: 28159718 DOI: 10.1016/j.actbio.2017.01.074] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/23/2016] [Accepted: 01/27/2017] [Indexed: 02/07/2023]
Abstract
The meniscus is comprised of circumferentially aligned fibers that resist the tensile forces within the meniscus (i.e., hoop stress) that develop during loading of the knee. Although these circumferential fibers are severed by radial meniscal tears, tibial contact stresses do not increase until the tear reaches ∼90% of the meniscus width, suggesting that the severed circumferential fibers still bear load and maintain the mechanical functionality of the meniscus. Recent data demonstrates that the interfibrillar matrix can transfer strain energy to disconnected fibrils in tendon fascicles. In the meniscus, interdigitating radial tie fibers, which function to stabilize and bind the circumferential fibers together, are hypothesized to function in a similar manner by transmitting load to severed circumferential fibers near a radial tear. To test this hypothesis, we developed an engineered fibrous analog of the knee meniscus using poly(ε-caprolactone) to create aligned scaffolds with variable amounts of non-aligned elements embedded within the scaffold. We show that the tensile properties of these scaffolds are a function of the ratio of aligned to non-aligned elements, and change in a predictable fashion following a simple mixture model. When measuring the loss of mechanical function in scaffolds with a radial tear, compared to intact scaffolds, the decrease in apparent linear modulus was reduced in scaffolds containing non-aligned layers compared to purely aligned scaffolds. Increased strains in areas adjacent to the defect were also noted in composite scaffolds. These findings indicate that non-aligned (disorganized) elements interspersed within an aligned network can improve overall mechanical function by promoting strain transfer to nearby disconnected fibers. This finding supports the notion that radial tie fibers may similarly promote tear tolerance in the knee meniscus, and will direct changes in clinical practice and provide guidance for tissue engineering strategies. STATEMENT OF SIGNIFICANCE The meniscus is a complex fibrous tissue, whose architecture includes radial tie fibers that run perpendicular to and interdigitate with the predominant circumferential fibers. We hypothesized that these radial elements function to preserve mechanical function in the context of interruption of circumferential bundles, as would be the case in a meniscal tear. To test this hypothesis, we developed a biomaterial analog containing disorganized layers enmeshed regularly throughout an otherwise aligned network. Using this material formulation, we showed that strain transmission is improved in the vicinity of defects when disorganized fiber layers were present. This supports the idea that radial elements within the meniscus improve function near a tear, and will guide future clinical interventions and the development of engineered replacements.
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Establishment of novel meniscal scaffold structures using polyglycolic and poly-l-lactic acids. J Biomater Appl 2017; 32:150-161. [DOI: 10.1177/0885328217713631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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46
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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: 91] [Impact Index Per Article: 13.0] [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.
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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
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Majd SE, Rizqy AI, Kaper HJ, Schmidt TA, Kuijer R, Sharma PK. An in vitro study of cartilage-meniscus tribology to understand the changes caused by a meniscus implant. Colloids Surf B Biointerfaces 2017; 155:294-303. [PMID: 28437755 DOI: 10.1016/j.colsurfb.2017.04.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
Active lifestyles increase the risk of meniscal injury. A permanent meniscus implant of polycarbonate urethane (PCU) is a promising treatment to postpone/prevent total knee arthroplasty. Study of the changes in articular cartilage tribology in the presence of PCU is essential in developing the optimum meniscus implant. Therefore, a cartilage-meniscus reciprocating, sliding model was developed in vitro, mimicking the stance and swing phases of the gait cycle. The meniscus was further replaced with PCU and surface-modified PCUs (with C18 chains, mono-functional polydimethylsiloxane groups and mono-functional polytetrafluoroethylene groups) to study the changes. The coefficient of friction (COF) was calculated, and cartilage wear was determined and quantified histologically. The cartilage-meniscus sliding resulted in low COF during both stance and swing (0.01< COF <0.12) and low wear of cartilage (scores <1). The cartilage-PCU sliding, during stance, revealed similar low COFs. But during swing, the COFs were high (average ∼1, maximum 1.6), indicating a breakdown in interstitial fluid pressurization lubrication and non-effective activation of the boundary lubrication. This may lead to wear of cartilage in long term. However, under the tested conditions the wear of cartilage against PCUs was not higher than its wear against meniscus, and the cartilage was occasionally damaged. The COF decreased with increasing the contact pressure (as-per a power equation) up to 1MPa. The changes in the surface modification of PCU did not affect PCU's tribological performance.
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Affiliation(s)
- Sara Ehsani Majd
- University of Groningen, University Medical Centre Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands
| | - Aditya Iman Rizqy
- University of Groningen, University Medical Centre Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands
| | - Hans J Kaper
- University of Groningen, University Medical Centre Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands
| | - Tannin A Schmidt
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Roel Kuijer
- University of Groningen, University Medical Centre Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands
| | - Prashant K Sharma
- University of Groningen, University Medical Centre Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands.
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Korpershoek JV, de Windt TS, Hagmeijer MH, Vonk LA, Saris DBF. Cell-Based Meniscus Repair and Regeneration: At the Brink of Clinical Translation?: A Systematic Review of Preclinical Studies. Orthop J Sports Med 2017; 5:2325967117690131. [PMID: 28321424 PMCID: PMC5347439 DOI: 10.1177/2325967117690131] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Meniscus damage can be caused by trauma or degeneration and is therefore common among patients of all ages. Repair or regeneration of the menisci could be of great importance not only for pain relief or regaining function but also to prevent degenerative disease and osteoarthritis. Current treatment does not offer consistent long-term improvement. Although preclinical research focusing on augmentation of meniscal tear repair and regeneration after meniscectomy is encouraging, clinical translation remains difficult. Purpose: To systematically evaluate the literature on in vivo meniscus regeneration and explore the optimal cell sources and conditions for clinical translation. We aimed at thorough evaluation of current evidence as well as clarifying the challenges for future preclinical and clinical studies. Study Design: Systematic review. Methods: A search was conducted using the electronic databases of MEDLINE, Embase, and the Cochrane Collaboration. Search terms included meniscus, regeneration, and cell-based. Results: After screening 81 articles based on title and abstract, 51 articles on in vivo meniscus regeneration could be included; 2 additional articles were identified from the references. Repair and regeneration of the meniscus has been described by intra-articular injection of multipotent mesenchymal stromal (stem) cells from adipose tissue, bone marrow, synovium, or meniscus or the use of these cell types in combination with implantable or injectable scaffolds. The use of fibrochondrocytes, chondrocytes, and transfected myoblasts for meniscus repair and regeneration is limited to the combination with different scaffolds. The comparative in vitro and in vivo studies mentioned in this review indicate that the use of allogeneic cells is as successful as the use of autologous cells. In addition, the implantation or injection of cell-seeded scaffolds increased tissue regeneration and led to better structural organization compared with scaffold implantation or injection of a scaffold alone. None of the studies mentioned in this review compare the effectiveness of different (cell-seeded) scaffolds. Conclusion: There is heterogeneity in animal models, cell types, and scaffolds used, and limited comparative studies are available. The comparative in vivo research that is currently available is insufficient to draw strong conclusions as to which cell type is the most promising. However, there is a vast amount of in vivo research on the use of different types of multipotent mesenchymal stromal (stem) cells in different experimental settings, and good results are reported in terms of tissue formation. None of these studies compare the effectiveness of different cell-scaffold combinations, making it hard to conclude which scaffold has the greatest potential.
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Affiliation(s)
- Jasmijn V Korpershoek
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tommy S de Windt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michella H Hagmeijer
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucienne A Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniel B F Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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Treatments of Meniscus Lesions of the Knee: Current Concepts and Future Perspectives. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2017. [DOI: 10.1007/s40883-017-0025-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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50
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Filardo G, Kon E, Perdisa F, Sessa A, Di Martino A, Busacca M, Zaffagnini S, Marcacci M. Polyurethane-based cell-free scaffold for the treatment of painful partial meniscus loss. Knee Surg Sports Traumatol Arthrosc 2017; 25:459-467. [PMID: 27395355 DOI: 10.1007/s00167-016-4219-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/14/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to document, at mid-term follow-up, the clinical and MRI outcome of a polyurethane-based cell-free scaffold implanted to treat painful partial meniscus loss. METHODS Eighteen consecutive patients were enrolled and treated with arthroscopic polyurethane meniscal scaffold implantation and, in case of other comorbidities, with concurrent surgical procedures: 16 patients (9 men and 7 women, mean age 45 ± 13 years, mean BMI 25 ± 3, 12 medial and 4 lateral implants) were prospectively evaluated with the subjective and objective IKDC and the Tegner scores at 24, 36, 48, 60, and 72 months of follow-up. Eleven patients were also evaluated by 1.5-T MRI at the final follow-up. RESULTS The IKDC subjective score showed a significant improvement from baseline to 24 months (45.6 ± 17.5 and 75.3 ± 14.8, respectively; p = 0.02) and subsequent stable results over time for up to 72 months (final score 75.0 ± 16.8). The Tegner score improvement between pre-operative status and final follow-up was also significant (p = 0.039). Nevertheless, the final score remained significantly lower than the pre-injury sports activity level (p = 0.027). High-resolution MRIs documented the presence of abnormal findings in terms of morphology, signal intensity, and interface between the implant and the native meniscus. Implant extrusion and bone oedema at the treated compartment were also observed in most of the cases, even though no correlation was found between imaging findings and clinical outcome. CONCLUSIONS The present study reports satisfactory clinical outcomes at mid-term follow-up after polyurethane-based meniscal cell-free scaffold implantation. The treatment was effective both in cases of isolated partial meniscal lesions and in complex cases requiring the combination with other surgical procedures. On the other hand, a high rate of altered MRI aspects was documented. However, no correlation was found between the altered imaging parameters and the overall positive clinical findings, thus supporting the use of this procedure to treat painful partial meniscus loss. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- G Filardo
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.,Bologna University, Bologna, Italy
| | - E Kon
- Bologna University, Bologna, Italy.,Laboratory of NanoBiotechnology (NABI), Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - F Perdisa
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - A Sessa
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
| | - A Di Martino
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - M Busacca
- Diagnostic and Interventional Radiology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy
| | - S Zaffagnini
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.,Bologna University, Bologna, Italy
| | - M Marcacci
- Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.,Bologna University, Bologna, Italy
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