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Lydon KL, Struijk C, Michielsen J, Prokop L, Krych AJ, Saris D, Verdonk P. Fresh Versus Frozen Meniscal Allograft Transplant: Revisit or Redundant? A Systematic Review. Am J Sports Med 2024; 52:2159-2167. [PMID: 38282584 DOI: 10.1177/03635465231200236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Fresh-frozen allografts are the current standard in meniscal allograft transplant (MAT) surgery, due to their availability, ease of preservation, and affordability. However, fresh-frozen grafts are associated with several clinical challenges such as graft shrinkage and extrusion, among many others. PURPOSE To present the current knowledge on the use of fresh meniscal allografts, presenting whether benefits associated with fresh grafts provide sufficient evidence to support their use in clinical practice. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A comprehensive search was conducted with keywords listed below. After an initial screening on title and abstract, full-text articles were assessed with the inclusion criteria. RESULTS A total of 78 studies matched the inclusion criteria. Literature and preclinical studies indicated that fresh meniscal allografts are beneficial for maintaining mechanical properties, graft ultrastructure, and matrix metabolism due to the presence of viable cells. Therefore, fresh allografts may address common complications associated with fresh-frozen MAT. To overcome challenges associated with both fresh-frozen and fresh allografts, a group has studied treating fresh-frozen allografts with a cell-based injection therapy. CONCLUSION Fresh meniscal allografts pose several challenges including limited availability, demanding preservation procedures, and high costs. Although the role of viable cells within meniscal allografts remains controversial, these cells may be vital for maintaining tissue properties.
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Affiliation(s)
- Katherine L Lydon
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Struijk
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
| | - Jozef Michielsen
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
| | - Larry Prokop
- Library Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Saris
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, University Medical Centre, Utrecht, the Netherlands
| | - Peter Verdonk
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
- ORTHOCA, Antwerp, Belgium
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Bachmaier S, Krych AJ, Smith PA, Feucht MJ, LaPrade RF, Wijdicks CA. Biomechanical Performance of Transtibial Pull-Out Posterior Horn Medial Meniscus Root Repair Is Improved With Knotless Adjustable Suture Anchor-Based Fixation. Orthop J Sports Med 2024; 12:23259671241239575. [PMID: 38584990 PMCID: PMC10998488 DOI: 10.1177/23259671241239575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 04/09/2024] Open
Abstract
Background While posterior medial meniscus root (PMMR) techniques have evolved, there remains a need to both optimize repair strength and improve resistance to cyclic loading. Hypothesis Adjustable tensioning would lead to higher initial repair strength and reduce displacement with cyclic loading compared with previously described transtibial pull-out repair (TPOR) fixation techniques. Study Design Controlled laboratory study. Methods A total of 56 porcine medial menisci were used. Eight intact specimens served as a control for the native meniscus. For the others, PMMR tears were created and repaired with 6 different TPOR techniques (8 in each group). Fixed PMMR repairs were executed using 4 different suture techniques (two No. 2 cinch sutures, two cinch tapes, two No. 2 simple sutures, and two No. 2 sutures in a Mason-Allen configuration) all tied over a cortical button. Adjustable PMMR repairs using Mason-Allen sutures were fixed with an adjustable soft tissue anchor fixation tensioned at either 80 N or 120 N. The initial force, stiffness, and relief displacement of the repairs were measured after fixation. Repair constructs were then cyclically loaded, with cyclic displacement and stiffness measured after 1000 cycles. Finally, the specimens were pulled to failure. Results The PMMR repaired with the 2 cinch sutures fixed technique afforded the lowest (P < .001) initial repair load, stiffness, and relief displacement. The adjustable PMMR repairs achieved a higher initial repair load (P < .001) and relief displacement (P < .001) than all fixed repairs. The 2 cinch sutures fixed technique showed an overall higher cyclic displacement (P < .028) and was completely loose compared with the native meniscus functional zone. Repairs with adjustable intratunnel fixation showed displacement with cyclic loading similar to the native meniscus. With cyclic loading, the Mason-Allen adjustable repair with 120 N of tension showed less displacement (P < .016) than all fixed repairs and a stiffness comparable to the fixed Mason-Allen repair. The fixed Mason-Allen technique demonstrated a higher ultimate load (P < .007) than the adjustable Mason-Allen techniques. All repairs were less stiff, with lower ultimate failure loads, than the native meniscus root attachment (P < .0001). Conclusion Adjustable TPOR led to considerably higher initial repair load and relief displacement than other conventional fixed repairs and restricted cyclic displacement to match the native meniscus function. However, the ultimate failure load of the adjustable devices was lower than that of a Mason-Allen construct tied over a cortical button. All repair techniques had a significantly lower load to failure than the native meniscus root. Clinical Relevance Knotless adjustable PMMR repair based on soft anchor fixation results in higher tissue compression and less displacement, but the overall clinical significance on healing rates remains unclear.
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Affiliation(s)
- Samuel Bachmaier
- Arthrex Department of Orthopedic Research, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Aaron J. Krych
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthias J. Feucht
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany
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Bandyopadhyay A, Ghibhela B, Mandal BB. Current advances in engineering meniscal tissues: insights into 3D printing, injectable hydrogels and physical stimulation based strategies. Biofabrication 2024; 16:022006. [PMID: 38277686 DOI: 10.1088/1758-5090/ad22f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
The knee meniscus is the cushioning fibro-cartilage tissue present in between the femoral condyles and tibial plateau of the knee joint. It is largely avascular in nature and suffers from a wide range of tears and injuries caused by accidents, trauma, active lifestyle of the populace and old age of individuals. Healing of the meniscus is especially difficult due to its avascularity and hence requires invasive arthroscopic approaches such as surgical resection, suturing or implantation. Though various tissue engineering approaches are proposed for the treatment of meniscus tears, three-dimensional (3D) printing/bioprinting, injectable hydrogels and physical stimulation involving modalities are gaining forefront in the past decade. A plethora of new printing approaches such as direct light photopolymerization and volumetric printing, injectable biomaterials loaded with growth factors and physical stimulation such as low-intensity ultrasound approaches are being added to the treatment portfolio along with the contemporary tear mitigation measures. This review discusses on the necessary design considerations, approaches for 3D modeling and design practices for meniscal tear treatments within the scope of tissue engineering and regeneration. Also, the suitable materials, cell sources, growth factors, fixation and lubrication strategies, mechanical stimulation approaches, 3D printing strategies and injectable hydrogels for meniscal tear management have been elaborated. We have also summarized potential technologies and the potential framework that could be the herald of the future of meniscus tissue engineering and repair approaches.
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Affiliation(s)
- Ashutosh Bandyopadhyay
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Baishali Ghibhela
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Biman B Mandal
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Schwer J, Ignatius A, Seitz AM. The biomechanical properties of human menisci: A systematic review. Acta Biomater 2024; 175:1-26. [PMID: 38092252 DOI: 10.1016/j.actbio.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
Biomechanical characterization of meniscal tissue ex vivo remains a critical need, particularly for the development of suitable meniscus replacements or therapeutic strategies that target the native mechanical properties of the meniscus. To date, a huge variety of test configurations and protocols have been reported, making it extremely difficult to compare the respective outcome parameters, thereby leading to misinterpretation. Therefore, the purpose of this systematic review was to identify test-specific parameters that contribute to uncertainties in the determination of mechanical properties of the human meniscus and its attachments, which derived from common quasi-static and dynamic tests in tension, compression, and shear. Strong evidence was found that the determined biomechanical properties vary significantly depending on the specific test parameters, as indicated by up to tenfold differences in both tensile and compressive properties. Test mode (stress relaxation, creep, cyclic) and configuration (unconfined, confined, in-situ), specimen shape and dimensions, preconditioning regimes, loading rates, post-processing of experimental data, and specimen age and degeneration were identified as the most critical parameters influencing the outcome measures. In conclusion, this work highlights an unmet need for standardization and reporting guidelines to facilitate comparability and may prove beneficial for evaluating the mechanical properties of novel meniscus constructs. STATEMENT OF SIGNIFICANCE: The biomechanical properties of the human meniscus have been studied extensively over the past decades. However, it remains unclear to what extent both test protocol and specimen-related differences are responsible for the enormous variability in material properties. Therefore, this systematic review analyzes the biomechanical properties of the human meniscus in the context of the underlying testing protocol. The most sensitive parameters affecting the determination of mechanical properties were identified and critically discussed. Currently, it is of utmost importance for scientists evaluating potential meniscal scaffolds and biomaterials to have a control group rather than a direct comparison to the literature. Standardization of both test procedures and reporting requirements is needed to improve and accelerate the development of meniscal replacement constructs.
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Affiliation(s)
- Jonas Schwer
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany.
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Amano Y, Ozeki N, Matsuda J, Nakamura T, Nakagawa Y, Sekiya I, Koga H. Augmentation of a Nonanatomical Repair of a Medial Meniscus Posterior Root Tear With Centralization Using Three Knotless Anchors May Be Associated With Less Meniscal Extrusion and Better Compressive Load Distribution in Mid-Flexion Compared With Non-Anatomical Root Repair Alone in a Porcine Knee Model. Arthroscopy 2023; 39:2487-2498.e4. [PMID: 37142135 DOI: 10.1016/j.arthro.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To investigate the biomechanics of the centralization augmentation using knotless soft anchors to a nonanatomical transtibial pull-out root repair in a porcine medial meniscus posterior root tear (MMPRT) model. METHODS Porcine knee joints (N = 10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) nonanatomical root repair; (4) nonanatomical root repair with centralization using 2 anchors: anchors were inserted at the posterior medial collateral ligament (MCL) border and 10 mm anterior to the posterior MCL border; and (5) nonanatomical root repair with centralization using 3 anchors: another anchor was placed 10 mm posterior to the posterior MCL border. Contact area on the medial meniscus (MM), contact pressure in the MM and tibial cartilage, and MM extrusion were evaluated at 30°, 45°, 60°, and 90° knee flexions under 200 N compressive force. RESULTS MM extrusion at the posterior MCL border was significantly reduced after root repair with centralization using 3 anchors than after root repair alone at 30° (-0.063 mm vs 1.5 mm, P = .017), 45° (0.21 mm vs 1.7 mm, P = .018), and 60° (0.78 mm vs 2.3 mm, P = .019). There were no significant differences in MM extrusion between the root repair alone and root repair with centralization using 2 anchors at all flexion angles. The contact area in the middle and posterior MM was significantly greater after centralization with 3 anchors than after root repair alone at all flexion angles (except the posterior MM at 90°). The mean contact pressure in the tibial cartilage was significantly lower after centralization with 3 anchors than after root repair at all angles. CONCLUSIONS Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution between 30° and 60° flexion compared with nonanatomical root repair alone in a porcine model. CLINICAL RELEVANCE This biomechanical study at time zero suggests that the addition of centralization using 3 knotless anchors may reduce MM extrusion and restore the load-distributing function of the MM.
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Affiliation(s)
- Yusuke Amano
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junpei Matsuda
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
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Jahangir S, Esrafilian A, Ebrahimi M, Stenroth L, Alkjær T, Henriksen M, Englund M, Mononen ME, Korhonen RK, Tanska P. Sensitivity of simulated knee joint mechanics to selected human and bovine fibril-reinforced poroelastic material properties. J Biomech 2023; 160:111800. [PMID: 37797566 DOI: 10.1016/j.jbiomech.2023.111800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
Fibril-reinforced poroviscoelastic material models are considered state-of-the-art in modeling articular cartilage biomechanics. Yet, cartilage material parameters are often based on bovine tissue properties in computational knee joint models, although bovine properties are distinctly different from those of humans. Thus, we aimed to investigate how cartilage mechanical responses are affected in the knee joint model during walking when fibril-reinforced poroviscoelastic properties of cartilage are based on human data instead of bovine. We constructed a finite element knee joint model in which tibial and femoral cartilages were modeled as fibril-reinforced poroviscoelastic material using either human or bovine data. Joint loading was based on subject-specific gait data. The resulting mechanical responses of knee cartilage were compared between the knee joint models with human or bovine fibril-reinforced poroviscoelastic cartilage properties. Furthermore, we conducted a sensitivity analysis to determine which fibril-reinforced poroviscoelastic material parameters have the greatest impact on cartilage mechanical responses in the knee joint during walking. In general, bovine cartilage properties yielded greater maximum principal stresses and fluid pressures (both up to 30%) when compared to the human cartilage properties during the loading response in both femoral and tibial cartilage sites. Cartilage mechanical responses were very sensitive to the collagen fibril-related material parameter variations during walking while they were unresponsive to proteoglycan matrix or fluid flow-related material parameter variations. Taken together, human cartilage material properties should be accounted for when the goal is to compare absolute mechanical responses of knee joint cartilage as bovine material parameters lead to substantially different cartilage mechanical responses.
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Affiliation(s)
- Sana Jahangir
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Amir Esrafilian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | | | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tine Alkjær
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; The Parker Institute, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Martin Englund
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mika E Mononen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Petri Tanska
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
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7
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Yang J, Wang H, Zhou Y, Duan L, Schneider KH, Zheng Z, Han F, Wang X, Li G. Silk Fibroin/Wool Keratin Composite Scaffold with Hierarchical Fibrous and Porous Structure. Macromol Biosci 2023; 23:e2300105. [PMID: 37247409 DOI: 10.1002/mabi.202300105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Indexed: 05/31/2023]
Abstract
The present study describes a silk microfiber reinforced meniscus scaffold (SMRMS) with hierarchical fibrous and porous structure made from silk fibroin (SF) and wool keratin (WK) using electrospinning and freeze-drying technology. This study focuses on the morphology, secondary structure, mechanical properties, and water absorption properties of the scaffold. The cytotoxicity and biocompatibility of SMRMS are assessed in vivo and in vitro. The scaffold shows hierarchical fibrous and porous structure, hierarchical pore size distribution (ranges from 50 to 650 µm), robust mechanical properties (compression strength can reach at 2.8 MPa), and stable biodegradability. A positive growth condition revealed by in vitro cytotoxicity testing indicates that the scaffold is not hazardous to cells. In vivo assessments of biocompatibility reveal that only a mild inflammatory reaction is present in implanted rat tissue. Meniscal scaffold made of SF/WK composite shows a potential application prospect in the meniscal repair engineering field with its development.
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Affiliation(s)
- Jie Yang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Huan Wang
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yuhang Zhou
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Lirong Duan
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Karl H Schneider
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Waehringer Gurtel 18-20, Vienna, 1090, Austria
| | - Zhaozhu Zheng
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Fengxuan Han
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaoqin Wang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Gang Li
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
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Sezaki S, Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Neo M. Biomechanical assessment of a novel meniscal scaffold compared to partial meniscectomy: A study on porcine meniscal injury. J Biomed Mater Res B Appl Biomater 2023; 111:895-902. [PMID: 36374005 DOI: 10.1002/jbm.b.35199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/26/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the appropriate size of scaffold implantation on stress distribution and evaluate its mechanical and biomechanical properties considering hydrolysis. The meniscus acts as a load distribution in the knee, and its biomechanical properties are essential for the development of the PGA scaffold. We established a novel meniscal scaffold, which consists of polyglycolic acid (PGA) covered with L-lactide-ε-caprolactone copolymer (P[LA/CL]). After 4 weeks of hydrolysis, the scaffold had a 7% volume reduction compared to the initial volume. In biomechanical tests, the implantation of scaffolds 20% larger than the circumferential and vertical defect size results in greater contact stress than the intact meniscus. In the mechanical evaluation associated with the decomposition behavior, the strength decreased after 4 weeks of hydrolysis. Meanwhile, in the biomechanical test considering hydrolysis, contact stress and area equivalent to intact were obtained after 4 weeks of hydrolysis. In conclusion, the implantation of the PGA scaffold might be a useful alternative to partial meniscectomy in terms of mechanical properties, and the PGA scaffold should be implanted up to 20% of the defect size.
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Affiliation(s)
- Shunsuke Sezaki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.,QOL Research Laboratory, Gunze Limited, Kyoto, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Seitz AM, Schwer J, de Roy L, Warnecke D, Ignatius A, Dürselen L. Knee Joint Menisci Are Shock Absorbers: A Biomechanical In-Vitro Study on Porcine Stifle Joints. Front Bioeng Biotechnol 2022; 10:837554. [PMID: 35372324 PMCID: PMC8968420 DOI: 10.3389/fbioe.2022.837554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this biomechanical in vitro study was to answer the question whether the meniscus acts as a shock absorber in the knee joint or not. The soft tissue of fourteen porcine knee joints was removed, leaving the capsuloligamentous structures intact. The joints were mounted in 45° neutral knee flexion in a previously validated droptower setup. Six joints were exposed to an impact load of 3.54 J, and the resultant loss factor (η) was calculated. Then, the setup was modified to allow sinusoidal loading under dynamic mechanical analysis (DMA) conditions. The remaining eight knee joints were exposed to 10 frequencies ranging from 0.1 to 5 Hz at a static load of 1210 N and a superimposed sinusoidal load of 910 N (2.12 times body weight). Forces (F) and deformation (l) were continuously recorded, and the loss factor (tan δ) was calculated. For both experiments, four meniscus states (intact, medial posterior root avulsion, medial meniscectomy, and total lateral and medial meniscectomy) were investigated. During the droptower experiments, the intact state indicated a loss factor of η = 0.1. Except for the root avulsion state (−15%, p = 0.12), the loss factor decreased (p < 0.046) up to 68% for the total meniscectomy state (p = 0.028) when compared to the intact state. Sinusoidal DMA testing revealed that knees with an intact meniscus had the highest loss factors, ranging from 0.10 to 0.15. Any surgical manipulation lowered the damping ability: Medial meniscectomy resulted in a reduction of 24%, while the resection of both menisci lowered tan δ by 18% compared to the intact state. This biomechanical in vitro study indicates that the shock-absorbing ability of a knee joint is lower when meniscal tissue is resected. In other words, the meniscus contributes to the shock absorption of the knee joint not only during impact loads, but also during sinusoidal loads. The findings may have an impact on the rehabilitation of young, meniscectomized patients who want to return to sports. Consequently, such patients are exposed to critical loads on the articular cartilage, especially when performing sports with recurring impact loads transmitted through the knee joint surfaces.
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10
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Wang D, Gonzalez-Leon E, Rodeo SA, Athanasiou KA. Clinical Replacement Strategies for Meniscus Tissue Deficiency. Cartilage 2021; 13:262S-270S. [PMID: 34802295 PMCID: PMC8808868 DOI: 10.1177/19476035211060512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022] Open
Abstract
Meniscus tissue deficiency resulting from primary meniscectomy or meniscectomy after failed repair is a clinical challenge because the meniscus has little to no capacity for regeneration. Loss of meniscus tissue has been associated with early-onset knee osteoarthritis due to an increase in joint contact pressures in meniscectomized knees. Clinically available replacement strategies range from allograft transplantation to synthetic implants, including the collagen meniscus implant, ACTIfit, and NUSurface. Although short-term efficacy has been demonstrated with some of these treatments, factors such as long-term durability, chondroprotective efficacy, and return to sport activities in young patients remain unpredictable. Investigations of cell-based and tissue-engineered strategies to treat meniscus tissue deficiency are ongoing.
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Affiliation(s)
- Dean Wang
- Department of Orthopedic Surgery,
University of California, Irvine, Orange, CA, USA
| | - Erik Gonzalez-Leon
- Department of Biomedical Engineering,
University of California, Irvine, Irvine, CA, USA
| | - Scott A. Rodeo
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
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Bansal S, Meadows KD, Miller LM, Saleh KS, Patel JM, Stoeckl BD, Lemmon EA, Hast MW, Zgonis MH, Scanzello CR, Elliott DM, Mauck RL. Six-Month Outcomes of Clinically Relevant Meniscal Injury in a Large-Animal Model. Orthop J Sports Med 2021; 9:23259671211035444. [PMID: 34796238 PMCID: PMC8593308 DOI: 10.1177/23259671211035444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/04/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The corrective procedures for meniscal injury are dependent on tear type, severity, and location. Vertical longitudinal tears are common in young and active individuals, but their natural progression and impact on osteoarthritis (OA) development are not known. Root tears are challenging and they often indicate poor outcomes, although the timing and mechanisms of initiation of joint dysfunction are poorly understood, particularly in large-animal and human models. PURPOSE/HYPOTHESIS In this study, vertical longitudinal and root tears were made in a large-animal model to determine the progression of joint-wide dysfunction. We hypothesized that OA onset and progression would depend on the extent of injury-based load disruption in the tissue, such that root tears would cause earlier and more severe changes to the joint. STUDY DESIGN Controlled laboratory study. METHODS Sham surgeries and procedures to create either vertical longitudinal or root tears were performed in juvenile Yucatan mini pigs through randomized and bilateral arthroscopic procedures. Animals were sacrificed at 1, 3, or 6 months after injury and assessed at the joint and tissue level for evidence of OA. Functional measures of joint load transfer, cartilage indentation mechanics, and meniscal tensile properties were performed, as well as histological evaluation of the cartilage, meniscus, and synovium. RESULTS Outcomes suggested a progressive and sustained degeneration of the knee joint and meniscus after root tear, as evidenced by histological analysis of the cartilage and meniscus. This occurred in spite of spontaneous reattachment of the root, suggesting that this reattachment did not fully restore the function of the native attachment. In contrast, the vertical longitudinal tear did not cause significant changes to the joint, with only mild differences compared with sham surgery at the 6-month time point. CONCLUSION Given that the root tear, which severs circumferential connectivity and load transfer, caused more intense OA compared with the circumferentially stable vertical longitudinal tear, our findings suggest that without timely and mechanically competent fixation, root tears may cause irreversible joint damage. CLINICAL RELEVANCE More generally, this new model can serve as a test bed for experimental surgical, scaffold-based, and small molecule-driven interventions after injury to prevent OA progression.
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Affiliation(s)
- Sonia Bansal
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle D. Meadows
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
| | - Liane M. Miller
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Kamiel S. Saleh
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Jay M. Patel
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Brendan D. Stoeckl
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Elisabeth A. Lemmon
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Michael W. Hast
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miltiadis H. Zgonis
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Carla R. Scanzello
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dawn M. Elliott
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Robert L. Mauck, PhD, Department of Orthopedic Surgery, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA 19104, USA () (Twitter: @MauckLab)
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12
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Yun HW, Song BR, Shin DI, Yin XY, Truong MD, Noh S, Jin YJ, Kwon HJ, Min BH, Park DY. Fabrication of decellularized meniscus extracellular matrix according to inner cartilaginous, middle transitional, and outer fibrous zones result in zone-specific protein expression useful for precise replication of meniscus zones. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 128:112312. [PMID: 34474863 DOI: 10.1016/j.msec.2021.112312] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022]
Abstract
Meniscus is a fibrocartilage composite tissue with three different microstructual zones, inner fibrocartilage, middle transitional, and outer fibrous zone. We hypothesized that decellularized meniscus extracellular matrix (DMECM) would have different characteristics according to zone of origin. We aimed to compare zone-specific DMECM in terms of biochemical characteristics and cellular interactions associated with tissue engineering. Micronized DMECM was fabricated from porcine meniscus divided into three microstructural zones. Characterization of DMECM was done by biochemical and proteomic analysis. Inner DMECM showed the highest glycosaminoglycan content, while middle DMECM showed the highest collagen content among groups. Proteomic analysis showed significant differences among DMECM groups. Inner DMECM showed better adhesion and migration potential to meniscus cells compared to other groups. DMECM resulted in expression of zone-specific differentiation markers when co-cultured with synovial mesenchymal stem cells (SMSCs). SMSCs combined with inner DMECM showed the highest glycosaminoglycan in vivo. Outer DMECM constructs, on the other hand, showed more fibrous tissue features, while middle DMECM constructs showed both inner and outer zone characteristics. In conclusion, DMECM showed different characteristics according to microstructural zones, and such material may be useful for zone-specific tissue engineering of meniscus.
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Affiliation(s)
- Hee-Woong Yun
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea; Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea
| | - Bo Ram Song
- Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea
| | - Dong Il Shin
- Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea; Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Xiang Yun Yin
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea; Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea
| | - Minh-Dung Truong
- Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea
| | - Sujin Noh
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Republic of Korea
| | - Young Jun Jin
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea; Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea
| | - Hyeon Jae Kwon
- Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea; Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea; Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea; Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea; Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea.
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13
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Marchiori G, Berni M, Cassiolas G, Vivarelli L, Lopomo NF, Fini M, Dallari D, Govoni M. Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts? MEMBRANES 2021; 11:membranes11070545. [PMID: 34357195 PMCID: PMC8307999 DOI: 10.3390/membranes11070545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/16/2023]
Abstract
Several studies demonstrated the efficacy of post-mortem extracorporeal membrane oxygenation (ECMO) on donors in preserving organ function addressing organ transplantation. Nevertheless, no common and shared evidence was reached about the possibility of using ECMO donors in tissue harvesting. Therefore, this work aimed first to review the current scientific literature about ECMO donors, and then to focus on the use of ECMO tissues as allografts, mainly addressing musculoskeletal tissues, which are of the most interest for reconstruction. A search was conducted on the current scientific literature, focusing on the keywords "ECMO" and "Donor". Several online databases were used, including PubMed, Scopus, and Web of Science. From the preliminary search, 478 articles were obtained, out of which 173 specifically reported the use of ECMO for donation and transplantation purposes. Literature reported extensive analyses of ECMO organs-overall from the abdomen-both in pre- and post-transplantation studies. On the other hand, ECMO tissues were explanted only in a very limited number of cases; moreover, no information was referred about their status and use. A revision of the current scientific literature highlighted the lack of information concerning ECMO tissues and the necessity to perform preclinical, ex vivo studies to compare allografts from ECMO donors, with respect to standard donors, and, thus, to verify whether they can be harvested and implanted safely and with efficacy.
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Affiliation(s)
- Gregorio Marchiori
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (G.M.); (M.F.)
| | - Matteo Berni
- Medical Technology Laboratory Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Giorgio Cassiolas
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.C.); (N.F.L.)
| | - Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
- Correspondence:
| | - Nicola Francesco Lopomo
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.C.); (N.F.L.)
| | - Milena Fini
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (G.M.); (M.F.)
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
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Regenerative Medicine for Equine Musculoskeletal Diseases. Animals (Basel) 2021; 11:ani11010234. [PMID: 33477808 PMCID: PMC7832834 DOI: 10.3390/ani11010234] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Lameness due to musculoskeletal disease is the most common diagnosis in equine veterinary practice. Many of these orthopaedic disorders are chronic problems, for which no clinically satisfactory treatment exists. Thus, high hopes are pinned on regenerative medicine, which aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. Some regenerative medicine therapies have already made their way into equine clinical practice mainly to treat tendon injures, tendinopathies, cartilage injuries and degenerative joint disorders with promising but diverse results. This review summarises the current knowledge of commonly used regenerative medicine treatments and critically discusses their use. Abstract Musculoskeletal injuries and chronic degenerative diseases commonly affect both athletic and sedentary horses and can entail the end of their athletic careers. The ensuing repair processes frequently do not yield fully functional regeneration of the injured tissues but biomechanically inferior scar or replacement tissue, causing high reinjury rates, degenerative disease progression and chronic morbidity. Regenerative medicine is an emerging, rapidly evolving branch of translational medicine that aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. It includes tissue engineering but also cell-based and cell-free stimulation of endogenous self-repair mechanisms. Some regenerative medicine therapies have made their way into equine clinical practice mainly to treat tendon injures, tendinopathies, cartilage injuries and degenerative joint disorders with promising results. However, the qualitative and quantitative spatiotemporal requirements for specific bioactive factors to trigger tissue regeneration in the injury response are still unknown, and consequently, therapeutic approaches and treatment results are diverse. To exploit the full potential of this burgeoning field of medicine, further research will be required and is ongoing. This review summarises the current knowledge of commonly used regenerative medicine treatments in equine patients and critically discusses their use.
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15
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Kara A, Koçtürk S, Bilici G, Havitcioglu H. Development of biological meniscus scaffold: Decellularization method and recellularization with meniscal cell population derived from mesenchymal stem cells. J Biomater Appl 2021; 35:1192-1207. [PMID: 33444085 DOI: 10.1177/0885328220981189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tissue engineering approaches which include a combination of cells and scaffold materials provide an alternative treatment for meniscus regeneration. Decellularization and recellularization techniques are potential treatment options for transplantation. Maintenance of the ultrastructure composition of the extracellular matrix and repopulation with cells are important factors in constructing a biological scaffold and eliminating immunological reactions.The aim of the study is to develop a method to obtain biological functional meniscus scaffolds for meniscus regeneration. For this purpose, meniscus tissue was decellularized by our modified method, a combination of physical, chemical, and enzymatic methods and then recellularized with a meniscal cell population composed of fibroblasts, chondrocytes and fibrochondrocytes that obtained from mesenchymal stem cells. Decellularized and recellularized meniscus scaffolds were analysed biochemically, biomechanically and histologically. Our results revealed that cellular components of the meniscus were successfully removed by preserving collagen and GAG structures without any significant loss in biomechanical properties. Recellularization results showed that the meniscal cells were localized in the empty lacuna on the decellularized meniscus, and also well distributed and proliferated consistently during the cell culture period (p < 0.05). Furthermore, a high amount of DNA, collagen, and GAG contents (p < 0.05) were obtained with the meniscal cell population in recellularized meniscus tissue.The study demonstrates that our decellularization and recellularization methods were effective to develop a biological functional meniscus scaffold and can mimic the meniscus tissue with structural and biochemical features. We predict that the obtained biological meniscus scaffolds may provide avoidance of adverse immune reactions and an appropriate microenvironment for allogeneic or xenogeneic recipients in the transplantation process. Therefore, as a promising candidate, the obtained biological meniscus scaffolds might be verified with a transplantation experiment.
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Affiliation(s)
- Aylin Kara
- Department of Bioengineering, İzmir Institute of Technology, İzmir, Turkey
| | - Semra Koçtürk
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, İzmir, Turkey
| | - Gokcen Bilici
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, İzmir, Turkey
| | - Hasan Havitcioglu
- Department of Bioengineering, İzmir Institute of Technology, İzmir, Turkey
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16
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Warnecke D, Balko J, Haas J, Bieger R, Leucht F, Wolf N, Schild NB, Stein SEC, Seitz AM, Ignatius A, Reichel H, Mizaikoff B, Dürselen L. Degeneration alters the biomechanical properties and structural composition of lateral human menisci. Osteoarthritis Cartilage 2020; 28:1482-1491. [PMID: 32739340 DOI: 10.1016/j.joca.2020.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Because the literature relating to the influence of degeneration on the viscoelasticity and tissue composition of human lateral menisci remains contradictory or completely lacking, the aim of this study was to fill these gaps by comprehensively characterising the biomechanical properties of menisci with regard to the degree of degeneration. DESIGN Meniscal tissue from 24 patients undergoing a total knee replacement was collected and the degeneration of each region classified according to Pauli et al. For biomechanical characterisation, compression and tensile tests were performed. Additionally, the water content was determined and infrared (IR) spectroscopy was applied to detect changes in the structural composition, particularly of the proteoglycan and collagen content. RESULTS With an increasing degree of degeneration, a significant decrease of the equilibrium modulus was detected, while simultaneously the water content and the hydraulic permeability significantly increased. However, the tensile modulus displayed a tendency to decrease with increasing degeneration, which might be due to the significantly decreasing amount of collagen content identified by the IR measurements. CONCLUSION The findings of the current study may contribute to the understanding of meniscus degeneration, showing that degenerative processes appear to mainly worsen viscoelastic properties of the inner circumference by disrupting the collagen integrity.
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Affiliation(s)
- D Warnecke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - J Balko
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - J Haas
- Institute for Analytical and Bioanalytical Chemistry, Ulm University, Germany.
| | - R Bieger
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Germany.
| | - F Leucht
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Germany.
| | - N Wolf
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - N B Schild
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - S E C Stein
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - A M Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - A Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
| | - H Reichel
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Germany.
| | - B Mizaikoff
- Institute for Analytical and Bioanalytical Chemistry, Ulm University, Germany.
| | - L Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany.
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Schwer J, Rahman MM, Stumpf K, Rasche V, Ignatius A, Dürselen L, Seitz AM. Degeneration Affects Three-Dimensional Strains in Human Menisci: In situ MRI Acquisition Combined With Image Registration. Front Bioeng Biotechnol 2020; 8:582055. [PMID: 33042980 PMCID: PMC7526678 DOI: 10.3389/fbioe.2020.582055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
Degenerative changes of menisci contribute to the evolution of osteoarthritis in the knee joint, because they alter the load transmission to the adjacent articular cartilage. Identifying alterations in the strain response of meniscal tissue under compression that are associated with progressive degeneration may uncover links between biomechanical function and meniscal degeneration. Therefore, the goal of this study was to investigate how degeneration effects the three-dimensional (3D; axial, circumferential, radial) strain in different anatomical regions of human menisci (anterior and posterior root attachment; anterior and posterior horn; pars intermedia) under simulated compression. Magnetic resonance imaging (MRI) was performed to acquire image sequences of 12 mild and 12 severe degenerated knee joints under unloaded and loaded [25%, 50% and 100% body weight (BW)] conditions using a customized loading device. Medial and lateral menisci as well as their root attachments were manually segmented. Intensity-based rigid and non-rigid image registration were performed to obtain 3D deformation fields under the respective load levels. Finally, the 3D voxels were transformed into hexahedral finite-element models and direction-dependent local strain distributions were determined. The axial compressive strain in menisci and meniscal root attachments significantly increased on average from 3.1% in mild degenerated joints to 7.3% in severe degenerated knees at 100% BW (p ≤ 0.021). In severe degenerated knee joints, the menisci displayed a mean circumferential strain of 0.45% (mild: 0.35%) and a mean radial strain of 0.41% (mild: 0.37%) at a load level of 100% BW. No significant changes were observed in the circumferential or radial directions between mild and severe degenerated knee joints for all load levels (p > 0.05). In conclusion, high-resolution MRI was successfully combined with image registration to investigate spatial strain distributions of the meniscus and its attachments in response to compression. The results of the current study highlight that the compressive integrity of the meniscus decreases with progressing tissue degeneration, whereas the tensile properties are maintained.
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Affiliation(s)
- Jonas Schwer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Muhammed Masudur Rahman
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany.,Department of Mechanical Engineering, University of Connecticut, Storrs, CT, United States
| | - Kilian Stumpf
- Experimental Cardiovascular Imaging, Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Volker Rasche
- Experimental Cardiovascular Imaging, Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
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Morphological changes in synovial mesenchymal stem cells during their adhesion to the meniscus. J Transl Med 2020; 100:916-927. [PMID: 32238905 DOI: 10.1038/s41374-020-0421-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 01/13/2023] Open
Abstract
Synovial mesenchymal stem cells (MSCs) are an attractive cell source for transplantation because of their high chondrogenic potential, especially in areas like the meniscus of the knee. A synovial MSC suspension placed onto the meniscus for 10 min promoted healing of repaired meniscal tears that generally do not heal. Here, we quantified the proportion of human synovial MSCs that adhered to a porcine abraded meniscus, clarified their morphological changes, and revealed the mechanism by which the synovial MSCs adhered to the meniscus. The numbers of adhering cells at immediately after 10, 60 min and 6, 24 h after suspension placement were calculated. The meniscus surface was examined by scanning electron microscopy, and 50 cells were randomly selected at each time period, classified, and quantified for each of the six donors. Approximately 28% of the synovial MSCs immediately adhered to the meniscus after placement and the proportion of adhered cells increased further with time. All cells maintained a round shape for 60 min, and then transformed to a mixture of round and semi-flattened cells. By 24 h, flattened cells covered the meniscus. Microspikes were observed in 36% of the floating synovial MSCs and in 76% of the cells on the meniscus shortly after placement on the meniscus, then the proportion of cells with pseudopodia increased. The bleb-dominant cell proportion significantly decreased, and the smooth-dominant cell proportion increased within 60 min. Microspikes or the bodies of synovial MSCs were trapped by meniscal fibers immediately after placement. The proportion of adhered cells increased with time, and the cell morphology changed dynamically for 24 h as the synovial MSCs adhered to the meniscus. The MSCs in the round morphological state had a heterogeneous morphology. The microspikes, and the subsequent development of pseudopodia, may play an important role in adhesion onto the meniscus.
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Constitutive modeling of menisci tissue: a critical review of analytical and numerical approaches. Biomech Model Mechanobiol 2020; 19:1979-1996. [PMID: 32572727 DOI: 10.1007/s10237-020-01352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
Menisci are fibrocartilaginous disks consisting of soft tissue with a complex biomechanical structure. They are critical determinants of the kinematics as well as the stability of the knee joint. Several studies have been carried out to formulate tissue mechanical behavior, leading to the development of a wide spectrum of constitutive laws. In addition to developing analytical tools, extensive numerical studies have been conducted on menisci modeling. This study reviews the developments of the most widely used continuum models of the meniscus mechanical properties in conjunction with emerging analytical and numerical models used to study the meniscus. The review presents relevant approaches and assumptions used to develop the models and includes discussions regarding strengths, weaknesses, and discrepancies involved in the presented models. The study presents a comprehensive coverage of relevant publications included in Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect, Springer, and Scopus databases. This review aims at opening novel avenues for improving menisci modeling within the framework of constitutive modeling through highlighting the needs for further research directed toward determining key factors in gaining insight into the biomechanics of menisci which is crucial for the elaborate design of meniscal replacements.
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Falcon JM, Karchner JP, Henning EA, Mauck RL, Pleshko N. Ethics of Using Animal Models as Predictors of Human Response in Tissue Engineering. ETHICS IN BIOLOGY, ENGINEERING & MEDICINE 2020; 10:37-49. [PMID: 38770223 PMCID: PMC11103864 DOI: 10.1615/ethicsbiologyengmed.2020033718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Use of outcomes from animal research for prediction of human response in tissue engineering studies has many ethical considerations. This article aims to contribute to the ethical discussion by delineating the framework of animal research and the ethical considerations at play, in particular with respect to cartilage tissue engineering. The history of animal research regulation and the current status of animal research in orthopedic tissue engineering is discussed. Questions addressed include how the proper animal models are chosen, how regulatory bodies ensure animal wellness and safety, and how guidelines are implemented and maintained throughout the life cycle of a project. Finally, we provide examples of both in vitro and in vivo cartilage tissue engineering research where animal models were employed as a predictive model of human response.
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Affiliation(s)
- Jessica M. Falcon
- Tissue Imaging and Spectroscopy Lab, Department of Bioengineering, Temple University, Philadelphia, PA 19122
| | - James P. Karchner
- Tissue Imaging and Spectroscopy Lab, Department of Bioengineering, Temple University, Philadelphia, PA 19122
| | - Elizabeth A. Henning
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert L. Mauck
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104
| | - Nancy Pleshko
- Tissue Imaging and Spectroscopy Lab, Department of Bioengineering, Temple University, Philadelphia, PA 19122
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Nakama GY, Aman ZS, Storaci HW, Kuczmarski AS, Krob JJ, Strauss MJ. Different Suture Materials for Arthroscopic Transtibial Pull-out Repair of Medial Meniscal Posterior Root Tears: A Human Biomechanical Study. Orthop J Sports Med 2019; 7:2325967119873274. [PMID: 31632997 PMCID: PMC6769225 DOI: 10.1177/2325967119873274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Transtibial pull-out repair of the medial meniscal posterior root (MMPR) has been largely assessed through biomechanical studies. Biomechanically comparing different suture types would further optimize MMPR fixation and affect clinical care. Purpose/Hypothesis The purpose of this study was to determine the optimal suture material for MMPR fixation. It was hypothesized that ultra high-molecular weight polyethylene (UHMWPE) suture tape would be biomechanically superior to UHMWPE suture and standard suture. Study Design Controlled laboratory study. Methods The MMPR attachment was divided in 24 human cadaveric knees and randomly assigned to 3 repair groups: UHMWPE suture tape, UHMWPE suture, and standard suture. Specimens were dissected down to the medial meniscus, and the posterior root attachments were sectioned off the tibia. Two-tunnel transtibial pull-out repair with 2 sutures, as determined by the testing group, was performed. The repair constructs were cyclically loaded between 10 and 30 N at 0.5 Hz for 1000 cycles to mimic the forces experienced on the medial meniscus during postoperative rehabilitation. Displacement was recorded at 1, 50, 100, 500, and 1000 cycles. Ultimate failure load, displacement at failure, and load at 3 mm of displacement (clinical failure) were also recorded. Results UHMWPE suture tape had significantly less displacement of the medial meniscus when compared with standard suture at 1 (-0.22 mm [95% CI, -0.41 to -0.02]; P = .025) and 50 (-0.35 mm [95% CI, -0.67 to -0.03]; P = .029) cycles. There were no other significant differences observed in displacement between groups at any number of cycles. UHMWPE suture tape had significantly less displacement at the time of failure than standard suture (-3.71 mm [95% CI, -7.17 to -0.24]; P = .034). UHMWPE suture tape had a significantly higher load to reach the clinical failure displacement of 3 mm than UHMWPE suture (15.64 N [95% CI, 0.02 to 31.26]; P = .05). There were no significant differences in ultimate failure load between groups. Conclusion The meniscal root repair construct with UHMWPE suture tape may be stronger and less prone to displacement than that with standard suture or UHMWPE suture. Clinical Relevance UHMWPE suture tape may provide better clinical results compared with UHMWPE suture and standard suture.
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Affiliation(s)
- Gilberto Y Nakama
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, Brazil
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Joseph J Krob
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marc J Strauss
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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22
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Pflieger I, Stolberg-Stolberg J, Foehr P, Kuntz L, Tübel J, Grosse CU, Burgkart R. Full biomechanical mapping of the ovine knee joint to determine creep-recovery, stiffness and thickness variation. Clin Biomech (Bristol, Avon) 2019; 67:1-7. [PMID: 31054436 DOI: 10.1016/j.clinbiomech.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/21/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical cartilage repair strategies can be tested using the sheep model as suggest by the European Medicines Agency. To characterize variation within the joint a full biomechanical mapping is necessary. The aim of this study is to establish a loading model, to map regional differences within the knee and determine reference areas for area specific replacement techniques. METHODS A porous indenter was selected to evaluate 22 defined test locations (femoral condyles, tibia plateau, patella, femoral groove) on ovine knees (n = 7). A high-dynamic force-controlled micro creep and creep-recovery indentation test system applied five loading (0.11 MPa) and unloading (5.6 kPa) cycles for 60 s each and recorded creep-recovery. Needle indentation was used to measure cartilage thickness and calculate total strain. FINDINGS Steady state behaviour was observed from the third cycle and further evaluated. Little variation of stiffness in N/mm was found within the patella (4.3SD0.5) and femoral groove (8.1SD0.7) compared to larger variations in the femur (7.9SD2.0) and tibia (7.5SD3.2). Creep indentation showed values of 14.5%(SD2.7%) for the patella and 17.4%(SD3%) for the femoral grove opposed to 13.4%(SD4.3%) for the femoral condyles and 21.8%(SD6.6%) for the tibia plateau. Similar trends were observed analysing creep-recovery. Values were normalized to cartilage thickness which ranged between 0.36 mm and 1.14 mm. INTERPRETATION Our setup allows a reliable evaluation of zonal differences. Homogenous biomechanical behaviour is found within the patella and femoral groove whereas significant biomechanical variation within the femoral condyles and tibia plateau indicates the need for site-specific cartilage repair products.
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Affiliation(s)
- Iris Pflieger
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Josef Stolberg-Stolberg
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany.
| | - Peter Foehr
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany; Chair of Non-destructive Testing, Technical University of Munich, Baumbachstr. 7, 81245 Munich, Germany
| | - Lara Kuntz
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jutta Tübel
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Christian U Grosse
- Chair of Non-destructive Testing, Technical University of Munich, Baumbachstr. 7, 81245 Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
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23
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Steineman BD, LaPrade RF, Haut Donahue TL. Loosening of Transtibial Pullout Meniscal Root Repairs due to Simulated Rehabilitation Is Unrecoverable: A Biomechanical Study. Arthroscopy 2019; 35:1232-1239. [PMID: 30871905 DOI: 10.1016/j.arthro.2018.11.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether meniscal root repairs recover from displacement due to rehabilitative loading. METHODS Transtibial pullout repairs of the posteromedial meniscal root were performed in 16 cadaveric ovine knees. Single- and double-tunnel repairs using the 2-simple suture technique were cyclically loaded in tension to 10,000 cycles, allowed to rest, and loaded in tension again. Paired differences in displacement with rest were recorded to evaluate recoverability. Displacement of repairs at cycles of interest was recorded, and the response of repairs to 10,000 cycles was assessed. RESULTS All outcomes were not significantly different between the single- and double-tunnel techniques; therefore, the results were pooled. The difference in displacement between the first cycle and the first cycle after rest was 1.59 ± 0.69 mm. Repair displacement did not reach an equilibrium within 10,000 cycles and instead resulted in a steady increase in displacement of 0.05 ± 0.02 mm per additional 1,000 cycles. Sutures macroscopically began to cut out of the meniscus in both single- and double-tunnel repairs. CONCLUSIONS This study showed that significant, unrecoverable loosening from rehabilitative loading occurred in single- and double-tunnel meniscal root repairs. Root repairs also gradually displaced with continued loading instead of reaching an equilibrium displacement after 10,000 cycles. This progressive, unrecoverable loosening needs to be studied further to better understand the resultant impact on knee mechanics. In addition, the quality and quantity of meniscal root repair healing at the time of rehabilitation should be studied to determine how susceptible patients are to repair loosening. CLINICAL RELEVANCE Rehabilitative loading caused unrecoverable and progressive loosening of root repairs, showing the importance of healing before loading. Investigations on the effects of loosening on mechanics and the quality of repair healing at weight bearing are necessary to better understand the clinical implications.
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Affiliation(s)
- Brett D Steineman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Robert F LaPrade
- The Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Tammy L Haut Donahue
- Department of Biomedical Engineering, University of Massachusetts, Amherst, Massachusetts, U.S.A..
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24
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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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25
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Li L, Yang X, Yang L, Zhang K, Shi J, Zhu L, Liang H, Wang X, Jiang Q. Biomechanical analysis of the effect of medial meniscus degenerative and traumatic lesions on the knee joint. Am J Transl Res 2019; 11:542-556. [PMID: 30899361 PMCID: PMC6413253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/23/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to determine the effect of the degenerative medial meniscus and traumatic lesions on the biomechanical behavior of the knee. An elaborate three-dimensional (3D) finite element model of the total knee joint containing bones, articular cartilages, main ligaments, and menisci was developed from a combination of magnetic resonance images and computed tomography. Three types of meniscus tears were employed to represent the degenerative and traumatic lesions. The stress and meniscus extrusion of healthy and injured knees were investigated under the posture of static stance. The traumatic longitudinal tear demonstrated the highest stress and the largest meniscus extrusion displacement. The degenerative horizontal and peripheral tears also showed an irregular biomechanical balance in the knee joint. Despite the damaged hemijoint, the stress on the healthy lateral hemijoint was increased. Although the biomechanics was deteriorated in all meniscus tear models, the variation degree was diverse. The transfixion damage could potentially cause future injury in the knee joint and accelerate the progress of osteoarthritis. Moreover, the meniscus injury may cause high-stress concentration on the contralateral side of the joint. The current results revealed the cause of different clinical manifestation after meniscus tears and the risk of knee osteoarthritis through biomechanical aspects.
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Affiliation(s)
- Lan Li
- School of Mechanical Engineering, Southeast UniversityChina
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing UniversityNanjing, China
- Institute of Medical 3D Printing, Nanjing UniversityNanjing, China
| | - Xianfeng Yang
- Department of Radiology, Drum Tower Hospital Affiliated to Medical School of Nanjing UniversityNanjing, China
| | - Longfei Yang
- School of Mechanical Engineering, Southeast UniversityChina
| | - Kaijia Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing UniversityNanjing, China
| | - Jianping Shi
- School of Electrical and Automation Engineering, Nanjing Normal UniversityNanjing, China
| | - Liya Zhu
- School of Electrical and Automation Engineering, Nanjing Normal UniversityNanjing, China
| | - Huixin Liang
- School of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and AstronauticsNanjing, China
| | - Xingsong Wang
- School of Mechanical Engineering, Southeast UniversityChina
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing UniversityNanjing, China
- Institute of Medical 3D Printing, Nanjing UniversityNanjing, China
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26
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Cope P, Ourradi K, Li Y, Sharif M. Models of osteoarthritis: the good, the bad and the promising. Osteoarthritis Cartilage 2019; 27:230-239. [PMID: 30391394 PMCID: PMC6350005 DOI: 10.1016/j.joca.2018.09.016] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a chronic degenerative disease of diarthrodial joints most commonly affecting people over the age of forty. The causes of OA are still unknown and there is much debate in the literature as to the exact sequence of events that trigger the onset of the heterogeneous disease we recognise as OA. There is currently no consensus model for OA that naturally reflects human disease. Existing ex-vivo models do not incorporate the important inter-tissue communication between joint components required for disease progression and differences in size, anatomy, histology and biomechanics between different animal models makes translation to the human model very difficult. This narrative review highlights the advantages and disadvantages of the current models used to study OA. It discusses the challenges of producing a more reliable OA-model and proposes a direction for the development of a consensus model that reflects the natural environment of human OA. We suggest that a human osteochondral plug-based model may overcome many of the fundamental limitations associated with animal and in-vitro models based on isolated cells. Such a model will also provide a platform for the development and testing of targeted treatment and validation of novel OA markers directly on human tissues.
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Affiliation(s)
| | | | | | - M. Sharif
- Address correspondence and reprint requests to: M. Sharif, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building level 2, Southmead Hospital, Bristol, BS10 5NB, UK. Tel: 44-117-414-7926.
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27
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Stein SEC, von Luebken F, Warnecke D, Gentilini C, Skaer N, Walker R, Kessler O, Ignatius A, Duerselen L. The challenge of implant integration in partial meniscal replacement: an experimental study on a silk fibroin scaffold in sheep. Knee Surg Sports Traumatol Arthrosc 2019; 27:369-380. [PMID: 30264241 PMCID: PMC6394547 DOI: 10.1007/s00167-018-5160-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/24/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE To restore meniscal function after excessive tissue damage, a silk fibroin implant for partial meniscal replacement was developed and investigated in an earlier sheep model. After 6 months implantation, it showed promising results in terms of chondroprotection and biocompatibility. To improve surgical fixation, the material was subjected to optimisation and a fibre mesh was integrated into the porous matrix. The aim of the study was the evaluation of this second generation of silk fibroin implants in a sheep model. METHODS Nine adult merino sheep received subtotal meniscal replacement using the silk fibroin scaffold. In nine additional animals, the defect was left untreated. Sham surgery was performed in another group of nine animals. After 6 months of implantation macroscopic, biomechanical and histological evaluations of the scaffold, meniscus, and articular cartilage were conducted. RESULTS Macroscopic evaluation revealed no signs of inflammation of the operated knee joint and most implants were located in the defect. However, there was no solid connection to the remaining peripheral meniscal rim and three devices showed a radial rupture at the middle zone. The equilibrium modulus of the scaffold increased after 6 months implantation time as identified by biomechanical testing (before implantation 0.6 ± 0.3 MPa; after implantation: 0.8 ± 0.3 MPa). Macroscopically and histologically visible softening and fibrillation of the articular cartilage in the meniscectomy- and implant group were confirmed biomechanically by indentation testing of the tibial cartilage. CONCLUSIONS In the current study, biocompatibility of the silk fibroin scaffold was reconfirmed. The initial mechanical properties of the silk fibroin implant resembled native meniscal tissue. However, stiffness of the scaffold increased considerably after implantation. This might have prevented integration of the device and chondroprotection of the underlying cartilage. Furthermore, the increased stiffness of the material is likely responsible for the partial destruction of some implants. Clinically, we learn that an inappropriate replacement device might lead to similar cartilage damage as seen after meniscectomy. Given the poor acceptance of the clinically available partial meniscal replacement devices, it can be speculated that development of a total meniscal replacement device might be the less challenging option.
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Affiliation(s)
- Svenja Emmi Catherine Stein
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Falk von Luebken
- Department of Trauma and Orthopaedic Surgery, Hospital of the German Armed Forces Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Daniela Warnecke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Cristina Gentilini
- Orthox Ltd., 66 Innovation Drive, Milton Park, Abingdon, Oxfordshire OX14 4RQ UK
| | - Nick Skaer
- Orthox Ltd., 66 Innovation Drive, Milton Park, Abingdon, Oxfordshire OX14 4RQ UK
| | - Robert Walker
- Orthox Ltd., 66 Innovation Drive, Milton Park, Abingdon, Oxfordshire OX14 4RQ UK
| | - Oliver Kessler
- Centre of Orthopaedics and Sports, Albisriederstraße 243 A, 8047 Zurich, Switzerland
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Lutz Duerselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstraße 14, 89081 Ulm, Germany
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28
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Warnecke D, Stein S, Haffner-Luntzer M, de Roy L, Skaer N, Walker R, Kessler O, Ignatius A, Dürselen L. Biomechanical, structural and biological characterisation of a new silk fibroin scaffold for meniscal repair. J Mech Behav Biomed Mater 2018; 86:314-324. [PMID: 30006280 PMCID: PMC6079190 DOI: 10.1016/j.jmbbm.2018.06.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 11/20/2022]
Abstract
Meniscal injury is typically treated surgically via partial meniscectomy, which has been shown to cause cartilage degeneration in the long-term. Consequently, research has focused on meniscal prevention and replacement. However, none of the materials or implants developed for meniscal replacement have yet achieved widespread acceptance or demonstrated conclusive chondroprotective efficacy. A redesigned silk fibroin scaffold, which already displayed promising results regarding biocompatibility and cartilage protection in a previous study, was characterised in terms of its biomechanical, structural and biological functionality to serve as a potential material for permanent partial meniscal replacement. Therefore, different quasi-static but also dynamic compression tests were performed. However, the determined compressive stiffness (0.56 ± 0.31 MPa and 0.30 ± 0.12 MPa in relaxation and creep configuration, respectively) was higher in comparison to the native meniscal tissue, which could potentially disturb permanent integration into the host tissue. Nevertheless, µ-CT analysis met the postulated requirements for partial meniscal replacement materials in terms of the microstructural parameters, like mean pore size (215.6 ± 10.9 µm) and total porosity (80.1 ± 4.3%). Additionally, the biocompatibility was reconfirmed during cell culture experiments. The current study provides comprehensive mechanical and biological data for the characterisation of this potential replacement material. Although some further optimisation of the silk fibroin scaffold may be advantageous, the silk fibroin scaffold showed sufficient biomechanical competence to support loads already in the early postoperative phase.
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Affiliation(s)
- Daniela Warnecke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstr. 14, 89081 Ulm, Germany.
| | - Svenja Stein
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstr. 14, 89081 Ulm, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstr. 14, 89081 Ulm, Germany
| | - Luisa de Roy
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstr. 14, 89081 Ulm, Germany
| | | | | | - Oliver Kessler
- Centre of Orthopaedics and Sports, Zurich, Switzerland; University Medical Centre, Clinic for Orthopaedic Surgery, Magdeburg, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstr. 14, 89081 Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstr. 14, 89081 Ulm, Germany
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29
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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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Ribitsch I, Peham C, Ade N, Dürr J, Handschuh S, Schramel JP, Vogl C, Walles H, Egerbacher M, Jenner F. Structure-Function relationships of equine menisci. PLoS One 2018. [PMID: 29522550 PMCID: PMC5844599 DOI: 10.1371/journal.pone.0194052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Meniscal pathologies are among the most common injuries of the femorotibial joint in both human and equine patients. Pathological forces and ensuing injuries of the cranial horn of the equine medial meniscus are considered analogous to those observed in the human posterior medial horn. Biomechanical properties of human menisci are site- and depth- specific. However, the influence of equine meniscus topography and composition on its biomechanical properties is yet unknown. A better understanding of equine meniscus composition and biomechanics could advance not only veterinary therapies for meniscus degeneration or injuries, but also further substantiate the horse as suitable translational animal model for (human) meniscus tissue engineering. Therefore, the aim of this study was to investigate the composition and structure of the equine knee meniscus in a site- and age-specific manner and their relationship with potential site-specific biomechanical properties. The meniscus architecture was investigated histologically. Biomechanical testing included evaluation of the shore hardness (SH), stiffness and energy loss of the menisci. The SH was found to be subjected to both age and site-specific changes, with an overall higher SH of the tibial meniscus surface and increase in SH with age. Stiffness and energy loss showed neither site nor age related significant differences. The macroscopic and histologic similarities between equine and human menisci described in this study, support continued research in this field.
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Affiliation(s)
- Iris Ribitsch
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
- * E-mail:
| | - Christian Peham
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Nicole Ade
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Zurich, Switzerland
| | - Julia Dürr
- Department of Pathobiology, Unit of Histology and Embryology, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Stephan Handschuh
- Vetcore Facility for Research, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Johannes Peter Schramel
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Claus Vogl
- Department of Biomedical Sciences, Unit of Molecular Genetics, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Heike Walles
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg and Translational Center Wuerzburg, Wuerzburg, Baveria, Germany
| | - Monika Egerbacher
- Department of Pathobiology, Unit of Histology and Embryology, Vetmeduni Vienna, Vienna, Vienna, Austria
| | - Florien Jenner
- Department for Companion Animals and Horses, Veterm, University Equine Hospital, Vetmeduni Vienna, Vienna, Vienna, Austria
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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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Camarda L, Pitarresi G, Lauria M, Fazzari F, D'Arienzo M. Three single loops enhance the biomechanical behavior of the transtibial pull-out technique for posterior meniscal root repair. Arch Orthop Trauma Surg 2017; 137:1301-1306. [PMID: 28674738 DOI: 10.1007/s00402-017-2739-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture-meniscus construct used during the transtibial pull-out repair technique. METHODS A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all specimens (N = 10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Further, stiffness (500-1000 cycles) and ultimate load and modes of failure of the suture-meniscus construct were also recorded. RESULTS There was no statistically significant difference between the Group 2SS and Group 3SS at the 1st (1.6 ± 0.7 vs 1.4 ± 0.4 mm) and the 100th cycle (2 ± 0.7 vs 1.8 ± 0.4 mm). At 500 and 1000 cycles, the 2SS fixation technique resulted in significantly more displacement than the 3SS fixation technique (2.8 ± 0.6 vs 2.3 ± 0.5 mm; 3.1 ± 0.7 vs 2.5 ± 0.5 mm) (p < 0.05). No differences between two groups were noted concerning ultimate load to failure and stiffness (500-1000 cycles). CONCLUSION Three single sutures technique provided superior biomechanical properties compared with the two single sutures technique during the conducted fatigue tests. CLINICAL RELEVANCE Applying three simple stitches during meniscal root repair might be beneficial for healing of the posterior meniscal root, potentially reducing the post-operative immobilization time.
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Affiliation(s)
- Lawrence Camarda
- Department of Orthopaedic Surgery (DiChirOnS), University of Palermo, Via del Vespro, Palermo, Italy.
| | - Giuseppe Pitarresi
- Dipartimento di Ingegneria Chimica, Gestionale, Informatica e Meccanica (DICGIM), University of Palermo, Viale delle Scienze, Palermo, Italy
| | - Michele Lauria
- Department of Orthopaedic Surgery (DiChirOnS), University of Palermo, Via del Vespro, Palermo, Italy
| | - Federico Fazzari
- Department of Orthopaedic Surgery (DiChirOnS), University of Palermo, Via del Vespro, Palermo, Italy
| | - Michele D'Arienzo
- Department of Orthopaedic Surgery (DiChirOnS), University of Palermo, Via del Vespro, Palermo, Italy
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Kondo S, Muneta T, Nakagawa Y, Koga H, Watanabe T, Tsuji K, Sotome S, Okawa A, Kiuchi S, Ono H, Mizuno M, Sekiya I. Transplantation of autologous synovial mesenchymal stem cells promotes meniscus regeneration in aged primates. J Orthop Res 2017; 35:1274-1282. [PMID: 26916126 DOI: 10.1002/jor.23211] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/17/2016] [Indexed: 02/04/2023]
Abstract
Transplantation of aggregates of synovial mesenchymal stem cells (MSCs) enhanced meniscus regeneration in rats. Anatomy and biological properties of the meniscus depend on animal species. To apply this technique clinically, it is valuable to investigate the use of animals genetically close to humans. We investigated whether transplantation of aggregates of autologous synovial MSCs promoted meniscal regeneration in aged primates. Chynomolgus primates between 12 and 13 years old were used. After the anterior halves of the medial menisci in both knees were removed, an average of 14 aggregates consisting of 250,000 synovial MSCs were transplanted onto the meniscus defect. No aggregates were transplanted to the opposite knee for the control. Meniscus and articular cartilage were analyzed macroscopically, histologically, and by MRI T1rho mapping at 8 (n = 3) and 16 weeks (n = 4). The medial meniscus was larger and the modified Pauli's histological score for the regenerated meniscus was better in the MSC group than in the control group in each primate at 8 and 16 weeks. Mankin's score for the medial femoral condyle cartilage was better in the MSC group than in the control group in all primates at 16 weeks. T1rho value for both the regenerated meniscus and adjacent articular cartilage in the MSC group was closer to the normal meniscus than in the control group in all primates at 16 weeks. Transplantation of aggregates of autologous synovial MSCs promoted meniscus regeneration and delayed progression of degeneration of articular cartilage in aged primates. This is the first report dealing with meniscus regeneration in primates. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1274-1282, 2017.
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Affiliation(s)
- Shimpei Kondo
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Muneta
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.,Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Watanabe
- Department of Cartilage Regeneration, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kunikazu Tsuji
- Department of Cartilage Regeneration, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Shinichi Sotome
- Department of Orthopaedic Research and Development, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Warnecke D, Schild N, Klose S, Joos H, Brenner R, Kessler O, Skaer N, Walker R, Freutel M, Ignatius A, Dürselen L. Friction properties of a new silk fibroin scaffold for meniscal replacement. TRIBOLOGY INTERNATIONAL 2017; 109:586-592. [PMID: 28469288 PMCID: PMC5327953 DOI: 10.1016/j.triboint.2017.01.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 05/27/2023]
Abstract
The menisci protect the articular cartilage by reducing contact pressure in the knee. To restore their function after injury, a new silk fibroin replacement scaffold was developed. To elucidate its tribological properties, friction of the implant was tested against cartilage and glass, where the latter is typically used in tribological cartilage studies. The silk scaffold exhibited a friction coefficient against cartilage of 0.056, which is higher than meniscus against cartilage but in range of the requirements for meniscal replacements. Further, meniscus friction against glass was lower than cartilage against glass, which correlated with the surface lubricin content. Concluding, the tribological properties of the new material suggest a possible long-term chondroprotective function. In contrast, glass always produced high, non-physiological friction coefficients.
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Affiliation(s)
- Daniela Warnecke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany
| | - N.B. Schild
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany
| | - S. Klose
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany
| | - H. Joos
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopaedics, Ulm University Medical Centre, Germany
| | - R.E. Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopaedics, Ulm University Medical Centre, Germany
| | - O. Kessler
- Centre of Orthopaedics and Sports, Zurich, Switzerland
- University Medical Centre, Clinic for Orthopaedic Surgery, Magdeburg, Germany
| | | | | | - M. Freutel
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany
| | - A. Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany
| | - L. Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Germany
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35
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Kremer A, Ribitsch I, Reboredo J, Dürr J, Egerbacher M, Jenner F, Walles H. Three-Dimensional Coculture of Meniscal Cells and Mesenchymal Stem Cells in Collagen Type I Hydrogel on a Small Intestinal Matrix—A Pilot Study Toward Equine Meniscus Tissue Engineering. Tissue Eng Part A 2017; 23:390-402. [DOI: 10.1089/ten.tea.2016.0317] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Antje Kremer
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center Wuerzburg ‘Regenerative therapies,’ Wuerzburg Branch of the Fraunhofer IGB, Wuerzburg, Germany
| | - Iris Ribitsch
- Vienna Equine Tissue Engineering and Regenerative Medicine, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Jenny Reboredo
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center Wuerzburg ‘Regenerative therapies,’ Wuerzburg Branch of the Fraunhofer IGB, Wuerzburg, Germany
| | - Julia Dürr
- Department of Pathobiology, Institute of Histology & Embryology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Monika Egerbacher
- Department of Pathobiology, Institute of Histology & Embryology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Florien Jenner
- Vienna Equine Tissue Engineering and Regenerative Medicine, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Heike Walles
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center Wuerzburg ‘Regenerative therapies,’ Wuerzburg Branch of the Fraunhofer IGB, Wuerzburg, Germany
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Gelse K, Körber L, Schöne M, Raum K, Koch P, Pachowsky M, Welsch G, Breiter R. Transplantation of Chemically Processed Decellularized Meniscal Allografts. Cartilage 2017; 8:180-190. [PMID: 28345410 PMCID: PMC5358822 DOI: 10.1177/1947603516646161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of this study was to evaluate the chondroprotective effect of chemically decellularized meniscal allografts transplanted into the knee joints of adult merino sheep. Methods Lateral sheep meniscal allografts were chemically processed by a multistep method to yield acellular, sterile grafts. The grafts were transplanted into the knee joints of sheep that were treated by lateral meniscectomy. Joints treated by meniscectomy only and untreated joints served as controls. The joints were analyzed morphologically 6 and 26 weeks after surgery by the macroscopical and histological OARSI (Osteoarthritis Research Society International) score. Additionally, the meniscal grafts were biomechanically tested by cyclic indentation. Results Lateral meniscectomy was associated with significant degenerative changes of the articular cartilage of the lateral joint compartment. Transplanted lateral meniscal allografts retained their integrity during the observation period without inducing significant synovitis or foreign body reactions. Cellular repopulation of the grafts was only present on the surface and the periphery of the lateral meniscus, but was still completely lacking in the center of the grafts at week 26. Transplantation of processed meniscal allografts could not prevent degenerative changes of the articular cartilage in the lateral joint compartment. Compared with healthy menisci, the processed grafts were characterized by a significantly reduced dynamic modulus, which did not improve during the observation period of 26 weeks in vivo. Conclusion Chemically decellularized meniscal allografts proved their biocompatibility and durability without inducing immunogenic reactions. However, insufficient recellularization and inferior stiffness of the grafts hampered chondroprotective effects on the articular cartilage.
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Affiliation(s)
- Kolja Gelse
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Erlangen, Germany,Kolja Gelse, Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany.
| | - Ludwig Körber
- Institute of Bioprocess Engineering, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Schöne
- Berlin Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kay Raum
- Berlin Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Koch
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Milena Pachowsky
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Götz Welsch
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roman Breiter
- Institute of Bioprocess Engineering, University of Erlangen-Nürnberg, Erlangen, Germany
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Danso EK, Oinas JMT, Saarakkala S, Mikkonen S, Töyräs J, Korhonen RK. Structure-function relationships of human meniscus. J Mech Behav Biomed Mater 2016; 67:51-60. [PMID: 27987426 DOI: 10.1016/j.jmbbm.2016.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 01/09/2023]
Abstract
Biomechanical properties of human meniscus have been shown to be site-specific. However, it is not known which meniscus constituents at different depths and locations contribute to biomechanical properties obtained from indentation testing. Therefore, we investigated the composition and structure of human meniscus in a site- and depth-dependent manner and their relationships with tissue site-specific biomechanical properties. Elastic and poroelastic properties were analyzed from experimental stress-relaxation and sinusoidal indentation measurements with fibril reinforced poroelastic finite element modeling. Proteoglycan (PG) and collagen contents, as well as the collagen orientation angle, were determined as a function of tissue depth using microscopic and spectroscopic methods, and they were compared with biomechanical properties. For all the measurement sites (anterior, middle and posterior) of lateral and medial menisci (n=26), PG content and collagen orientation angle increased as a function of tissue depth while the collagen content had an initial sharp increase followed by a decrease across tissue depth. The highest values (p<0.05) of elastic parameters (equilibrium and instantaneous moduli) and strain-dependent biomechanical parameters (strain-dependent fibril network modulus and permeability) were observed in the anterior horn of the medial meniscus. This location had also higher (p<0.05) PG content in the deep meniscus, higher (p<0.05) collagen content in the entire tissue depth, and lower (p<0.05) collagen orientation angle at the superficial tissue, as compared to many other locations. On the other hand, in certain comparisons (such as anterior vs. middle sites of the medial meniscus) significantly higher (p<0.05) collagen content and lower orientation angle, without any difference in the PG content, were consistent with increased meniscus modulus and/or nonlinear permeability. This study suggests that nonlinear biomechanical properties of meniscus, caused by the collagen network and fluid, may be strongly influenced by tissue osmotic swelling from the deep meniscus caused by the increased PG content, leading to increased collagen fibril tension. These nonlinear biomechanical properties are suggested to be further amplified by higher collagen content at all tissue depths and superficial collagen fibril orientation. However, these structure-function relationships are suggested to be highly site-specific.
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Affiliation(s)
- Elvis K Danso
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, KYS, POB 100, FI-70029 Kuopio, Finland.
| | - Joonas M T Oinas
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, FI-90029 Oulu, Finland
| | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, KYS, POB 100, FI-70029 Kuopio, Finland
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, KYS, POB 100, FI-70029 Kuopio, Finland
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Takroni T, Laouar L, Adesida A, Elliott JAW, Jomha NM. Anatomical study: comparing the human, sheep and pig knee meniscus. J Exp Orthop 2016; 3:35. [PMID: 27928740 PMCID: PMC5143332 DOI: 10.1186/s40634-016-0071-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Animal models are commonly used in investigating new treatment options for knee joint injuries including injuries to the meniscus. The reliability and applicability of these models to replicate findings in humans depends on determining the most suitable animal proxy. Therefore, this study was designed to compare the wet weight, volume and dimensions of the human meniscus with two commonly used animal models: sheep and pig. METHODS Human menisci (n = 6 pairs) were obtained from the knee joints of cadaveric male donors. Sheep menisci (n = 6 pairs) and pig menisci (n = 22 pairs) were obtained from the stifle joints of adult sheep and pigs. Meniscal wet weight, volume and dimensions of the body were measured and compared among the species. Anatomical dimensions included circumference, width, peripheral height, articular height and superior articular length. RESULTS The circumference of human menisci (lateral: 84.0 mm, medial: 88.7 mm) was significantly longer than that of sheep (lateral: 50.0 mm, medial: 55.5 mm) and pig (lateral: 66.8 mm, medial: 64.9 mm). The majority of the remaining dimensions of the medial and all of the remaining dimensions of the lateral menisci in sheep showed no statistical difference in comparison to the human menisci. The meniscal weight in pig was significantly larger (lateral: 6.4 g, medial: 5.0 g) than the human (lateral: 4.9 g, medial: 4.4 g) and sheep (lateral: 2.5 g, medial: 2.2 g). Porcine meniscal volume (lateral: 6.5 ml, medial: 5.1 ml) was also larger than the human (lateral: 5.0 ml, medial: 4.5 ml) and sheep (lateral: 2.3 ml, medial: 2.2 ml) menisci. The dimensions measured in the pig meniscus were generally larger than human menisci with statistically significant differences in most categories. CONCLUSION Sheep meniscal dimensions more closely matched human meniscal dimensions than the pig meniscal dimensions. This information may help guide the choice of an animal proxy in meniscal research.
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Affiliation(s)
- Talal Takroni
- Department of Surgery, Laboratory of Orthopaedic Research, University of Alberta, Edmonton, Canada.
- Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Leila Laouar
- Department of Surgery, Laboratory of Orthopaedic Research, University of Alberta, Edmonton, Canada
| | - Adetola Adesida
- Department of Surgery, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Nadr M Jomha
- Department of Surgery, Laboratory of Orthopaedic Research, University of Alberta, Edmonton, Canada
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Ogawa S, Awaga Y, Takashima M, Hama A, Matsuda A, Takamatsu H. Knee osteoarthritis pain following medial meniscectomy in the nonhuman primate. Osteoarthritis Cartilage 2016; 24:1190-9. [PMID: 26944197 DOI: 10.1016/j.joca.2016.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A number of promising compounds developed for osteoarthritic pain have failed to demonstrate clinical efficacy. To enhance preclinical translational research for osteoarthritis, a model of knee osteoarthritis pain was developed in Macaca fascicularis and the effects of two distinct pharmacological classes of drugs were tested on pain-related behavior. DESIGN Behavioral assessments were developed specifically for the macaque. Baseline knee pressure threshold and weight bearing were assessed prior to a unilateral medial meniscectomy (MMx). Fifteen days following MMx, macaques underwent a once daily exercise regimen for 36 days. Sixty-seven days following MMx, macaques were assigned to one of three treatment groups (n = 3/group), either non-steroidal anti-inflammatory drug (NSAID) diclofenac, NK1 receptor antagonist aprepitant or vehicle, and treated for 5 days. Animals were tested 3-4 h after p.o. dosing and testing was performed blinded. Treatment utilized a crossover design-each animal received all treatments-and a 9-day washout period was utilized between treatments. RESULTS Vehicle-treated macaques consistently demonstrated decreased ipsilateral pressure threshold ("hyperalgesia") and decreased weight bearing. While diclofenac increased weight bearing and pressure threshold, full attenuation of pain was not obtained. No significant improvement of either knee pressure or weight bearing was observed with aprepitant. CONCLUSIONS Unilateral MMx in the macaque evoked pain-related behaviors and knee joint pathology reminiscent of osteoarthritis. The behavioral endpoints were sensitive to NSAID treatment but not sensitive to NK1 receptor block, which parallel clinical findings. The current macaque osteoarthritis model could be used to test potential treatments for osteoarthritis pain.
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Affiliation(s)
- S Ogawa
- Hamamatsu Pharma Research, Inc., Hamamatsu, Japan
| | - Y Awaga
- Hamamatsu Pharma Research, Inc., Hamamatsu, Japan
| | - M Takashima
- Hamamatsu Pharma Research, Inc., Hamamatsu, Japan
| | - A Hama
- Hamamatsu Pharma Research, Inc., Hamamatsu, Japan.
| | - A Matsuda
- Hamamatsu Pharma Research, Inc., Hamamatsu, Japan
| | - H Takamatsu
- Hamamatsu Pharma Research, Inc., Hamamatsu, Japan
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Miller AT, Safranski DL, Smith KE, Guldberg RE, Gall K. Compressive cyclic ratcheting and fatigue of synthetic, soft biomedical polymers in solution. J Mech Behav Biomed Mater 2016; 54:268-82. [DOI: 10.1016/j.jmbbm.2015.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 12/14/2022]
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Abstract
Biomaterials are artificial or natural materials, which are used in living organisms for a wide variety of reasons. Currently, there are biomaterials available for practically all types of tissue and can fulfill temporary and permanent functions. Ideally, materials used for temporary roles should be completely resorbed after the fulfilling the function and those with a permanent role should remain stable within the body. Many of the currently available biomaterials do not possess these optimal features. Those with temporary roles often remain unchanged within the organism or only induce an incomplete regeneration and those with permanent roles suffer biological alterations which reduce the function. Despite the enormous number of biomaterials, it must always be considered whether the therapeutic target can be achieved without using an implant.
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Affiliation(s)
- S Vogt
- Hessing Stiftung Augsburg, Augsburg, Deutschland,
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Abstract
Osteoarthritis (OA) is unquestionably one of the most important chronic health issues in humans, affecting millions of individuals and costing billions of dollars annually. Despite widespread awareness of this disease and its devastating impact, the pathogenesis of early OA is not completely understood, hampering the development of effective tools for early diagnosis and disease-modifying therapeutics. Most human tissue available for study is obtained at the time of joint replacement, when OA lesions are end stage and little can be concluded about the factors that played a role in disease development. To overcome this limitation, over the past 50 years, numerous induced and spontaneous animal models have been utilized to study disease onset and progression, as well as to test novel therapeutic interventions. Reflecting the heterogeneity of OA itself, no single "gold standard" animal model for OA exists; thus, a challenge for researchers lies in selecting the most appropriate model to answer a particular scientific question of interest. This review provides general considerations for model selection, as well as important features of species such as mouse, rat, guinea pig, sheep, goat, and horse, which researchers should be mindful of when choosing the "best" animal model for their intended purpose. Special consideration is given to key variations in pathology among species as well as recommended guidelines for reporting the histologic features of each model.
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Affiliation(s)
- A M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA
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Gaugler M, Wirz D, Ronken S, Hafner M, Göpfert B, Friederich NF, Elke R. Fibrous cartilage of human menisci is less shock-absorbing and energy-dissipating than hyaline cartilage. Knee Surg Sports Traumatol Arthrosc 2015; 23:1141-6. [PMID: 24614927 DOI: 10.1007/s00167-014-2926-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To test meniscal mechanical properties such as the dynamic modulus of elasticity E* and the loss angle δ at two loading frequencies ω at different locations of the menisci and compare it to E* and δ of hyaline cartilage in indentation mode with spherical indenters. METHODS On nine pairs of human menisci, the dynamic E*-modulus and loss angle δ (as a measure of the energy dissipation) were determined. The measurements were performed at two different strain rates (slow sinusoidal and fast single impact) to show the strain rate dependence of the material. The measurements were compared to previous similar measurements with the same equipment on human hyaline cartilage. RESULTS The resultant E* at fast indentation (median 1.16 MPa) was significantly higher, and the loss angle was significantly lower (median 10.2°) compared to slow-loading mode's E* and δ (median 0.18 MPa and 16.9°, respectively). Further, significant differences for different locations are shown. On the medial meniscus, the anterior horn shows the highest resultant dynamic modulus. CONCLUSION In dynamic measurements with a spherical indenter, the menisci are much softer and less energy-dissipating than hyaline cartilage. Further, the menisci are stiffer and less energy-dissipating in the middle, intermediate part compared to the meniscal base. In compression, the energy dissipation of meniscus cartilage plays a minor role compared to hyaline cartilage. At high impacts, energy dissipation is less than on low impacts, similar to cartilage.
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Affiliation(s)
- Mario Gaugler
- Center of Biomechanics and Calorimetry Basel, University of Basel, Klingelbergstrasse 50-70, 4056, Basel, Switzerland
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LaPrade RF, LaPrade CM, Ellman MB, Turnbull TL, Cerminara AJ, Wijdicks CA. Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation. Am J Sports Med 2015; 43:892-8. [PMID: 25556220 DOI: 10.1177/0363546514562554] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent biomechanical evidence suggests that the meniscus-suture interface contributes the most displacement to the transtibial pull-out repair for meniscal root tears. Therefore, optimization of surgical technique at the meniscus-suture interface may minimize displacement and improve the strength of meniscal root repairs. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the cyclic displacement and ultimate failure loads of 4 different meniscus-suture fixation techniques for posterior medial meniscal root repairs in human meniscus tissue. The hypothesis was that there would be no significant difference between the two simple sutures (TSS) technique and 3 other techniques in cyclic displacement or ultimate failure load. STUDY DESIGN Controlled laboratory study. METHODS A total of 32 fresh-frozen, human, medial meniscal transplant specimens were randomly assigned to 4 meniscus-suture fixation techniques used for transtibial pull-out repair in posterior medial meniscal root tears (n = 8 per group). The suture techniques studied were (1) TSS, (2) modified Mason-Allen (MMA), (3) single double-locking loop (S-DLL), and (4) double double-locking loop (D-DLL). The menisci were subjected to a cyclic tensioning protocol representative of postoperative rehabilitation (10-30 N for 1000 cycles) and pulled to failure at a rate of 0.5 mm/s. RESULTS After 1000 cycles, the TSS group displaced the least (mean ± SD, 1.78 ± 0.64 mm), followed by the MMA (2.14 ± 0.65 mm), D-DLL (2.97 ± 0.57 mm), and S-DLL (3.81 ± 0.78 mm) groups. After 100, 500, and 1000 cycles, suture displacements using the TSS and MMA techniques were not significantly different (P > .13), while the TSS technique resulted in significantly less displacement than the S-DLL and D-DLL (P < .03) techniques. The ultimate failure loads of the MMA (325 ± 77 N) and D-DLL (320 ± 50 N) techniques were significantly greater than those of the TSS (192 ± 52 N) and S-DLL (217 ± 51 N) techniques (P < .05). CONCLUSION The TSS and MMA fixation techniques were not significantly different, while the TSS was significantly better at resisting displacement when compared with the S-DLL and D-DLL stitch configurations. The MMA and D-DLL techniques exhibited significantly greater failure loads than did the TSS and S-DLL techniques; however, all techniques demonstrated ultimate failure loads above the currently accepted rehabilitation force threshold. CLINICAL RELEVANCE The TSS fixation technique combines the lowest technical difficulty and the ability to resist displacement at time zero. The MMA technique, although more technically challenging, may provide an alternative means to resist displacement while enhancing the failure load.
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Affiliation(s)
- Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | - Michael B Ellman
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | - Anthony J Cerminara
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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LaPrade CM, LaPrade MD, Turnbull TL, Wijdicks CA, LaPrade RF. Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels. Am J Sports Med 2015; 43:899-904. [PMID: 25573393 DOI: 10.1177/0363546514563278] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current methods of the transtibial pull-out meniscal root repair significantly displace under cyclic loading in porcine models but have not been evaluated in human models. One potential explanation for the displacement is that a single transtibial tunnel may not fully restore the attachment of the entire posterior medial meniscal root. PURPOSE/HYPOTHESIS The purpose of this study was to biomechanically evaluate the transtibial pull-out technique in a human cadaveric model using either 1 or 2 transtibial bone tunnels. The hypothesis was that a transtibial pull-out technique using 2 transtibial bone tunnels would confer superior biomechanical properties in comparison to an iteration using 1 transtibial bone tunnel. STUDY DESIGN Controlled laboratory study. METHODS Ten matched pairs of male human cadaveric knees (average age, 52.7 years) were randomly assigned (1 each of the pair) to 2 groups consisting of a transtibial pull-out technique using either 1 or 2 transtibial bone tunnels. The knees were cyclically loaded for 1000 cycles from 10 to 30 N at 0.5 Hz, representing the loads experienced during a typical meniscal root repair postoperative rehabilitation program, and then pulled to failure at a rate of 0.5 mm/s. RESULTS Differences between 1- and 2-tunnel repair groups were neither statistically nor clinically significant with respect to displacement or ultimate failure load. On average, the 1- and 2-tunnel repair groups resulted in 3.32 mm and 3.23 mm of displacement, respectively, after 1000 testing cycles. At 1, 100, 500, and 1000 testing cycles, displacement was not significantly different between groups (P > .799). The 2-tunnel repair technique resulted in a 10.2% higher ultimate failure load (135 N vs. 123 N); however, this was not significant (P = .333). CONCLUSIONS Similar biomechanical properties were seen between transtibial pull-out repairs using either 1 or 2 transtibial bone tunnels in a human cadaveric model. Both repair groups exceeded the 3-mm threshold for nonanatomic displacement. CLINICAL RELEVANCE This study indicates that a newly proposed iteration of the transtibial pull-out repair technique using a second transtibial tunnel, which theoretically restores more of the posterior medial meniscal root, was almost identical to the current clinical standard involving a single transtibial tunnel. As the importance of repairing meniscal root tears is increasingly recognized, further studies on new iterations of both techniques are warranted to minimize the risk of displacement caused by early motion in the initial postoperative rehabilitation period.
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Affiliation(s)
| | | | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 2015; 43:912-20. [PMID: 25622987 DOI: 10.1177/0363546514566191] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior medial meniscal root tears have been reported to extrude with the meniscus becoming adhered posteromedially along the posterior capsule. While anatomic repair has been reported to restore tibiofemoral contact mechanics, it is unknown whether nonanatomic positioning of a meniscal root repair to a posteromedial location would restore the loading profile of the knee joint. PURPOSE/HYPOTHESIS The purpose of this study was to compare the tibiofemoral contact mechanics of a nonanatomic posterior medial meniscal tear with that of the intact knee or anatomic repair. It was hypothesized that a nonanatomic root repair would not restore the tibiofemoral contact pressures and areas to that of the intact or anatomic repair state. STUDY DESIGN Controlled laboratory study. METHODS Tibiofemoral contact mechanics were recorded in 6 male human cadaveric knee specimens (average age, 45.8 years) using pressure sensors. Each knee underwent 5 testing conditions for the posterior medial meniscal root: (1) intact knee; (2) root tear; (3) anatomic transtibial pull-out repair; (4) nonanatomic transtibial pull-out repair, placed 5 mm posteromedially along the edge of the articular cartilage; and (5) root tear concomitant with an ACL tear. Knees were loaded with a 1000-N axial compressive force at 4 flexion angles (0°, 30°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated. RESULTS Contact area was significantly lower after nonanatomic repair than for the intact knee at all flexion angles (mean = 44% reduction) and significantly higher for anatomic versus nonanatomic repair at all flexion angles (mean = 27% increase). At 0° and 90°, and when averaged across flexion angles, the nonanatomic repair significantly increased mean contact pressures in comparison to the intact knee or anatomic repair. When averaged across flexion angles, the peak contact pressures after nonanatomic repair were significantly higher than the intact knee but not the anatomic repair. In contrast, when averaged across all flexion angles, the anatomic repair resulted in a 17% reduction in contact area and corresponding increases in mean and peak contact pressures of 13% and 26%, respectively, compared with the intact knee. CONCLUSION For most testing conditions, the nonanatomic repair did not restore the contact area or mean contact pressures to that of the intact knee or anatomic repair. However, the anatomic repair produced near-intact contact area and resulted in relatively minimal increases in mean and peak contact pressures compared with the intact knee. CLINICAL RELEVANCE Results emphasize the importance of ensuring an anatomic posterior medial meniscal root repair by releasing the extruded menisci from adhesions and the posteromedial capsule. Similar caution toward preventing displacement of the meniscal root repair construct should be emphasized.
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Affiliation(s)
| | - Abdullah Foad
- Quality Care Clinic and Surgicenter, Clinton, Iowa, USA
| | - Sean D Smith
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF. Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med 2014; 42:2988-95. [PMID: 25239930 DOI: 10.1177/0363546514549447] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A common treatment for posterior meniscal root tears is transtibial pull-out repair, which has been biomechanically reported to restore tibiofemoral contact mechanics to those of the intact knee. Biomechanical data suggest that there is significant displacement of the repaired meniscal root with cyclic loading, which may be responsible for the poor healing and meniscal extrusion demonstrated in some clinical studies. HYPOTHESIS/PURPOSE The purpose of this study was to quantify the time-zero displacement of the posterior meniscal root in response to cyclic loading after transtibial pull-out repair and to quantify the individual contributions to displacement of the following: (1) suture elongation, (2) button-bone interface, and (3) meniscus-suture interface. The meniscus-suture interface was hypothesized to result in significantly more displacement than the button-bone interface or suture elongation. STUDY DESIGN Descriptive laboratory study. METHODS Transtibial pull-out repair of the posterior medial meniscal root was performed in 6 porcine knees, and cyclic displacement was measured using a loading protocol representative of postoperative rehabilitation. Displacement from (1) suture elongation, (2) the button-bone interface, and (3) the meniscus-suture interface was determined by cyclically loading 6 specimens for each construct using the same loading protocol to determine the contribution of each component to the overall displacement of the repair construct. RESULTS After 1000 cycles, the repair construct displaced by a mean of 3.28 mm (95% CI, 2.07-4.49). The meniscus-suture component (mean, 2.52 mm; 95% CI, 2.21-2.83) displaced significantly more than the button-bone component (mean, 0.90 mm; 95% CI, 0.64-1.15; P = .006) and suture elongation component (mean, 0.71 mm; 95% CI, 0.36-1.06; P = .006) after 1000 cycles. Displacement of the button-bone and suture elongation components was not significantly different after 1000 cycles (P = .720). CONCLUSION There was substantial displacement of the posterior medial meniscal root repaired with the transtibial pull-out technique under a cyclic loading protocol simulating postoperative rehabilitation. The meniscus-suture interface contributed to significantly more displacement than the button-bone interface and suture elongation in the transtibial pull-out repair construct. CLINICAL RELEVANCE The results provide a framework for optimizing the transtibial pull-out repair technique. Future studies should focus on improving suture fixation strength within the meniscus-suture interface.
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Affiliation(s)
- Anthony J Cerminara
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | - Sean D Smith
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Michael B Ellman
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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