1
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Chen K, Aggarwal S, Baker H, Athiviraham A. Biologic Augmentation of Isolated Meniscal Repair. Curr Rev Musculoskelet Med 2024; 17:223-234. [PMID: 38652368 PMCID: PMC11156815 DOI: 10.1007/s12178-024-09898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW The limited blood supply and intrinsic healing capacity of the meniscus contributes to suboptimal tissue regeneration following injury and surgical repair. Biologic augmentation techniques have been utilized in combination with isolated meniscal repair to improve tissue regeneration. Several innovative strategies such as Platelet-Rich Plasma (PRP), fibrin clots, mesenchymal stem cells (MSCs), bone marrow stimulation, meniscal scaffolds, and meniscal wrapping, are being explored to enhance repair outcomes. This article provides a comprehensive review of recent findings and conclusions regarding biologic augmentation techniques. RECENT FINDINGS Studies on PRP reveal mixed outcomes, with some suggesting benefits in reducing failure rates of isolated meniscal repair, while others question its efficacy. Fibrin clots and PRF (Platelet-rich fibrin), although promising, show inconsistent results and lack sufficient evidence for definitive conclusions. MSCs demonstrate potential in preclinical studies, but clinical trials have been limited and inconclusive. Bone marrow stimulation appears effective in certain contexts, but its broader applicability remains uncertain. Meniscal scaffolds, including CMI (Collagen Meniscal Implants) and Actifit (polyurethane scaffolds), show encouraging short- and mid-term outcomes but have not consistently surpassed traditional methods in the long term. Meniscal wrapping is infrequently studied but demonstrates positive short-term results with certain applications. The review reveals a diverse range of outcomes for biologic augmentation in meniscal repair. While certain techniques show promise, particularly in specific scenarios, the overall efficacy of these methods has yet to reach a consensus. The review underscores the necessity for standardized, high-quality research to establish the definitive effectiveness of these biologic augmentation methods.
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Affiliation(s)
- Kevin Chen
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarthak Aggarwal
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Hayden Baker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 S. Maryland Ave MC 3079, Chicago, IL, 60637, USA
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 S. Maryland Ave MC 3079, Chicago, IL, 60637, USA.
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2
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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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3
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Bandyopadhyay A, Ghibhela B, Shome S, Hoque S, Nandi SK, Mandal BB. Photo-Polymerizable Autologous Growth-Factor Loaded Silk-Based Biomaterial-Inks toward 3D Printing-Based Regeneration of Meniscus Tears. Adv Biol (Weinh) 2024; 8:e2300710. [PMID: 38402426 DOI: 10.1002/adbi.202300710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Indexed: 02/26/2024]
Abstract
Meniscus tears in the avascular region undergoing partial or full meniscectomy lead to knee osteoarthritis and concurrent lifestyle hindrances in the young and aged alike. Here they reported ingenious photo-polymerizable autologous growth factor loaded 3D printed scaffolds to potentially treat meniscal defects . A shear-thinning photo-crosslinkable silk fibroin methacrylate-gelatin methacrylate-polyethylene glycol dimethacrylate biomaterial-ink is formulated and loaded with freeze-dried growth factor rich plasma (GFRP) . The biomaterial-ink exhibits optimal rheological properties and shape fidelity for 3D printing. Initial evaluation revealed that the 3D printed scaffolds mimic mechanical characteristics of meniscus, possess favourable porosity and swelling characteristics, and demonstrate sustained GFRP release. GFRP laden 3D scaffolds are screened with human neo-natal stem cells in vitro and biomaterial-ink comprising of 25 mg mL-1 of GFRP (GFRP25) is found to be amicable for meniscus tissue engineering. GFRP25 ink demonstrated rigorous rheological compliance, and printed constructs demonstrated long term degradability (>6 weeks), GFRP release (>5 weeks), and mechanical durability (3 weeks). GFRP25 scaffolds aided in proliferation of seeded human neo-natal stem cellsand their meniscus-specific fibrochondrogenic differentiation . GFRP25 constructs show amenable inflammatory response in vitro and in vivo. GFRP25 biomaterial-ink and printed GFRP25 scaffolds could be potential patient-specific treatment modalities for meniscal defects.
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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
| | - Sayanti Shome
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Samsamul Hoque
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, West Bengal, 700037, India
| | - Samit K Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, West Bengal, 700037, 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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4
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Wang S, Mueller D, Chen P, Pan G, Wilson M, Sun S, Chen Z, Lee T, Damon B, Hepfer RG, Hill C, Kern MJ, Pullen WM, Wu Y, Brockbank KGM, Yao H. Viable Vitreous Grafts of Whole Porcine Menisci for Transplant in the Knee and Temporomandibular Joints. Adv Healthc Mater 2024:e2303706. [PMID: 38523366 DOI: 10.1002/adhm.202303706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/20/2024] [Indexed: 03/26/2024]
Abstract
The shortage of suitable donor meniscus grafts from the knee and temporomandibular joint (TMJ) impedes treatments for millions of patients. Vitrification offers a promising solution by transitioning these tissues into a vitreous state at cryogenic temperatures, protecting them from ice crystal damage using high concentrations of cryoprotectant agents (CPAs). However, vitrification's success is hindered for larger tissues (>3 mL) due to challenges in CPA penetration. Dense avascular meniscus tissues require extended CPA exposure for adequate penetration; however, prolonged exposure becomes cytotoxic. Balancing penetration and reducing cell toxicity is required. To overcome this hurdle, a simulation-based optimization approach is developed by combining computational modeling with microcomputed tomography (µCT) imaging to predict 3D CPA distributions within tissues over time accurately. This approach minimizes CPA exposure time, resulting in 85% viability in 4-mL meniscal specimens, 70% in 10-mL whole knee menisci, and 85% in 15-mL whole TMJ menisci (i.e., TMJ disc) post-vitrification, outperforming slow-freezing methods (20%-40%), in a pig model. The extracellular matrix (ECM) structure and biomechanical strength of vitreous tissues remain largely intact. Vitreous meniscus grafts demonstrate clinical-level viability (≥70%), closely resembling the material properties of native tissues, with long-term availability for transplantation. The enhanced vitrification technology opens new possibilities for other avascular grafts.
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Affiliation(s)
- Shangping Wang
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Dustin Mueller
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Peng Chen
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Ge Pan
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Marshall Wilson
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Shuchun Sun
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Zhenzhen Chen
- Tissue Testing Technologies LLC, North Charleston, SC, 29406, USA
| | - Thomas Lee
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Brooke Damon
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - R Glenn Hepfer
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Cherice Hill
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Michael J Kern
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - William M Pullen
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Yongren Wu
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kelvin G M Brockbank
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Tissue Testing Technologies LLC, North Charleston, SC, 29406, USA
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
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5
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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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6
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Morgan C, Bell R, Burland JP, Edgar CM. Meniscus Allograft Transplantation Augmented With Autologous Bone Marrow Aspirate Concentrate. Arthrosc Tech 2023; 12:e1021-e1026. [PMID: 37533910 PMCID: PMC10390746 DOI: 10.1016/j.eats.2023.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 08/04/2023] Open
Abstract
Meniscus allograft transplantation (MAT) has been shown to be a feasible surgical option for younger patients, below 50 years of age who have meniscal insufficiency and have failed conservative treatment measures. In this technical note, we describe a procedure of harvesting and injecting bone marrow aspirate concentrate in a meniscus allograft during a MAT procedure, which may allow for longer lasting transplants and improve patient outcomes. In this technical note, bone marrow aspirate concentrate is harvested arthroscopically from the intercondylar notch at the surgical site, which prevents additional donor site morbidity, as seen with harvesting from other locations, such as the iliac crest. This also reduces operating time, since harvesting from the iliac crest requires different patient positioning and usually additional anesthesia. The authors of this surgical technique believe that biological augmentation during MATs will assist surgeons in maximizing graft survivorship and, ultimately, lead to better patient outcomes.
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Affiliation(s)
- Courtney Morgan
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Julie P. Burland
- UConn Institute for Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- UConn Institute for Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
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7
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Wei J, Zhang W, Ding X. Design and Finite Element Analysis of Artificial Braided Meniscus Model. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4775. [PMID: 37445089 DOI: 10.3390/ma16134775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Currently, artificial meniscus prostheses are mostly homogenous, low strength, and difficult to mimic the distribution of internal fibers in the native meniscus. To promote the overall mechanical performance of meniscus prostheses, this paper designed a new artificial braided meniscus model and conducted finite element analysis. Firstly, we designed the spatial fiber interweaving structure of meniscus model to mimic the internal fiber distribution of the native meniscus. Secondly, we provided the detailed braiding steps and forming process principles based on the weaving structure. Thirdly, we adopted the models of the fiber-embedded matrix and multi-scale methods separately for finite element analysis to achieve the reliable elastic properties. Meanwhile, we compared the results for two models, which are basically consistent, and verified the accuracy of analysis. Finally, we conducted the comparative simulation analysis of the meniscus model and the pure matrix meniscus model based on the solved elastic constants through Abaqus, which indicated a 60% increase in strength.
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Affiliation(s)
- Jiakai Wei
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Wuxiang Zhang
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Ningbo Institute of Technology, Beihang University, Ningbo 315832, China
| | - Xilun Ding
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Ningbo Institute of Technology, Beihang University, Ningbo 315832, China
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8
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de Paula AP, de Lima JD, Bastos TSB, Czaikovski AP, dos Santos Luz RB, Yuasa BS, Smanioto CCS, Robert AW, Braga TT. Decellularized Extracellular Matrix: The Role of This Complex Biomaterial in Regeneration. ACS OMEGA 2023; 8:22256-22267. [PMID: 37396215 PMCID: PMC10308580 DOI: 10.1021/acsomega.2c06216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/12/2023] [Indexed: 07/04/2023]
Abstract
Organ transplantation is understood as a technique where an organ from a donor patient is transferred to a recipient patient. This practice gained strength in the 20th century and ensured advances in areas of knowledge such as immunology and tissue engineering. The main problems that comprise the practice of transplants involve the demand for viable organs and immunological aspects related to organ rejection. In this review, we address advances in tissue engineering for reversing the current challenges of transplants, focusing on the possible use of decellularized tissues in tissue engineering. We address the interaction of acellular tissues with immune cells, especially macrophages and stem cells, due to their potential use in regenerative medicine. Our goal is to exhibit data that demonstrate the use of decellularized tissues as alternative biomaterials that can be applied clinically as partial or complete organ substitutes.
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Affiliation(s)
| | - Jordana Dinorá de Lima
- Department
of Pathology, Federal University of Parana, Curitiba, Parana 80060-000, Brazil
| | | | | | | | - Bruna Sadae Yuasa
- Department
of Pathology, Federal University of Parana, Curitiba, Parana 80060-000, Brazil
| | | | - Anny Waloski Robert
- Stem
Cells Basic Biology Laboratory, Carlos Chagas
Institute − FIOCRUZ/PR, Curitiba, Parana 81350-010, Brazil
| | - Tárcio Teodoro Braga
- Department
of Pathology, Federal University of Parana, Curitiba, Parana 80060-000, Brazil
- Graduate
Program in Biosciences and Biotechnology, Institute Carlos Chagas, Fiocruz, Parana 81310-020, Brazil
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9
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Turati M, Boerci L, Piatti M, Russo L, Rigamonti L, Buonanotte F, Courvoisier A, Zatti G, Piscitelli D, Bigoni M. Meniscal Allograft Transplants in Skeletally Immature Patients: A Systematic Review of Indications and Outcomes. Healthcare (Basel) 2023; 11:healthcare11091312. [PMID: 37174854 PMCID: PMC10178226 DOI: 10.3390/healthcare11091312] [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: 02/03/2023] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Meniscal lesions in skeletally immature patients can lead to joint degradation and knee instability. Meniscal allograft transplant (MAT) surgery is a solution to maintain knee stability. There is a lack of consensus on MAT surgery outcomes in pediatric patients. A systematic review was conducted according to the PRISMA guidelines. PubMed, Scopus and EMBASE databases were searched from 1965 to June 2022. Studies were evaluated using the Newcastle-Ottawa Scale (NOS). Three studies were selected, and 58 patients were included (mean age 15.9 years) in total. The lateral meniscus was involved in 82.8% of all MAT surgeries. Post-meniscectomy syndrome and discoid meniscus were the main indications for MAT surgery. All studies reported improved subjective clinical scores and levels of sport after the surgery. The complication rate was 27.5%. Partial meniscectomy, meniscus knot removal, chondral defect treatment and lysis of adhesions were the most frequent procedures performed during reoperation. MAT surgery can improve clinical outcomes in pediatric patients with strictly selected indications. MAT surgery is safe when there are no limb asymmetries or malalignments, but it remains a challenging procedure with a high complication rate. Long-term follow-up is needed for definitive statements on the use of MAT in skeletally immature patients.
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Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, 38700 Grenoble, France
| | - Linda Boerci
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
| | - Massimiliano Piatti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, 24036 Ponte San Pietro, Italy
| | - Laura Russo
- Department of Biotechnology and Biosciences, University of Milano Bicocca, 20126 Milano, Italy
| | - Luca Rigamonti
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, 24036 Ponte San Pietro, Italy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Francesco Buonanotte
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
| | - Aurelien Courvoisier
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, 38700 Grenoble, France
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Orthopaedic and Trauma, Policlinico San Pietro Hospital, 24036 Ponte San Pietro, Italy
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10
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Liu X, Yan P, Cui R, Wu Y, Xu B, Zhou W, Li F, Wu X. Controllable Damping Magnetorheological Elastomer Meniscus. ACS Biomater Sci Eng 2023; 9:869-876. [PMID: 36580436 DOI: 10.1021/acsbiomaterials.2c01083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The human healthy meniscus fulfills key biomechanical functions in the tibiofemoral (knee) joint. Meniscal injury leads to an increased risk for symptomatic osteoarthritis. In order to prevent osteoarthritis, many researchers have put efforts into developing new-type meniscal substitute materials. In this study, MRI data of the human knee joint is obtained by CT scanning, and a three-dimensional finite element model of the meniscus is established. Compressive forces of 400 N, 600 N, 800 N, and 1000 N are selected to complete the meniscus modeling and finite element simulation analysis of the meniscus by ANSYS; at the same time, the compressive force and compressive displacement of the magnetorheological elastomer are controlled by changing the current size. The results show that the compressive force and compressive displacement of the magnetorheological elastomer can be controlled by an electric current, so as to adapt to the required mechanical properties of the meniscus under external complex loads and provide a theoretical and experimental basis for clinical meniscus replacement.
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Affiliation(s)
- Xuhui Liu
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - PianPian Yan
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Ran Cui
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yan Wu
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Bin Xu
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Wentong Zhou
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Fang Li
- School of Mechanical Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Xiaoxue Wu
- Shanghai Minhang Vocational and Technical College, 4080 Yuanjiang Road, Minhang District, Shanghai 201109, China
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11
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Jin P, Liu L, Chen X, Cheng L, Zhang W, Zhong G. Applications and prospects of different functional hydrogels in meniscus repair. Front Bioeng Biotechnol 2022; 10:1082499. [PMID: 36568293 PMCID: PMC9773848 DOI: 10.3389/fbioe.2022.1082499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
The meniscus is a kind of fibrous cartilage structure that serves as a cushion in the knee joint to alleviate the mechanical load. It is commonly injured, but it cannot heal spontaneously. Traditional meniscectomy is not currently recommended as this treatment tends to cause osteoarthritis. Due to their good biocompatibility and versatile regulation, hydrogels are emerging biomaterials in tissue engineering. Hydrogels are excellent candidates in meniscus rehabilitation and regeneration because they are fine-tunable, easily modified, and capable of delivering exogenous drugs, cells, proteins, and cytokines. Various hydrogels have been reported to work well in meniscus-damaged animals, but few hydrogels are effective in the clinic, indicating that hydrogels possess many overlooked problems. In this review, we summarize the applications and problems of hydrogels in extrinsic substance delivery, meniscus rehabilitation, and meniscus regeneration. This study will provide theoretical guidance for new therapeutic strategies for meniscus repair.
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Affiliation(s)
- Pan Jin
- Health Science Center, Yangtze University, Jingzhou, China,Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China,*Correspondence: Pan Jin, ; Gang Zhong,
| | - Lei Liu
- Articular Surgery, The Second Nanning People’s Hospital (Third Affiliated Hospital of Guangxi Medical University), Nanning, China
| | - Xichi Chen
- Health Science Center, Yangtze University, Jingzhou, China
| | - Lin Cheng
- Health Science Center, Yangtze University, Jingzhou, China
| | - Weining Zhang
- Health Science Center, Yangtze University, Jingzhou, China
| | - Gang Zhong
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,*Correspondence: Pan Jin, ; Gang Zhong,
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12
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Pereira H, Cengiz IF, Silva-Correia J, Oliveira JM, Vasconcelos JC, Gomes S, Ripoll PL, Karlsson J, Reis RL, Espregueira-Mendes J. Integration of polyurethane meniscus scaffold during ACL revision is not reliable at 5 years despite favourable clinical outcome. Knee Surg Sports Traumatol Arthrosc 2022; 30:3422-3427. [PMID: 35338384 DOI: 10.1007/s00167-022-06946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical outcome at 5-year follow-up of a one-step procedure combining anterior cruciate ligament (ACL) reconstruction and partial meniscus replacement using a polyurethane scaffold for the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy. Moreover, the implanted scaffolds have been evaluated by MRI protocol in terms of morphology, volume, and signal intensity. METHODS Twenty patients with symptomatic knee laxity after failed ACL reconstruction and partial medial meniscectomy underwent ACL revision combined with polyurethane-based meniscal scaffold implant. Clinical assessment at 2- and 5-year follow-ups included VAS, Tegner Activity Score, International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lysholm Score. MRI evaluation of the scaffold was performed according to the Genovese scale with quantification of the scaffold's volume at 1- and 5-year follow-ups. RESULTS All scores revealed clinical improvement as compared with the preoperative values at the 2- and 5-year follow-ups. However, a slight, but significant reduction of scores was observed between 2 and 5 years. Concerning the MRI assessment, a significant reduction of the scaffold's volume was observed between 1 and 5 years. Genovese Morphology classification at 5 years included two complete resorptions (Type 3) and all the remaining patients had irregular morphology (Type 2). With regard to the Genovese Signal at the 5-year follow-up, three were classified as markedly hyperintense (Type 1), 15 as slightly hyperintense (Type 2), and two as isointense (Type 1). CONCLUSION Simultaneous ACL reconstruction and partial meniscus replacement using a polyurethane scaffold provides favourable clinical outcomes in the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy at 5 years. However, MRI evaluation suggests that integration of the scaffold is not consistent. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hélder Pereira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. .,Orthopedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal. .,Ripoll y de Prado Sports Clinic-FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.
| | - Ibrahim Fatih Cengiz
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joana Silva-Correia
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joaquim M Oliveira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Sérgio Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
| | - Pedro L Ripoll
- Ripoll y de Prado Sports Clinic-FIFA Medical Centre of Excellence, Murcia-Madrid, Spain
| | - Jón Karlsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Rui L Reis
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João Espregueira-Mendes
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
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13
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Loofah-chitosan and poly (-3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) based hydrogel scaffolds for meniscus tissue engineering applications. Int J Biol Macromol 2022; 221:1171-1183. [PMID: 36087757 DOI: 10.1016/j.ijbiomac.2022.09.031] [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: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
The meniscus is a fibrocartilaginous tissue that is very important for the stability of the knee joint. However, it has a low ability to heal itself, so damage to it will always lead to articular cartilage degeneration. The goal of this study was to make a new type of meniscus scaffold made of chitosan, loofah mat, and PHBV nanofibers, as well as to describe hydrogel composite scaffolds in terms of their shape, chemical composition, mechanical properties, and temperature. Three different concentrations of genipin (0.1, 0.3, and 0.5 %) were used and the optimal crosslinker concentration was 0.3 % for Chitosan/loofah (CL) and Chitosan/loofah/PHBV fiber (CLF). Scaffolds were seeded using undifferentiated MSCs and incubated for 21 days to investigate the chondrogenic potential of hydrogel scaffolds. Cell proliferation analyses were performed using WST-1 assay, GAG content was analyzed, SEM and fluorescence imaging observed morphologies and cell attachment, and histological and immunohistochemical studies were performed. The in vitro analysis showed no cytotoxic effect and enabled cells to attach, proliferate, and migrate inside the scaffold. In conclusion, the hydrogel composite scaffold is a promising material for engineering meniscus tissue.
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14
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Mameri ES, Dasari SP, Fortier LM, Verdejo FG, Gursoy S, Yanke AB, Chahla J. Review of Meniscus Anatomy and Biomechanics. Curr Rev Musculoskelet Med 2022; 15:323-335. [PMID: 35947336 DOI: 10.1007/s12178-022-09768-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW Anatomic repair of meniscal pathology is critical for restoring native joint biomechanics and kinematics for patients who suffer from meniscal tears. The purpose of this review was to summarize the pertinent anatomy, biomechanics, and kinematics of the meniscus to guide surgeons during meniscal repair procedures. RECENT FINDINGS Over the past decade, there has been a growing trend to save the meniscus whenever possible. The goal of repair should be to recreate native anatomy as close as possible to recapitulate normal mechanics. Studies describing the quantitative and qualitative relationship of the meniscus roots, ligaments, and attachments are key in guiding any meniscus repair. This review summarizes these relationships, with particular emphasis on meniscal roots and other key attachments to the meniscus. The composition, embryology, vascularization, biomechanics, in vivo kinetics, and in vivo kinematics of the meniscus are also discussed in this review. Meniscal tears can cause profound functional, biomechanical, and kinematic derangements within the knee joint leading to accelerated degeneration of the articular cartilage. A strong understanding of the quantitative and qualitative relationships of the meniscus and its attachments with key arthroscopic landmarks will allow a surgeon to anatomically repair meniscal pathology in order to restore native joint biomechanics.
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Affiliation(s)
- Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA.,Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.,Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Fernando Gómez Verdejo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA.
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15
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Kluyskens L, Debieux P, Wong KL, Krych AJ, Saris DBF. Biomaterials for meniscus and cartilage in knee surgery: state of the art. J ISAKOS 2022; 7:67-77. [PMID: 35543667 DOI: 10.1136/jisakos-2020-000600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
Meniscus and cartilage injuries of the knee joint lead to cartilage degeneration and osteoarthritis (OA). The research on biomaterials and artificial implants as substitutes in reconstruction and regeneration has become a main international focus in order to solve clinical problems such as irreparable meniscus injury, postmeniscectomy syndrome, osteochondral lesions and generalised chronic OA. In this review, we provide a summary of biomaterials currently used in clinical practice as well as state-of-the-art tissue engineering strategies and technologies that are developed for articular cartilage and meniscus repair and regeneration. The literature was reviewed over the last 5 years on clinically used meniscus and cartilage repair biomaterials, such as Collagen Meniscal Implant, Actifit, NUsurface, TruFit, Agili-C and MaioRegen. There are clinical advantages for these biomaterials and the application of these treatment options should be considered individually. Standardised evaluation protocols are needed for biological and mechanical assessment and comparison between different scaffolds, and long-term randomised independent clinical trials with large study numbers are needed to provide more insight into the use of these biomaterials. Surgeons should become familiar and stay up to date with evolving repair options to improve their armamentarium for meniscal and cartilage defects.
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Affiliation(s)
- Louis Kluyskens
- Orthopedics, AZ Monica Antwerpen, Antwerpen, Belgium; Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
| | - Pedro Debieux
- Department of Orthopedics and Traumatology, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil; Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Keng Lin Wong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore; Department of Orthopaedic Surgery, National University of Singapore, Singapore
| | - Aaron J Krych
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA; Department of Orthopedic Surgery, University Medical Centre, Utrecht, Netherlands.
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16
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Trivedi J, Betensky D, Desai S, Jayasuriya CT. Post-Traumatic Osteoarthritis Assessment in Emerging and Advanced Pre-Clinical Meniscus Repair Strategies: A Review. Front Bioeng Biotechnol 2021; 9:787330. [PMID: 35004646 PMCID: PMC8733822 DOI: 10.3389/fbioe.2021.787330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Surgical repair of meniscus injury is intended to help alleviate pain, prevent further exacerbation of the injury, restore normal knee function, and inhibit the accelerated development of post-traumatic osteoarthritis (PTOA). Meniscus injuries that are treated poorly or left untreated are reported to significantly increase the risk of PTOA in patients. Current surgical approaches for the treatment of meniscus injuries do not eliminate the risk of accelerated PTOA development. Through recent efforts by scientists to develop innovative and more effective meniscus repair strategies, the use of biologics, allografts, and scaffolds have come into the forefront in pre-clinical investigations. However, gauging the extent to which these (and other) approaches inhibit the development of PTOA in the knee joint is often overlooked, yet an important consideration for determining the overall efficacy of potential treatments. In this review, we catalog recent advancements in pre-clinical therapies for meniscus injuries and discuss the assessment methodologies that are used for gauging the success of these treatments based on their effect on PTOA severity. Methodologies include histopathological evaluation of cartilage, radiographic evaluation of the knee, analysis of knee function, and quantification of OA predictive biomarkers. Lastly, we analyze the prevalence of these methodologies using a systemic PubMed® search for original scientific journal articles published in the last 3-years. We indexed 37 meniscus repair/replacement studies conducted in live animal models. Overall, our findings show that approximately 75% of these studies have performed at least one assessment for PTOA following meniscus injury repair. Out of this, 84% studies have reported an improvement in PTOA resulting from treatment.
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Affiliation(s)
| | | | | | - Chathuraka T. Jayasuriya
- Department of Orthopaedics, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, United States
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17
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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18
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Abstract
The menisci are fibrocartilaginous semilunar structures in the knee that provide load support. Injury to the meniscus alters its load sharing and biomechanical profile. Knee arthroscopy with meniscus débridement is the most common orthopaedic surgical procedure done in the United States. The current goals of meniscal surgery are to preserve native meniscal tissue and maintain structural integrity. Meniscal preservation is critical to maintain the normal mechanics and homeostasis of the knee; however, it is not always feasible because of the structure's poor blood supply and often requires removal of irreparable tissue with meniscectomy. Efforts have increasingly focused on the promotion of meniscal healing and the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. The purpose of this article was to review current and future meniscal salvage treatments such as meniscus transplant, synthetic arthroplasty, and possible bioprinted meniscus to allow patients to maintain quality of life, limit pain, and delay osteoarthritis.
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19
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Bansal S, Floyd ER, Kowalski MA, Aikman E, Elrod P, Burkey K, Chahla J, LaPrade RF, Maher SA, Robinson JL, Patel JM. Meniscal repair: The current state and recent advances in augmentation. J Orthop Res 2021; 39:1368-1382. [PMID: 33751642 PMCID: PMC8249336 DOI: 10.1002/jor.25021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Meniscal injuries represent one of the most common orthopedic injuries. The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health. For this reason, the field has shifted gradually towards suture repair, with the intent of preservation of the tissue. "Save the Meniscus" is now a prolific theme in the field; however, meniscal repair can be challenging and ineffective in many scenarios. The objectives of this review are to present the current state of surgical management of meniscal injuries and to explore current approaches being developed to enhance meniscal repair. Through a systematic literature review, we identified meniscal tear classifications and prevalence, approaches being used to improve meniscal repair, and biological- and material-based systems being developed to promote meniscal healing. We found that biologic augmentation typically aims to improve cellular incorporation to the wound site, vascularization in the inner zones, matrix deposition, and inflammatory relief. Furthermore, materials can be used, both with and without contained biologics, to further support matrix deposition and tear integration, and novel tissue adhesives may provide the mechanical integrity that the meniscus requires. Altogether, evaluation of these approaches in relevant in vitro and in vivo models provides new insights into the mechanisms needed to salvage meniscal tissue, and along with regulatory considerations, may justify translation to the clinic. With the need to restore long-term function to injured menisci, biologists, engineers, and clinicians are developing novel approaches to enhance the future of robust and consistent meniscal reparative techniques.
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Affiliation(s)
- Sonia Bansal
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Kyley Burkey
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | | | - Jay M. Patel
- Emory University, Atlanta, Georgia, USA
- Atlanta VA Medical Center, Decatur, Georgia, USA
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20
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Liang Y, Zhou R, Liu X, Liu Z, You L, Chen C, Ye X. Investigation into the effects of leukemia inhibitory factor on the bone repair capacity of BMSCs-loaded BCP scaffolds in the mouse calvarial bone defect model. J Bioenerg Biomembr 2021; 53:381-391. [PMID: 34110599 DOI: 10.1007/s10863-021-09899-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 01/09/2023]
Abstract
Leukemia inhibitory factor (LIF) is known to play a major role in bone physiology. In the present study, we examined the in vitro effects of LIF on osteoblast differentiation of bone marrow stem cells (BMSCs) and explored in vivo effects of LIF on the bone repair capacity of BMSCs-loaded biphasic calcium phosphate (BCP) scaffolds in mouse calvarial bone defect model. The mRNA and protein expression levels in the BMSCs were determined by quantitative real-time PCR and western blot, respectively; the in vitro osteoblast differentiation of the BMSCs was evaluated by using Alizarin Red S staining. The bone volume and bone density in the repaired calvarial bone defect were determined by Micro-CT. Bone regeneration was also histologically evaluated by hematoxylin and eosin staining and Masson's trichrome staining. Hypoxia treatment induced the up-regulation of Lif mRNA and LIF protein in the BMSCs. Lif overexpression up-regulated the mRNA expression levels of osteopontin and Runt-related transcription factor 2, and increased intensity of Alizarin Red S staining in the BMSCs; while Lif silence exerted the opposite effects. The in vivo studies showed that implantation of Lif-overexpressing BMSCs-loaded BCP scaffolds significantly increased the bone volume and bone density at 4 and 8 weeks after transplantation, and promoted the regeneration of bone tissues in the mouse calvarial bone defect at 8 weeks after transplantation when compared to the BMSCs-loaded BCP scaffolds group; while Lif-silencing BMSCs-loaded BCP scaffolds had the opposite effects. The present study for the first time demonstrated that LIF promoted the in vitro osteoblast differentiation of hypoxia-treated BMSCs; and further studies revealed that LIF exerted enhanced effects on the bone repair capacity of BMSCs-load BCP scaffolds in mouse calvarial bone defect model. However, future studies are warranted to determine the detailed mechanisms of LIF in the large-scale bone defect repair.
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Affiliation(s)
- Youde Liang
- Department of Stomatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China. .,Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China.
| | - Ruiping Zhou
- Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China
| | - Xin Liu
- Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China
| | - Zhikang Liu
- Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China
| | - Lin You
- Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China
| | - Chang Chen
- Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China
| | - Xiaoling Ye
- Department of Stomatology, Southern University of Science and Technology Yantian Hospital, Shenzhen, China
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21
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Hollier-Larousse B, Kim SH, Pujol N. Does intermeniscal ligament tenodesis affect meniscal allograft extrusion? Retrospective comparative study at a minimum follow-up of 2 years. Orthop Traumatol Surg Res 2021; 107:102815. [PMID: 33484905 DOI: 10.1016/j.otsr.2021.102815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/25/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Meniscal allograft transplantation (MAT) is indicated for the treatment of post-meniscectomy syndrome in young patients who do not have severe cartilage loss. While its clinical effectiveness is well established in the short- and mid-term, it does not appear to stop the progression of osteoarthritis. Meniscal extrusion often occurs early on and is irreversible. The aim of this study was to evaluate results of arthroscopic MAT combined with reconstruction of the intermeniscal ligament (IML). HYPOTHESIS Concurrent reconstruction of the IML decreases the incidence of early allograft extrusion when compared to conventional soft-tissue techniques. MATERIALS AND METHODS This was a retrospective single-centre comparative study of 55 patients operated between 2011 and 2018. The 34 patients who met the inclusion criteria were divided into two subgroups: the IML group (MAT with IML repair, n=14) and the non-IML group (MAT without IML repair, n=20). Clinical outcomes consisted of the KOOS at the last follow-up visit and the surgical revision rate. MRI was performed at a minimum of 12 months (mean 34±25 months) to determine absolute and relative meniscal extrusion, sagittal anterior and posterior extrusion, and cartilage coverage in the frontal and sagittal planes. RESULTS The KOOS score was not significantly different between the two groups. There were no reoperations in the IML group, but there were four in the non-IML group (13%) (p=0.13). Meniscal extrusion of the allograft occurred in 43% of patients (6/14) in the IML group versus 85% (17/20) in the non-IML group (p<0.03). Absolute meniscal extrusion was 2.9mm ([2.2-3.6] SD=1.2) in the ILM group versus 5.4 mm ([4.1-6.7] SD=2.9) (p=0.004) in the non-ILM group. DISCUSSION Adding ILM tenodesis or reconstruction can significantly limit early extrusion of the meniscal allograft. Clinical outcomes at a mean of 34 months are not different when compared to standard procedure. These patients should be re-evaluated in the long term to determine whether the incidence of osteoarthritis is lower with ILM tenodesis. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Bernard Hollier-Larousse
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Seong Hwan Kim
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France; Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Nicolas Pujol
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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22
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Li W, Pan J, Li J, Guo J, Zeng C, Xie D. Clinical application of polyurethane meniscal scaffold: A meta-analysis. J Orthop 2021; 24:173-181. [PMID: 33716423 PMCID: PMC7933599 DOI: 10.1016/j.jor.2021.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/14/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE In patients with partial meniscus defect, the implantation of polyurethane meniscal scaffold has become a common method for the treatment of meniscus vascular entry and tissue regeneration. However, it is unclear whether polyurethane meniscal scaffold will yield better clinical and MRI results after surgery. This meta-analysis compared the clinical and MRI results of polyurethane meniscal scaffold in some patients with meniscus defects. METHODS By searching PubMed, Embase, and Cochrane Library, a systematic review of studies evaluating the clinical outcomes of patients with polyurethane meniscal scaffold implantation. The search terms used are: "meniscus", "meniscal", "scaffold", "Actifit" "polyurethane" and "implant". The study was evaluated based on the patient's reported outcome score, accompanying surgery, and radiology results. Genovese scale was used to evaluate morphology and signal intensity, and Yulish score was used to evaluate the imaging performance of articular cartilage. RESULTS There were 16 studies that met the inclusion criteria, a total of 613 patients, and the overall average follow-up time was 41 months. The clinical scores at the final follow-up, such as VAS, IKDC, Tegner, and KOOS, were significantly improved compared with preoperatively. The MS, SI, and IIRMC scores evaluated in MRI showed no significant difference between preoperative and final follow-up. However, for AC (OR 0.34, 95% CI 0.11-1.00; P = 0.05) and AME (OR 0.08, 95% CI 0.03-0.22; P < 0.01), the final follow-up results were worse than preoperatively. CONCLUSIONS This meta-analysis found that compared with preoperative, the clinical effect of the final follow-up was significantly improved. However, MS, SI, and IIRMC in MRI parameters did not change significantly. In addition, the final follow-up results of AC and AME showed a deteriorating trend. Therefore, for patients with partial meniscus defects, polyurethane meniscal scaffold seem to be a viable option, and further research is needed to determine whether the deterioration of AC and AME is clinically relevant.
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Affiliation(s)
- Wei Li
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Jianying Pan
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Jintao Li
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Jinshan Guo
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
- Department of Histology and Embryology, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Chun Zeng
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
| | - Denghui Xie
- Department of orthopedic Surgery, Center for Orthop aedic Surgery, The Third Afiliated Hospital of Southern Medical University, China
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Kester CR, Caldwell PE, Pearson SE. Lateral Meniscal Allograft Transplant: Dovetail Bone Bridge Preparation. Arthrosc Tech 2021; 10:e969-e973. [PMID: 33981538 PMCID: PMC8084757 DOI: 10.1016/j.eats.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 02/03/2023] Open
Abstract
Meniscal tears are among the most common knee injuries encountered by an orthopaedic surgeon. Once treated with total meniscectomy, meniscal preservation is now the standard of care. Not all meniscal tears are repairable, and meniscal allograft transplantation has become an integral part of the preservation algorithm. This procedure is often recommended in a young active patient with healthy articular cartilage who has undergone a previous subtotal or total meniscectomy. There are many surgical methods for meniscal allograft transplantation, and the bone bridge technique has shown good improvement in outcome scores and good long-term survival. We describe our preferred technique for preparation of the dovetail bone bridge meniscal allograft for lateral meniscal allograft transplantation.
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Affiliation(s)
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell, III, M.D., 1501 Maple Ave., Suite 200, Richmond, VA 23226.
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24
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Yeung DA, Kelly NH. The Role of Collagen-Based Biomaterials in Chronic Wound Healing and Sports Medicine Applications. Bioengineering (Basel) 2021; 8:bioengineering8010008. [PMID: 33429996 PMCID: PMC7827215 DOI: 10.3390/bioengineering8010008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Advancements in tissue engineering have taken aim at treating tissue types that have difficulty healing naturally. In order to achieve improved healing conditions, the balance of exogenous matrix, cells, and different factors must be carefully controlled. This review seeks to explore the aspects of tissue engineering in specific tissue types treated in sports medicine and advanced wound management from the perspective of the matrix component. While the predominant material to be discussed is collagen I, it would be remiss not to mention its relation to the other contributing factors to tissue engineered healing. The main categories of materials summarized here are (1) reconstituted collagen scaffolds, (2) decellularized matrix tissue, and (3) non-decellularized tissue. These three groups are ordered by their increase in additional components beyond simply collagen.
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Schreiner AJ, Stannard JP, Cook CR, Bozynski CC, Kuroki K, Stoker AM, Smith PA, Cook JL. Comparison of meniscal allograft transplantation techniques using a preclinical canine model. J Orthop Res 2021; 39:154-164. [PMID: 32198782 DOI: 10.1002/jor.24668] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 02/04/2023]
Abstract
Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with menisco-capsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibial-osteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with menisco-tibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.
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Affiliation(s)
- Anna J Schreiner
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Traumatology and Reconstructive Surgery, BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Division of Sports Medicine, Columbia Orthopaedic Group, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Schreiner AJ, Stannard JP, Cook CR, Oladeji LO, Smith PA, Rucinski K, Cook JL. Initial clinical outcomes comparing frozen versus fresh meniscus allograft transplants. Knee 2020; 27:1811-1820. [PMID: 33197821 DOI: 10.1016/j.knee.2020.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/18/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate initial clinical outcomes using fresh meniscal allografts with high cell viability at transplantation time and meniscotibial ligament (MTL) reconstruction (Fresh) in comparison to standard fresh-frozen (Frozen) meniscus allograft transplantation (MAT). METHODS Patients treated for medial and/or lateral meniscal deficiency using either Fresh or Frozen MAT with minimum of 1-year follow-up were identified from a prospective registry. Patient demographics, prior surgeries, MAT surgery data, complications, revisions, and failures were documented. Functional outcome scores were collected preoperatively, and 6 months and yearly after surgery and radiographic joint space measurements were performed. Treatment cohorts were compared for statistically significant (P < 0.005) differences using t-Tests and Fisher's exact tests. RESULTS Twenty-seven patients (14 Fresh, 13 Frozen) met inclusion criteria and showed comparable characteristics. For Fresh MAT + MTL, 10 medial, two lateral, and two medial + lateral MAT were performed. For Frozen MAT, nine medial, and four lateral MAT were performed. There was significantly more improvement in the Fresh cohort compared to the Frozen cohort for VAS pain (P = 0.014), PROMIS Physical Function (P = 0.036) and Single Assessment Numeric Evaluation (P = 0.033) from preoperatively to 2 years postoperatively. Tegner Activity Scale and PROMIS Mobility score showed no significant differences. The International Knee Documentation Committee score revealed a clinically meaningful change for the Fresh group. Radiographic measurements showed no significant differences between groups. There were two Fresh MAT + MTL revisions and one conversion to TKA in each cohort. CONCLUSIONS Fresh MAT + MTL is safe and associated with potential advantages with respect to initial pain relief and function compared to standard frozen MAT.
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Affiliation(s)
- Anna J Schreiner
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA
| | - Cristi R Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA
| | - Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Columbia Orthopaedic Group, Columbia, MO, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA.
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27
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Nanoscience and nanotechnology in fabrication of scaffolds for tissue regeneration. INTERNATIONAL NANO LETTERS 2020. [DOI: 10.1007/s40089-020-00318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Functional and magnetic resonance imaging outcome after polyurethane meniscal scaffold implantation following partial meniscectomy. INTERNATIONAL ORTHOPAEDICS 2020; 45:971-975. [PMID: 33034754 DOI: 10.1007/s00264-020-04844-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Prevention of the knee osteoarthritis following meniscectomy is implantation of an allotransplant or an artificial meniscus. We present retrospective study of our early results of the treatment using polyurethane meniscal scaffold. METHODS From 2016 to 2020, we implanted nine polyurethane scaffolds (Actifit) after partial meniscectomy, five males and four females, age 36 (16-47), BMI 26.7 (17.2-35.9) kg/m2. Functional status, activity, pain, and MRI were assessed. RESULTS FU 20.8 (6-48.5) months, 35.2 (0-68) months from the meniscectomy to the implantation. The average implant length was 46.1 (35-60) mm, average number of sutures was 7.6 (5-10). Lysholm score before surgery was 61.7 (49-85), after the surgery 86.4 (62-95) with p 0.0045, Tegner activity score before meniscectomy was 5.8 (4-7), after 3.8 (2-5), and after the scaffold implantation 4.6 (3-7) with p 0.0488. Before surgery, VAS score was 3.1 (2-4), and after 7.7 (5-9) with p 0.0042. Pursuant to the Genovese classification, the last follow-up MRI showed a type 2 meniscal morphology in four cases and a type 3 in five cases. Seven patients had type 1 and two had type 2 signal intensity. On average, the absolute extrusion of a transplanted meniscus was 3.67 mm, and the relative extrusion was 0.58 mm. Extrusion progress was not detected. CONCLUSION Significantly improved knee functionality, increased level of physical activity, and reduced pain. MRI analysis revealed the meniscal transplant morphology and volume loss, as well as its extrusion without progression.
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29
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Samitier G, Vinagre G, Alentorn-Geli E, Sava M, Cugat R. All-Arthroscopic Meniscal Allograft Transplantation Technique with Bone Plugs and Preloaded Sutures. Arthrosc Tech 2020; 9:e1357-e1362. [PMID: 33024677 PMCID: PMC7528607 DOI: 10.1016/j.eats.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023] Open
Abstract
The meniscus is an essential structure for the knee functioning and survival. Meniscectomy is the most common surgical procedure in orthopaedic surgery. Following total or subtotal meniscectomy, meniscal allograft transplantation (MAT) should be considered in symptomatic active young patients. Several MAT techniques have been described in the literature as an attempt to restore normal knee kinematics and potentially decrease the risk of developing knee osteoarthritis. The purpose of this article is to describe in detail an efficient and reproducible all-arthroscopic MAT technique with bone plugs and preloaded sutures.
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Affiliation(s)
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,Address correspondence to Gustavo Vinagre, M.D., Ph.D., Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
| | - Eduard Alentorn-Geli
- Instituto Cugat, Hospital Quironsalud, Barcelona, Spain,Fundación García Cugat, Barcelona, Spain
| | - Maria Sava
- Western University of Health Sciences, Pomona, California, U.S.A
| | - Ramón Cugat
- Instituto Cugat, Hospital Quironsalud, Barcelona, Spain,Fundación García Cugat, Barcelona, Spain
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Patel H, Skalski MR, Patel DB, White EA, Tomasian A, Gross JS, Vangsness CT, Matcuk GR. Illustrative review of knee meniscal tear patterns, repair and replacement options, and imaging evaluation. Clin Imaging 2020; 69:4-16. [PMID: 32650296 DOI: 10.1016/j.clinimag.2020.06.045] [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: 03/31/2020] [Revised: 06/07/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022]
Abstract
This review article aims to reinforce anatomical concepts about meniscal tears while linking associated treatment options. The main teaching points start with the basic meniscal anatomy and key differences between the medial and lateral menisci. Subsequently, various meniscal tear patterns along with their associated history and physical exam findings will be discussed with corresponding illustrations and MR images. Additional discussion will involve the different surgical repair techniques (with arthroscopic correlates), their indications with pertinent imaging findings, imaging related to previous meniscal tear repairs, and novel surgical techniques. Lastly, keys to evaluating for retear with an emphasis on MRI arthrogram findings will be reviewed. While each of these topics is not discussed in totality, the key points of the review article will enforce key concepts and help radiologists evaluate the menisci on imaging.
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Affiliation(s)
- Heetabh Patel
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic - West Campus, San Jose, CA 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - Eric A White
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - Anderanik Tomasian
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - Jordan S Gross
- Department of Radiology, University of Southern California, Los Angeles, CA 90033, USA
| | - C Thomas Vangsness
- Department of Orthopaedics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - George R Matcuk
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Abstract
From once being labelled as a functionless remain of leg muscle, extensive scientific investigations in recent decades have described the meniscus as one of the most crucial structures of the knee. The incidence of meniscal injuries is on the rise and can be attributed to the increased participation of youth in sporting activities. MRI continues to be the imaging modality of choice, and surgical management is the mainstay of treatment for meniscal tears. Arthroscopic partial meniscectomy (APM) is currently the most performed orthopedic procedure around the globe. However, recent studies have conclusively shown that outcomes after an APM are no better than the outcomes after a sham/placebo surgery. Meniscal repair is now being touted as a viable and effective alternative. Meniscal repair aims to achieve meniscal healing while completely avoiding the adverse effects of partial meniscectomy. Meniscal repairs have grown in popularity over the past three decades and have proved to be a much more efficient alternative to partial meniscectomy. It is now increasingly recommended to attempt meniscal repair in all repairable tears, especially in young and physically active patients. Partial Meniscal implants have also shown excellent outcomes in long-term studies, but its efficacy in acute settings still requires further research. Research performed on various techniques of meniscal regeneration looks promising, and regenerative medicine appears to be the way forward. This review aims to critically discuss the current understanding of the meniscus, its role in biomechanics of the knee joint, and the current methods used to diagnose and manage meniscal tears.
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Affiliation(s)
- Kavyansh Bhan
- Department of Trauma and Orthopaedics, Whipps Cross University Hospital, London, GBR
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32
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Inyang AO, Vaughan CL. Functional Characteristics and Mechanical Performance of PCU Composites for Knee Meniscus Replacement. MATERIALS 2020; 13:ma13081886. [PMID: 32316407 PMCID: PMC7215399 DOI: 10.3390/ma13081886] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/14/2022]
Abstract
The potential use of fiber-reinforced based polycarbonate-urethanes (PCUs) as candidate meniscal substitutes was investigated in this study. Mechanical test pieces were designed and fabricated using a compression molding technique. Ultra-High Molecular Weight Polyethylene (UHMWPE) fibers were impregnated into PCU matrices, and their mechanical and microstructural properties evaluated. In particular, the tensile moduli of the PCUs were found unsuitable, since they were comparatively lower than that of the meniscus, and may not be able to replicate the inherent role of the meniscus effectively. However, the inclusion of fibers produced a substantial increment in the tensile modulus, to a value within a close range measured for meniscus tissues. Increments of up to 227% were calculated with a PCU fiber reinforcement composite. The embedded fibers in the PCU composites enhanced the fracture mechanisms by preventing the brittle failure and plastic deformation exhibited in fractured PCUs. The behavior of the composites in compression varied with respect to the PCU matrix materials. The mechanical characteristics demonstrated by the developed PCU composites suggest that fiber reinforcements have a considerable potential to duplicate the distinct and multifaceted biomechanical roles of the meniscus.
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Early Functional Rehabilitation after Meniscus Surgery: Are Currently Used Orthopedic Rehabilitation Standards Up to Date? Rehabil Res Pract 2020; 2020:3989535. [PMID: 32292602 PMCID: PMC7146095 DOI: 10.1155/2020/3989535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
Meniscus therapy is a challenging process. Besides the respective surgical procedure such as partial meniscectomy, meniscus repair, or meniscus replacement, early postoperative rehabilitation is important for meniscus regeneration and return to sport and work as well as long-term outcome. Various recommendations are available. However, the current literature lacks information concerning the actual early rehabilitation in daily routine recommended by orthopedic surgeons. Thus, the purpose of this study was to investigate currently used standard early rehabilitation protocols in the daily routine of orthopedic surgeons. This study investigated the recommendations and concepts for early rehabilitation after meniscus therapy given by German, Austrian, and Swiss orthopedic institutions. Standardized criteria such as weight bearing, range of motion, use of an orthosis, and rehabilitation training were analyzed according to the conducted surgical procedure: partial meniscectomy, meniscus repair, or meniscus replacement. The analysis of standard rehabilitation concepts for partial meniscectomy (n = 15), meniscus repair (n = 54), and meniscus replacement (n = 7) showed significantly earlier functional rehabilitation in all criteria after partial meniscectomy in contrast to meniscus repair techniques (p < 0.001). In addition, significant restrictions were found in full weight bearing, full range of motion, and the use of braces. In summary, a wide range of recommendations for weight bearing, ROM, brace therapy, and mobilization is available, particularly after meniscus repair and meniscus replacement. Most concepts are in accordance with those described in the current literature. Further research is necessary to enhance the scientific evidence on currently used early rehabilitation concepts after meniscus therapy.
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Resmi R, Parvathy J, John A, Joseph R. Injectable self-crosslinking hydrogels for meniscal repair: A study with oxidized alginate and gelatin. Carbohydr Polym 2020; 234:115902. [DOI: 10.1016/j.carbpol.2020.115902] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/02/2020] [Accepted: 01/20/2020] [Indexed: 12/25/2022]
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35
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Cengiz IF, Maia FR, da Silva Morais A, Silva-Correia J, Pereira H, Canadas RF, Espregueira-Mendes J, Kwon IK, Reis RL, Oliveira JM. Entrapped in cage (EiC) scaffolds of 3D-printed polycaprolactone and porous silk fibroin for meniscus tissue engineering. Biofabrication 2020; 12:025028. [PMID: 32069441 DOI: 10.1088/1758-5090/ab779f] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The meniscus has critical functions in the knee joint kinematics and homeostasis. Injuries of the meniscus are frequent, and the lack of a functional meniscus between the femur and tibial plateau can cause articular cartilage degeneration leading to osteoarthritis development and progression. Regeneration of meniscus tissue has outstanding challenges to be addressed. In the current study, novel Entrapped in cage (EiC) scaffolds of 3D-printed polycaprolactone (PCL) and porous silk fibroin were proposed for meniscus tissue engineering. As confirmed by micro-structural analysis the entrapment of silk fibroin was successful, and all scaffolds had excellent interconnectivity (≥99%). The EiC scaffolds had more favorable micro-structure compared with the PCL cage scaffolds by improving the pore size while keeping the interconnectivity almost the same. When compared with the PCL cage, the entrapment of porous silk fibroin into the PCL cage decreased the high compressive modulus in a favorable matter in the wet state thanks to the silk fibroin's high swelling properties. The in vitro studies with human stem cells or meniscocytes seeded constructs, demonstrated that the EiC scaffolds had superior cell adhesion, metabolic activity, and proliferation compared to the PCL cage scaffolds. Upon subcutaneous implantation of scaffolds in nude mice, all groups were free of adverse incidents, and mildly invaded by inflammatory cells with neovascularization, while the EiC scaffolds showed better tissue infiltration. The results of this work indicated that the EiC scaffolds of PCL and silk fibroin are favorable for meniscus tissue engineering, and the findings are encouraging for further studies using a larger animal model.
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Affiliation(s)
- Ibrahim Fatih Cengiz
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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