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Stem Cell Research & Therapy Jul 2022Tissue engineering focuses on reconstructing the damaged meniscus by mimicking the native meniscus. The application of mechanical loading on chondrocyte-laden...
BACKGROUND
Tissue engineering focuses on reconstructing the damaged meniscus by mimicking the native meniscus. The application of mechanical loading on chondrocyte-laden decellularized whole meniscus is providing the natural microenvironment. The goal of this study was to evaluate the effects of dynamic compression and shear load on chondrocyte-laden decellularized meniscus.
MATERIAL AND METHODS
The fresh samples of rabbit menisci were decellularized, and the DNA removal was confirmed by histological assessments and DNA quantification. The biocompatibility, degradation and hydration rate of decellularized menisci were evaluated. The decellularized meniscus was injected at a density of 1 × 10 chondrocyte per scaffold and was subjected to 3 cycles of dynamic compression and shear stimuli (1 h of 5% strain, ± 25°shear at 1 Hz followed by 1 h rest) every other day for 2 weeks using an ad hoc bioreactor. Cytotoxicity, GAG content, ultrastructure, gene expression and mechanical properties were examined in dynamic and static condition and compared to decellularized and intact menisci.
RESULTS
Mechanical stimulation supported cell viability and increased glycosaminoglycan (GAG) accumulation. The expression of collagen-I (COL-I, 10.7-folds), COL-II (6.4-folds), aggrecan (AGG, 3.2-folds), and matrix metalloproteinase (MMP3, 2.3-folds) was upregulated compared to the static conditions. Furthermore, more aligned fibers and enhanced tensile strength were observed in the meniscus treated in dynamic condition with no sign of mineralization.
CONCLUSION
Compress and shear stimulation mimics the loads on the joint during walking and be able to improve cell function and ultrastructure of engineered tissue to recreate a functional artificial meniscus.
Topics: Animals; Bioreactors; Chondrocytes; DNA; Glycosaminoglycans; Meniscus; Rabbits; Tissue Engineering; Tissue Scaffolds
PubMed: 35908010
DOI: 10.1186/s13287-022-03058-w -
Knee Surgery, Sports Traumatology,... Jun 2023The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair.
PURPOSE
The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair.
METHODS
In total, 147 patients (mean age: 66.2 ± 8.3 years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy.
RESULTS
No significant differences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Significant differences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 ± 1.2; 2B, 6.2 ± 1.7; and 2C, 6.2 ± 1.7 mm; p = 0.045); type 2A tears were the widest. There was a significant difference in post-operative medial meniscus extrusion (2A, 3.2 ± 0.9; 2B, 4.0 ± 1.2; and 2C, 4.0 ± 1.4 mm; p = 0.004) and its progression (2A, 0.7 ± 0.6; 2B, 1.2 ± 0.8; and 2C, 1.2 ± 0.8 mm; p = 0.008), and type 2A tears were the shortest.
CONCLUSION
Although there was no significant difference in the post-operative clinical scores among different type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes.
LEVEL OF EVIDENCE
III.
Topics: Humans; Middle Aged; Aged; Menisci, Tibial; Retrospective Studies; Tibial Meniscus Injuries; Magnetic Resonance Imaging; Osteoarthritis; Rupture; Arthroscopy
PubMed: 36566386
DOI: 10.1007/s00167-022-07293-9 -
Connective Tissue Research Sep 2016The discoid lateral meniscus (DLM) is an anatomically abnormal meniscus that covers a greater area of the tibial plateau than the normal meniscus. The DLM is classified... (Comparative Study)
Comparative Study
The discoid lateral meniscus (DLM) is an anatomically abnormal meniscus that covers a greater area of the tibial plateau than the normal meniscus. The DLM is classified into two types: complete (CDLM) and incomplete (ICDLM) types. In this study, we investigated the histological and cell biological characteristics of CDLM and ICDLM. The number of blood vessels, proteoglycan deposition, and collagen distribution were assessed using meniscal tissues. Collagen production was also investigated in CDLM and ICDLM cells. The intercondylar region of the CDLM had a higher number of blood vessels than the inner region of the ICDLM. Safranin O staining density and type II collagen deposition in ICDLM were higher than those in CDLM. Type II collagen-positive cells were higher in ICLDM than in CDLM. CDLM cells showed slender fibroblastic morphology, while ICDLM cells were triangular chondrocytic in shape. This study demonstrated that the intercondylar region of the CDLM showed similar properties to the outer region of the meniscus. The inner region of the ICDLM, on the other hand, differed from the intercondylar region of the CDLM. Our results suggest that the intercondylar region of the CDLM may have a high healing potential like the outer meniscus.
Topics: Adolescent; Adult; Cell Proliferation; Cell Shape; Child; Chondrocytes; Collagen Type II; Demography; Fibroblasts; Humans; Menisci, Tibial; Neovascularization, Physiologic; Proteoglycans; Staining and Labeling; Young Adult
PubMed: 27267748
DOI: 10.1080/03008207.2016.1195827 -
Chinese Journal of Traumatology =... Dec 2010Meniscal injury is one of the most common injuries to the knee. The menisci are important for normal knee function. And loss of a meniscus increases the risk of... (Review)
Review
Meniscal injury is one of the most common injuries to the knee. The menisci are important for normal knee function. And loss of a meniscus increases the risk of subsequent development of degenerative changes in the knee. Now there are different techniques available for meniscal injury. These techniques include expectant treatment, meniscectomy, meniscal repair, meniscal replacement, and meniscal tissue engineering. Expectant treatment is the appropriate treatment for minor tears of the menisci. Meniscectomy being favored at the beginning is now obsolete. Meniscus repair has become a standard procedure. Meniscal replacement and tissue engineering are used to deal with considerable meniscal injuries. The purpose of this paper is to provide current knowledge regarding the anatomy and function of the menisci, incidence, aetiology, symptoms, signs, investigations and treatments of meniscal injury.
Topics: Animals; Humans; Knee Injuries; Menisci, Tibial; Tibial Meniscus Injuries; Tissue Engineering
PubMed: 21126396
DOI: No ID Found -
Journal of Orthopaedic Surgery (Hong... 2021This study aimed to investigate how fibroblastic and chondrocytic properties of human meniscal fibrochondrocytes are affected in culture conditions according to the type...
PURPOSE
This study aimed to investigate how fibroblastic and chondrocytic properties of human meniscal fibrochondrocytes are affected in culture conditions according to the type of meniscal pathology and localization, and to provide basic information for tissue-engineering studies.
METHODS
Primary fibrochondrocyte cultures were prepared from meniscus samples of patients who had either traumatic tear or degeneration due to osteoarthritis. Cultures were compared in terms of mRNA expression levels of COL1A1, COL2A1, COMP1, HIF1A, HIF2A, and SOX9 and secreted total collagen and sulfated sGAG levels according to the type of meniscal pathology, anatomical localization, and the number of subcultures.
RESULTS
mRNA expression levels of COL1A1, COMP1, HIF1A, HIF2A, and SOX9 were found to be increased in subsequent subcultures in all specimens. COL1A1 mRNA expression levels of both lateral and medial menisci of patients with traumatic tear were significantly higher than in patients with degenerative pathology, indicating a more fibroblastic character. P1 subculture of lateral and P3 or further subculture of medial meniscus showed more fibroblastic characteristics in patients with degenerative pathology. Furthermore, in patients with degenerative pathology, the subcultures of the lateral meniscus (especially on the inner part) presented more chondrocytic characteristics than did those of medial meniscus.
CONCLUSIONS
The mRNA expression levels of the cultures showed significant differences according to the anatomical localization and pathology of the meniscus, indicating distinct chondrocytic and fibroblastic features. This fundamental knowledge would help researchers to choose more efficient cell sources for cell-seeding of a meniscus scaffold, and to generate a construct resembling the original meniscus tissue.
Topics: Adolescent; Adult; Aged; Cells, Cultured; Chondrocytes; Female; Fibrocartilage; Gene Expression Profiling; Humans; Joints; Male; Meniscus; Middle Aged; Osteoarthritis; Primary Cell Culture; Rupture; Transcriptome; Young Adult
PubMed: 33729061
DOI: 10.1177/23094990211000168 -
Knee Surgery, Sports Traumatology,... Jan 2022During knee arthroscopy, irrigation fluid from the surgical site accumulates in the sterile reservoir. Whether these fluid collections and also suture material used...
Bacterial contamination of irrigation fluid and suture material during ACL reconstruction and meniscus surgery : Low infection rate despite increasing contamination over surgery time.
PURPOSE
During knee arthroscopy, irrigation fluid from the surgical site accumulates in the sterile reservoir. Whether these fluid collections and also suture material used during the arthroscopic surgical processes show bacterial contamination over time during surgery remains unclear. The purpose of this study was to determine this contamination rate and to analyze its possible influence on postoperative infection.
MATERIALS AND METHODS
In this study, 155 patients were included. Fifty-eight underwent reconstruction of the anterior cruciate ligament (ACL), 63 meniscal surgery and 34 patients combined ACL reconstruction and meniscus repair. We collected pooled samples of irrigation fluid from the reservoir on the sterile drape every 15 min during the surgery. In addition, we evaluated suture material of ACL graft and meniscus repair for bacterial contamination. Samples were sent for microbiological analysis, incubation time was 14 days. All patients were seen in the outpatient department 6, 12 weeks and 12 months postoperatively and examined for clinical signs of infection.
RESULTS
A strong statistical correlation (R = 0.81, p = 0.015) was found between an advanced duration of surgery and the number of positive microbiological findings in the accumulated fluid. Suture and fixation material showed a contamination rate of 28.4% (29 cases). Despite the high contamination rate, only one infection was found in the follow-up examinations, caused by Staphylococcus lugdunensis.
CONCLUSION
Since bacterial contamination of accumulated fluid increases over time the contact with the fluid reservoirs should be avoided.
LEVEL OF EVIDENCE
IV.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Humans; Menisci, Tibial; Meniscus; Retrospective Studies; Sutures; Tibial Meniscus Injuries
PubMed: 33566145
DOI: 10.1007/s00167-021-06481-3 -
Knee Surgery, Sports Traumatology,... Jun 2023The purpose of this first-in-human study was to evaluate the effect of a polycarbonate anatomical meniscus prosthesis system, including the surgical procedure, on knee...
PURPOSE
The purpose of this first-in-human study was to evaluate the effect of a polycarbonate anatomical meniscus prosthesis system, including the surgical procedure, on knee pain and describe potential adverse events in patients with post-meniscectomy pain syndrome.
METHODS
Eleven patients with post-meniscectomy pain syndrome and limited underlying cartilage damage were enrolled in the study. Five received a medial polycarbonate urethane meniscus prosthesis which was clicked onto 2 titanium screws fixated at the native horn attachments on the tibia. The KOOS score was planned to be collected at baseline and at 3, 6, 12 and 24 months following the intervention including radiographs at 6, 12 and 24 months. MRI scans were repeated after 12 and 24 months.
RESULTS
The surgical technique to select an appropriately sized implant and correct positioning of the fixation screws and meniscus prosthesis onto the tibia was demonstrated to be feasible and reproducible. Inclusion stopped after 5 patients because of serious adverse device-related events. All patients reported knee joint stiffness and slight effusion in their knee at 6 months follow-up. In 3 patients the implant was removed because of implant failure and in 1 patient the implant was removed because of persistent pain and extension limitation. In none of the patients did the KOOS score improve in the first 6 months after surgery. However, in the patient who still has the implant in situ, PROMs started to improve 1 year after surgery and this improvement continued through 2 years of follow-up. The KOOS Pain, symptoms and ADL were close to the maximal 100 points. KOOS QoL and sport did improve but remained suboptimal.
CONCLUSION
This first version of the meniscus prosthesis led to impaired knee function and failed in four out of five patients. The patients where the prosthesis was removed were salvable and the PROMs returned to pre-study levels. The results in the patient where the device is still in place are promising.
LEVEL OF EVIDENCE
Level II.
Topics: Humans; Menisci, Tibial; Quality of Life; Knee Joint; Joint Prosthesis; Pain; Treatment Outcome
PubMed: 36336744
DOI: 10.1007/s00167-022-07205-x -
The Journal of Knee Surgery Jan 2009The meniscus is a fibrocartilaginous tissue uniquely adapted to enable load transmission in the knee. Although the meniscus was once considered a useless remnant of... (Review)
Review
The meniscus is a fibrocartilaginous tissue uniquely adapted to enable load transmission in the knee. Although the meniscus was once considered a useless remnant of joint formation, removal of all or part of the meniscus initiates osteoarthritis. Surgical repair methods focus on fragment stabilization or biologic enhancement of healing. An alternative approach based on tissue-engineering principles involves the development of new materials for implantation. Our meniscus tissue-engineering efforts aim to recapitulate the architectural features and mechanical anisotropies essential to native tissue function. We use a novel scaffold production technology called electrospinning, in which organized three-dimensional arrays of ultrafine biodegradable fibers are generated. Using these scaffolds as micropatterns for directed growth, we have generated constructs with mechanical properties and architectural features comparable to native meniscus. This review details our progress and outlines the remaining hurdles that must be addressed to translate this work into clinical implementation.
Topics: Animals; Humans; Menisci, Tibial; Mesenchymal Stem Cell Transplantation; Regeneration; Tibial Meniscus Injuries; Tissue Engineering; Tissue Scaffolds
PubMed: 19216353
DOI: 10.1055/s-0030-1247727 -
BMC Musculoskeletal Disorders Dec 2022The adverse consequences of medial meniscus posterior root tears have become increasingly familiar to surgeons, and treatment strategies have become increasingly...
BACKGROUND
The adverse consequences of medial meniscus posterior root tears have become increasingly familiar to surgeons, and treatment strategies have become increasingly abundant. In this paper, the finite element gait analysis method was used to explore the differences in the biomechanical characteristics of the knee joint under different conditions.
METHODS
Based on CT computed tomography and MR images, (I) an intact knee (IK) model with bone, cartilage, meniscus and main ligaments was established. Based on this model, the posterior root of the medial meniscus was resected, and (ii) the partial tear (PT) model, (iii) the entire radial tear (ERT) model, and (iv) the entire oblique tear (EOT) model were established according to the scope and degree of resection. Then, the (v) meniscus repair (MR) model and (vi) partial meniscectomy (PM) model were developed according to the operation method. The differences in stress, displacement and contact area among different models were evaluated under ISO gait loading conditions.
RESULTS
Under gait loading, there was no significant difference in the maximum stress of the medial and lateral tibiofemoral joints among the six models. Compared with the medial tibiofemoral joint stress of the IK model, the stress of the PM model increased by 8.3%, while that of the MR model decreased by 18.9%; at the same time, the contact stress of the medial tibiofemoral joint of the ERT and EOT models increased by 17.9 and 25.3%, respectively. The displacement of the medial meniscus in the ERT and EOT models was significantly larger than that in the IK model (P < 0.05), and the tibial and femoral contact areas of these two models were lower than those of the IK model (P < 0.05).
CONCLUSIONS
The integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics. Partial meniscectomy is not beneficial for improving the tibial-thigh contact situation. Meniscal repair has a positive effect on restoring the normal biomechanical properties of the medial meniscus.
Topics: Humans; Tibial Meniscus Injuries; Finite Element Analysis; Biomechanical Phenomena; Knee Injuries; Menisci, Tibial; Knee Joint; Cartilage Diseases
PubMed: 36517757
DOI: 10.1186/s12891-022-06069-z -
Journal of the Mechanical Behavior of... Sep 2022The mechanical wear and tear of soft connective tissue from repetitive joint loading is a primary factor in degenerative joint disease, and therefore methods are needed...
The mechanical wear and tear of soft connective tissue from repetitive joint loading is a primary factor in degenerative joint disease, and therefore methods are needed to accurately characterize wear in joint structures. Here, we evaluate the accuracy of using a structured light 3D optical scanning system and modeling software to quantify and visualize volume loss in whole human meniscus subjected to in vitro joint loading. Using 3D printed meniscus replicas with known wear volumes, we determined that this novel imaging method has a mean accuracy of approximately 13 mm, corresponding to a mean error of less than 7% when measuring meniscal volumetric changes of 0.2 cm (size of a pea). The imaging method was then applied to measure the in vitro wear of whole human menisci at four time points when a single cadaveric knee was subjected to one million cycles of controlled joint loading. The medial and lateral menisci reached steady state volumetric reductions of 0.72 cm and 0.34 cm per million cycles, respectively. Colorimetric maps of linear wear depth revealed high wear and deformation in the posterior regions of both the medial and lateral menisci. For the first time, this study has developed a method to accurately characterize volume loss in whole meniscus subjected to in vitro joint loading. This 3D scanning method offers researchers a new investigative tool to study mechanical wear and joint degeneration in meniscus, and other soft connective tissues.
Topics: Humans; Knee; Knee Joint; Menisci, Tibial; Meniscus; Tibial Meniscus Injuries
PubMed: 35834895
DOI: 10.1016/j.jmbbm.2022.105338