A Rare Complication after Synthetic Meniscus Replacement

Verhaeghe, L; Boeren, K

doi:10.5334/jbsr.1601

Cited by 10 publications

(7 citation statements)

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“…The geometry of NUsurface R meniscal implant (ACTIVE IMPLANTS LLC, TN, USA) designed for animal study in sheep model was anatomically shaped [14], while a free-floating disc-shaped meniscal implant geometry was designed for use in human subjects [15]. NUsurface R meniscal implant designed for human subjects do not necessitate fixation to bone or adjacent cartilage, which may lead to loosening and dislocation of the implant [71]. Given the demand for the synthetic meniscal implant for use in the growing number of clinical applications [71], immediate care must be given to improve the geometry of the meniscal implants.…”

Section: Figure 5 Comparison Of Lateral Compartment Biomechanics Between Knee Joint Finite Element Models With Different Meniscus Conditimentioning

confidence: 99%

“…NUsurface R meniscal implant designed for human subjects do not necessitate fixation to bone or adjacent cartilage, which may lead to loosening and dislocation of the implant [71]. Given the demand for the synthetic meniscal implant for use in the growing number of clinical applications [71], immediate care must be given to improve the geometry of the meniscal implants. This study evaluated two design configurations of the meniscal implant and both designs address the complications of non-anatomic design features by incorporating the anatomical shaped geometry with provision for anterior and posterior horn attachments.…”

Section: Figure 5 Comparison Of Lateral Compartment Biomechanics Between Knee Joint Finite Element Models With Different Meniscus Conditimentioning

confidence: 99%

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Biomechanical Evaluation of Isotropic and Shell-Core Composite Meniscal Implants for Total Meniscus Replacement: A Nonlinear Finite Element Study

2019

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Loss of meniscal function due to symptomatic meniscal tears or meniscectomy leads to biomechanical instability and articular cartilage degeneration. Synthetic meniscal implants ought to ideally restore normal joint contact mechanics and thus forfending the overlying cartilage from degeneration. The purpose of this study was to quantify the contact stresses in both tibiofemoral compartments and joint kinematics during a gait cycle after implantation of a synthetic meniscal implant. Anatomically-detailed finite element model of the knee joint was developed from magnetic resonance images of a healthy female volunteer. Gait analysis was conducted using a three-dimensional motion capture system and computed the knee joint forces and moments and quadriceps muscle forces for a complete walking cycle. The effects of a synthetic meniscal implant on joint mechanics during gait were studied by conducting finite element simulations for the following meniscus conditions: (i) intact meniscus, (ii) meniscus with complete radial posterior root tear, (iii) total meniscectomy, (iv) isotropic meniscal implant, and (v) shell-core composite meniscal implant. Posterior root tear and total meniscectomy caused substantially increased contact stresses in both tibiofemoral compartments and altered tibial kinematics. Compared to posterior root tear and total meniscectomy, the isotropic and composite meniscal implants reduced the peak contact stresses in both compartments and reduced the cartilage nodes with higher contact stresses by disseminating the load over a large surface area. The shell-core composite meniscal implant resulted in lower contact stresses in the medial compartment relative to the other meniscus conditions. This study demonstrated that posterior root tear and total meniscectomy leads to detrimental changes in joint mechanics. Superseding the injured meniscus with a synthetic meniscal implant restored the joint mechanics close to the intact meniscal state. This novel synthetic meniscal implantation approach appears to be a promising strategy for treating patients with severe meniscal injuries.INDEX TERMS Biomechanics, finite element model, gait analysis, medical imaging, meniscal implant, musculoskeletal modeling.

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Section: Figure 5 Comparison Of Lateral Compartment Biomechanics Between Knee Joint Finite Element Models With Different Meniscus Conditimentioning

confidence: 99%

Section: Figure 5 Comparison Of Lateral Compartment Biomechanics Between Knee Joint Finite Element Models With Different Meniscus Conditimentioning

confidence: 99%

Biomechanical Evaluation of Isotropic and Shell-Core Composite Meniscal Implants for Total Meniscus Replacement: A Nonlinear Finite Element Study

2019

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“…One of the efforts to overcome these problems has been to develop a tissue-engineered scaffold for meniscal replacement using synthetic alternatives, which are now classified as medical devices. ACTIfit polymer (80% polyester 1 20% polyurethane; Orteq Ltd), 49,53 Menaflex Collagen Meniscus Implant (ReGen Biologics), 14,29,35 and Nusurface (Active Implants LLC) 52 are scaffolds used clinically. But these alternatives have problems in terms of matching the shape or size of the patient's meniscus, and they have the technical problem of securing the implant through suturing.…”

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confidence: 99%

Injectable Fibrin/Polyethylene Oxide Semi-IPN Hydrogel for a Segmental Meniscal Defect Regeneration

Kim

Yim

et al. 2021

Am J Sports Med

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Background: Meniscal deficiency from meniscectomy is a common situation in clinical practices. Regeneration of the deficient meniscal portion, however, is still not feasible. Purpose: To develop an injectable hydrogel system consisting of fibrin (Fb) and polyethylene oxide (PEO) and to estimate its clinical potential for treating a segmental defect of the meniscus in a rabbit meniscal defect model. Study Design: Controlled laboratory study. Methods: The Fb/PEO hydrogel was fabricated by extruding 100 mg·mL-1 of fibrinogen solution and 2,500 U·mL-1 of thrombin solution containing 100 mg·mL-1 of PEO through a dual-syringe system. The hydrogels were characterized by rheological analysis and biodegradation tests. The meniscal defects of New Zealand White male rabbits were generated by removing 60% of the medial meniscus from the anterior side. The removed portion included the central portion. The Fb/PEO hydrogel was injected into the meniscal defect of the experimental knee through the joint space between the femoral condyle and tibial plateau at the anterior knee without a skin incision. The entire medial menisci from both knees of each rabbit were collected and photographed before placement in formalin for histological processing. Hematoxylin and eosin, safranin O, and immunohistochemical staining for type II collagen was performed. The biomechanical property of the regenerated meniscus was evaluated using a universal tensile machine. Results: The Fb/PEO hydrogel was fabricated by an in situ gelation process, and the hydrogel displayed a semi-interpenetrating polymer network structure. We demonstrated that the mechanical properties of Fb-based hydrogels increased in a PEO-dependent manner. Furthermore, the addition of PEO delayed the biodegradation of the hydrogel. Our in vivo data demonstrated that, as compared with Fb hydrogel, Fb/PEO hydrogel injection into the meniscectomy model showed improved tissue regeneration. The regenerated meniscal tissue by Fb/PEO hydrogel showed enhanced tissue quality, which was supported by the histological and biomechanical properties. Conclusion: The Fb/PEO hydrogel had an effective tissue-regenerative ability through injection into the in vivo rabbit meniscal defect model. Clinical Relevance: This injectable hydrogel system can promote meniscal repair and be readily utilized in clinical application.

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“…A synthetic implant which aims to function as a “spacer” for load distribution NUsurface Meniscus Implant ® , built on non‐absorbable polycarbonate–urethane, has been proposed [10, 39]. However, it is not dedicated to re‐establishing the biology of the joint, and pitfalls such as implant displacement have been reported [38].…”

Section: Discussionmentioning

confidence: 99%

Integration of polyurethane meniscus scaffold during ACL revision is not reliable at 5 years despite favourable clinical outcome

Pereira

Cengiz

Silva‐Correia

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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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 scafold for the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy. Moreover, the implanted scafolds 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 scafold 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 scafold was performed according to the Genovese scale with quantiication of the scafold'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 signiicant reduction of scores was observed between 2 and 5 years. Concerning the MRI assessment, a signiicant reduction of the scafold's volume was observed between 1 and 5 years. Genovese Morphology classiication 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 classiied 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 scafold 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 scafold is not consistent. Level of evidence Level IV.

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A Rare Complication after Synthetic Meniscus Replacement

Cited by 10 publications

References 1 publication

Biomechanical Evaluation of Isotropic and Shell-Core Composite Meniscal Implants for Total Meniscus Replacement: A Nonlinear Finite Element Study

Biomechanical Evaluation of Isotropic and Shell-Core Composite Meniscal Implants for Total Meniscus Replacement: A Nonlinear Finite Element Study

Injectable Fibrin/Polyethylene Oxide Semi-IPN Hydrogel for a Segmental Meniscal Defect Regeneration

Integration of polyurethane meniscus scaffold during ACL revision is not reliable at 5 years despite favourable clinical outcome

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