Comparative Study of Collagen versus Synthetic-Based Meniscal Scaffolds in Treating Meniscal Deficiency in Young Active Population

Abstract

Purpose:The aim of this study was to compare the effectiveness of 2 different meniscal scaffolds in treating patients with irreparable partial medial meniscal tear and patients complaining of pain in the medial compartment of the knee due to a previous partial medial meniscectomy. Based on previous studies, we hypothesized that both the scaffolds are effective in improving clinical outcomes in these patient populations.Material and Methods:Twenty-eight patients underwent collagen-based medial meniscus implantation (CMI-Menaflex) and 25 with a second-generation scaffold (Actifit). All patients were assessed with Lysholm, Tegner scale, and MRI evaluation—preoperatively, at 6 months, at 12 moths, and followed-up for a minimum of 2 years. Second look arthroscopy and concomitant biopsy were performed in 7 and 12 patients of CMI and Actifit groups, respectively.Results:The CMI group at final follow-up showed improvement in Lysholm score from 58.4 ± 17.3 to 94.5 ± 6.0, while the Actifit group showed improvement from 67.0 ± 15.7 to 90.3 ± 13.1; the improvement was statistically significant in both the groups but intergroup difference was not statistically significant (P = 0.1061). Tegner Activity Scale score improved in both the groups, but intergroup difference was not statistically significant (P = 0.5918). MRI evaluation showed in situ scaffold and no progression of degenerative arthritis in both the groups at final follow-up. Histological evaluation showed more fibrous tissue with blood vessels in the CMI group and the Actift group showed avascular cartilaginous features.Conclusion:Both the scaffolds are effective in improving patients’ symptoms and joint function at short-term follow-up.

Current perspectives on biological approaches for osteoarthritis

“…187,188 Other synthetically derived meniscus scaffolds, such as Actifit R (Orteq Bioengineering Ltd, London, UK), present an alternative to collagen-based scaffolds and have been shown to be just as effective in the short term. 189 Leroy et al 190 recently reported that failure rates for Actifit R remain relatively high after 5-year follow-up. Despite the advancements in enhancing meniscus healing and regeneration using bioresorbable scaffolds, the challenges to control implant resorption and maintain durability persist.…”

“…Superior short‐term and long‐term clinical improvements have been reported using absorbable collagen implants for meniscal tears that have undergone partial meniscectomies . Other synthetically derived meniscus scaffolds, such as Actifit ® (Orteq Bioengineering Ltd, London, UK), present an alternative to collagen‐based scaffolds and have been shown to be just as effective in the short term . Leroy et al .…”

Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art

“…Clinical studies reported improvement in clinical outcomes scores despite evidence of scaffold resorption and extrusion on MRI,86–89 and two case series reported a 62% survival of implants at 5 year follow-up 87 88. Bulgheroni et al compared subjects with CMI and porous polymer scaffold implants and found clinical improvement in both groups with no statistical difference in outcomes between CMI and polymer scaffolds 90. While studies show improved results with cell-seeded scaffolds compared with injections or cell-free scaffolds, very little research has compared the efficacy of different cell and scaffold compositions with one another 91.…”

Cell-Free Strategies for Repair and Regeneration of Meniscus Injuries through the Recruitment of Endogenous Stem/Progenitor Cells

“…Therefore, cell-free strategies may have a broader clinical application. There are two kinds of cell-free meniscal scaffolds currently in clinical use: (1) the collagen meniscus implant (CMI; Ivy Sports Medicine, Montvale, NJ) and (2) the Actifit scaffold (Orteq, London, England) [ 56 ]. Both have been shown to reduce pain and improve knee function when used to treat partial meniscal defects.…”