Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection

Piontek, Tomasz; Ciemniewska-Gorzela, Kinga; Naczk, Jakub; Jakob, R. P.; Szulc, Andrzej; Grygorowicz, Monika; Slomczykowski, M.

doi:10.1177/1947603515608988

Cited by 45 publications

(51 citation statements)

References 49 publications

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“…The 2-year follow-up data of tears treated with arthroscopic suturing and wrapping technique were presented in a subsequent article. 99 Inclusion criteria for this study included full-thickness tears greater than 20 mm in length, horizontal, radial tears, and extensive bucket-handle tears, tears located at greater than 6 mm from the capsular junction including the avascular zone, as well as both degenerative and nondegenerative menisci. Of the 48 cases analyzed, only 2 patients underwent subsequent partial meniscectomy and were considered failures.…”

Section: Augmentation Of Meniscus Repair By Wrappingmentioning

confidence: 99%

Augmentation Techniques for Meniscus Repair

et al. 2017

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Menisci display exquisitely complex structure and play an essential weight-bearing role in the knee joint. A torn meniscus is one of the most common knee injuries which can result in pain and mechanical abnormalities. Tear location is one aspect which determines the endogenous healing response; tears that occur in the peripheral densely vascularized zone of the meniscus have the potential to heal while the healing capacity is more limited in the less vascularized inner zones. Meniscectomy was once widely performed, but led to poor radiographic and patient-reported mid- and long-term outcomes. After the advent of arthroscopy, orthopaedic opinion in the 1980s has been swaying toward salvaging or repairing the torn meniscus tissue to prevent osteoarthritis rather than performing meniscectomy. Meniscus repair in young active individuals has been shown to be effective, reproducible, and reliable if indications are met; however, only a small proportion of all tears are considered repairable with available technologies. Biological augmentation techniques and meniscus tissue engineering strategies are being devised to enhance the likelihood and rate of healing in meniscus repair. Preclinical and clinical studies have shown that introduction of cellular elements of the blood, bone marrow, and related growth factors have the potential to enhance meniscus repair. This article reviews the current state of clinical management of meniscus tears (primary repair) as well as augmentation techniques to improve healing by meniscus wrapping with extracellular matrix materials, trephination, synovial rasping and abrasion, fibrin/blood clot placement, and platelet-rich plasma injections. In addition, the rationale for using polymer/autologous blood component implants to improve meniscus repair will be discussed.

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Section: Augmentation Of Meniscus Repair By Wrappingmentioning

confidence: 99%

Augmentation Techniques for Meniscus Repair

et al. 2017

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“…Similarly, broad clinical adoption would likely require timely and secure fixation through an arthroscopic surgical approach. Related clinical studies have reported secure fixation of fascia sheaths (Henning et al 1991 ) and collagen matrix membranes (Piontek et al 2016 ) enveloping meniscus repairs, suggesting the feasibility of applying the scaffold sheet through an arthroscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Augmented repair of radial meniscus tear with biomimetic electrospun scaffold: an in vitro mechanical analysis

et al. 2016

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BackgroundLarge radial tears that disrupt the circumferential fibers of the meniscus are associated with reduced meniscal function and increased risk of joint degeneration. Electrospun fibrous scaffolds can mimic the topography and mechanics of fibrocartilaginous tissues and simultaneously serve as carriers of cells and growth factors, yet their incorporation into clinically relevant suture repair techniques for radial meniscus tears is unexplored. The purposes of this study were to (1) evaluate the effect of fiber orientation on the tensile properties and suture-retention strength of multilayered electrospun scaffolds and (2) determine the mechanical effects of scaffold inclusion within a surgical repair of a simulated radial meniscal tear. The experimental hypothesis was that augmentation with a multilayered scaffold would not compromise the strength of the repair.MethodsThree multilayered electrospun scaffolds with different fiber orientations were fabricated–aligned, random, and biomimetic. The biomimetic scaffold was comprised of four layers in the following order (deep to superficial)–aligned longitudinal, aligned transverse, aligned longitudinal, and random–respectively corresponding to circumferential, radial, circumferential, and superficial collagen fibers of the native meniscus. Material properties (i.e., ultimate stress, modulus, etc.) of the scaffolds were determined in the parallel and perpendicular directions, as was suture retention strength. Complete radial tears of lateral bovine meniscus explants were repaired with a double horizontal mattress suture technique, with or without inclusion of the biomimetic scaffold sheath. Both repair groups, as well as native controls, were cyclically loaded between 5 and 20 N for 500 cycles and then loaded to failure. Clamp-to-clamp distance (i.e., residual elongation) was measured following various cycles. Ultimate load, ultimate elongation, and stiffness, were also determined. Group differences were evaluated by one-way ANOVA or Student’s t-test where appropriate.ResultsAligned scaffolds possessed the most anisotropic mechanical properties, whereas random scaffolds showed uniform properties in the parallel and perpendicular directions. In comparison, the biomimetic scaffold possessed moduli in the parallel (68.7 ± 14.7 MPa) and perpendicular (39.4 ± 11.6 MPa) directions that respectively approximate the reported circumferential and radial tensile properties of native menisci. The ultimate suture retention load of the biomimetic scaffold in the parallel direction (7.2 ± 1.6 N) was significantly higher than all other conditions (p < 0.001). Biomimetic scaffold augmentation did not compromise mechanical properties when compared against suture repair in terms of residual elongation after 500 cycles (scaffold: 5.05 ± 0.89 mm vs. repair: 4.78 ± 1.24 mm), ultimate failure load (137.1 ± 31.0 N vs. 124.4 ± 21.4 N), ultimate elongation (12.09 ± 5.89 mm vs. 10.14 ± 4.61 mm), and stiffness (20.8 ± 3.6 vs. 18.4 ± 4.7 N/mm).ConclusionsWhile multilayered scaffold sheets wer...

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“…In another preclinical study by Moriguchi et al ,73 synovial MSCs cultured in monolayers to develop a scaffold-free tissue matrix demonstrated repair of meniscus defects and reduction of chondral degeneration. In a clinical series by Piontek et al , patients treated with all-inside meniscus repair followed by collagen matrix wrapping and bone marrow aspirate injection demonstrated evidence of healing on MRI and clinical improvement in 76% and 86% of patients, respectively, at 2-year follow-up 74. This series reported 13 adverse events including graft failure requiring reoperation and compartment syndrome in another patient, though the authors concluded none of the adverse events were from the meniscus repair.…”

Section: Bodymentioning

confidence: 95%