Current Concepts in Meniscus Tissue Engineering and Repair

Abstract

The meniscus is the most commonly injured structure in the human knee. Meniscus deficiency has been shown to lead to advanced osteoarthritis (OA) due to abnormal mechanical forces, and replacement strategies for this structure have lagged behind other tissue engineering endeavors. The challenges include the complex 3D structure with individualized size parameters, the significant compressive, tensile and shear loads encountered, and the poor blood supply. In this progress report, a review of the current clinical treatments for different types of meniscal injury is provided. The state-of-the-art research in cellular therapies and novel cell sources for these therapies is discussed. The clinically available cell-free biomaterial implants and the current progress on cell-free biomaterial implants are reviewed. Cell-based tissue engineering strategies for the repair and replacement of meniscus are presented, and the current challenges are identified. Tissue-engineered meniscal biocomposite implants may provide an alternative solution for the treatment of meniscal injury to prevent OA in the long run, because of the limitations of the existing therapies.

Human Cartilage-Derived Progenitors Resist Terminal Differentiation and Require CXCR4 Activation to Successfully Bridge Meniscus Tissue Tears

“…Unfortunately, both treatment options are reported to be significant risk factors of osteoarthritis (OA) development [4]. Prospective cell-based repair strategies have recently come to the forefront of meniscal injury research with the hopes of achieving better tissue repair in comparison to currently practiced clinical treatment strategies [5, 6]. …”

Anatomical meniscus construct with zone specific biochemical composition and structural organization

“…Large animal models are essential for the preclinical assessment of tissue engineered menisci [46]. The anatomical fit of the implant is decisive as it affects the knee mechanics directly.…”

Biological and Mechanical Predictors of Meniscus Function: Basic Science to Clinical Translation

“…This implant is approved for clinical use in Europe, with outcomes similar to that of CMI. Similar to CMI, the Actifit scaffold failed to maintain size and shape in long‐term evaluation, which may compromise long‐term outcomes . Finally, a permanent, non‐degradable polycarbonate‐urethane meniscus replacement implant (NuSurface; Active Implants, Memphis, TN) is available for use in Israel and Europe and is currently undergoing evaluation in the United States in two clinical trials to support regulatory approval from the FDA.…”

“…Several other approaches are being evaluated, which have exciting potential for regeneration of meniscus replacement materials. New three‐dimensional (3D)‐printing techniques in combination with electrospinning have demonstrated promising results . For example, Lee et al demonstrated that a 3D‐printed fibrous polycaprolactone scaffold in conjunction with growth factor releasing microspheres can induce differentiation of MSCs seeded on the scaffold to fibrochondrocytes .…”

“…However, the loss of protein content (GAGs) observed in other decellularization techniques persists. The cell‐seeded scaffolds represent another approach for meniscus replacement . Early studies have established proof of concept that scaffold recellularization is possible in vitro.…”