Meniscus Tears in the Young Athlete

Vanderhave, Kelly L.; Moravek, James E.; Sekiya, Jon K.; Wojtys, Edward M.

doi:10.1097/bpo.0b013e31821ffb8d

Cited by 75 publications

(38 citation statements)

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“…They also concluded that medial meniscal repairs were significantly more likely to fail than lateral meniscal repairs. Vanderhave et al23) compared 31 cases of inside-out meniscal repairs with concomitant ACL reconstruction in young athletes with 14 cases of meniscal repairs without ACL reconstruction. Forty-three of the 45 patients showed excellent clinical outcomes at a mean of 27-month follow-up.…”

Section: Inside-out Repair Techniquementioning

confidence: 99%

“…The indications for meniscal repair have remained controversial. However, the ideal indication for meniscal repair is an acute 1 to 2 cm longitudinal peripheral tear that can be repaired in conjunction with anterior cruciate ligament (ACL) reconstruction in young patients16,22,23,24). Nevertheless, some authors reported good clinical results after repair of meniscus tears extending into the avascular zone in patients less than 20 years of age25).…”

Section: Introductionmentioning

confidence: 99%

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Meniscal Repair

Yoon

Park

2014

Knee Surg Relat Res

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The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

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Section: Inside-out Repair Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meniscal Repair

Yoon

Park

2014

Knee Surg Relat Res

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“…Meniscal ECM structure is intrinsic to its function, where circumferential collagen bundles develop to resist tensile hoop stresses [12, 13]. Tissue maturation is inversely related to the healing capacity of the meniscus, such that increasing patient age is correlated with worse clinical outcomes, including higher rates of repair failure [14, 15]. Importantly, patients over 40 with meniscal tears have fewer cells at the wound interface than younger patients [16].…”

Section: Introductionmentioning

confidence: 99%

Repair of dense connective tissues via biomaterial-mediated matrix reprogramming of the wound interface

Pintauro

Haughan

et al. 2015

Biomaterials

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Repair of dense connective tissues in adults is limited by their intrinsic hypocellularity and is exacerbated by a dense extracellular matrix (ECM) that impedes cellular migration to and local proliferation at the wound site. Conversely, healing in fetal tissues occurs due in part to an environment conducive to cell mobility and division. Here, we investigated whether the application of a degradative enzyme, collagenase, could reprogram the adult wound margin to a more fetal-like state, and thus abrogate the biophysical impediments that hinder migration and proliferation. We tested this concept using the knee meniscus, a commonly injured structure for which few regenerative approaches exist. To focus delivery and degradation to the wound interface, we developed a system in which collagenase was stored inside poly(ethylene oxide) (PEO) electrospun nanofibers and released upon hydration. Through a series of in vitro and in vivo studies, our findings show that partial digestion of the wound interface improves repair by creating a more compliant and porous microenvironment that expedites cell migration to and/or proliferation at the wound margin. This innovative approach of targeted manipulation of the wound interface, focused on removing the naturally occurring barriers to adult tissue repair, may find widespread application in the treatment of injuries to a variety of dense connective tissues.

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“…Moreover, increasing patient age correlates with worse clinical outcomes after meniscal repair, including higher rates of repair failure [30-33]. Importantly, patients >40 years of age with meniscal tears have significantly fewer meniscus cells at the wound interface than younger patients [34].…”

Section: Impediments To Meniscus Repairmentioning

confidence: 99%

From Repair to Regeneration: Biomaterials to Reprogram the Meniscus Wound Microenvironment

Mauck

Burdick

2015

Ann Biomed Eng

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When the field of tissue engineering first arose, scaffolds were conceived of as inert 3-dimensional structures whose primary function was to support cellularity and tissue growth. Since then, advances in scaffold and biomaterial design have evolved to not only guide tissue formation, but also to interact dynamically with and manipulate the wound environment. At present, these efforts are being directed towards strategies that directly address limitations in endogenous wound repair, with the goal of reprogramming the local wound environment (and the cells within that locality) from a state that culminates in an inferior tissue repair into a state in which functional regeneration is achieved. This review will address this approach with a focus on recent advances in scaffold design towards the resolution of tears of the knee meniscus as a case example. The inherent limitations to endogenous repair will be discussed, as will specific examples of how biomaterials are being designed to overcome these limitations. Examples will include design of fibrous scaffolds that promote colonization by modulating local ECM density and delivering recruitment factors. Furthermore, we will discuss scaffolds that are themselves modulated by the wound environment to alter porosity and modulate therapeutic release through precise coordination of scaffold degradation. Finally, we will close with emerging concepts in local control of cell mechanics to improve interstitial cell migration and so advance repair. Overall, these examples will illustrate how emergent features within a biomaterial can be tuned to manipulate and harness the local tissue microenvironment in order to promote robust regeneration.

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Meniscus Tears in the Young Athlete

Abstract: Level III retrospective cohort series.

Cited by 75 publications

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Meniscal Repair

Meniscal Repair

Repair of dense connective tissues via biomaterial-mediated matrix reprogramming of the wound interface

From Repair to Regeneration: Biomaterials to Reprogram the Meniscus Wound Microenvironment

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