Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures

Gomoll, Andreas H.; Filardo, Giuseppe; Almqvist, Fredrik; Bugbee, William D.; Jelić, Mislav; Monllau, Juan Carlos; Puddu, Giancarlo; Rodkey, William G.; Verdonk, Peter; Verdonk, René; Zaffagnini, Stefano; Marcacci, Maurilio

doi:10.1007/s00167-011-1714-7

Cited by 101 publications

(71 citation statements)

References 117 publications

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“…Patients with traumatic or iatrogenic meniscal tissue loss of more than 25% with normal articular cartilage or minimal chondral lesions (Kallgren-Lawrence grade I, II, Outbridge I, II) are suitable for meniscal scaffold transplantation [5].…”

Section: Indicationsmentioning

confidence: 99%

“…Enlargement of the anteromedial or anterolateral portal, for medial or lateral meniscus implant, allows easier passage of the scaffold. The location of the portals should be low and adjacent to the patellar tendon lateral margins in order to obtain optimal angle of suture insertion [5,6]. An accessory portal 2-3 cm lateral to the medial or lateral portal can be useful if the implantation is to be at the anterior third of the meniscus.…”

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confidence: 99%

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Meniscal Scaffolds: a Mini Review

Koukoulias¹

2015

J Surg Surgical Res

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Partial meniscal defects can be the cause of knee joint line pain. Synthetic meniscal scaffolds have been used as substitutes for the meniscal defect. CMI (Collagen Meniscus Implant, Ivy Sports Medicine, Gräfelfing, Germany) was the first product designed and Actifit (Orteq Bioengineering, London, United Kingdom), a polyurethane scaffold, is a more recent one. Both implants have been proven safe and clinically efficient so far. The indications, surgical technique, postoperative regime, results and complications are discussed.scaffolds that have been used in vivo and investigated for their clinical and radiographic outcomes. CMI is a collagen matrix implant comprised of bovine type I collagen and Actifit is a polyurethane highly interconnected porous implant. IndicationsThe use of meniscal scaffolds is mainly indicated in the postmeniscectomy knee joint line pain. Patients with traumatic or iatrogenic meniscal tissue loss of more than 25% with normal articular cartilage or minimal chondral lesions (Kallgren-Lawrence grade I, II, Outbridge I, II) are suitable for meniscal scaffold transplantation [5].Intact anterior-posterior horn attachments and a circumferential rim are prerequisites for the implantation. As a result, patients with previous total meniscectomy do not meet the criteria for this treatment.As with all implants, allergy to the scaffold materials is a possible side effect and should be kept in mind. Surgical TechniqueThe procedure could be completed fully arthroscopically using the two standard anteromedial and anterolateral portals. Enlargement of the anteromedial or anterolateral portal, for medial or lateral meniscus implant, allows easier passage of the scaffold. The location of the portals should be low and adjacent to the patellar tendon lateral margins in order to obtain optimal angle of suture insertion [5,6]. An accessory portal 2-3 cm lateral to the medial or lateral portal can be useful if the implantation is to be at the anterior third of the meniscus.The procedure [7,8] begins with a complete diagnostic arthroscopy. In medial meniscus implantation, many surgeons suggest MCL release in order to improve the view of the affected medial compartment and protect the healthy articular cartilage. After all, this is chondro-protective procedure. The release is carried out only to the extent that is needed, in order to obtain the desired access to the medial meniscus. The meniscus is thoroughly evaluated and the presence of intact anterior-posterior horn attachments and a circumferential rim is confirmed. Other concomitant intra-articular lesions are recognized and treated accordingly. Preparation of the meniscus consists of removing any flaps, loose or degenerative tissue. The goal is to leave healthy and uniform meniscal rim. The anterior and posterior attachment points are trimmed in order to have a square shape, thus allowing precise fit of the scaffold. In order to

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Section: Indicationsmentioning

confidence: 99%

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confidence: 99%

Meniscal Scaffolds: a Mini Review

Koukoulias¹

2015

J Surg Surgical Res

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“…FOAT has been used in other countries for decades (1)(2)(3)(4)(5) . This technique was initially introduced for the treatment of post-traumatic bone defects (6,7) ; however, today, it is used for various pathologies of the knee, such as osteochondritis dissecans, secondary osteonecrosis, degenerative disease of the knee, and complications arising from fractures (8)(9)(10)(11) . The current treatment options for large chondral and osteochondral lesions of the knee are autologous transplant of chondrocytes, and fresh osteochondral allograft transplantation, the principle of this technique being to reestablish the biological anatomy of the joint, and provide an osteochondral tissue capable of mechanical weight-bearing.…”

Section: Introductionmentioning

confidence: 99%

O uso do transplante osteocondral a fresco no tratamento das lesões osteocondrais do joelho

Tírico¹,

Demange²

2012

Rev. bras. ortop.

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“…At present, there is no established therapy of cell-assisted tissue regeneration for sufficiently reliable and durable replacement of damaged articular cartilage [8][9][10][11]. In recent years, however, tissue engineering has shown promise toward the treatment of OA, enabling researchers to produce functional replacements for diseased cartilage [12,13]. Developments in therapeutic strategies for damaged cartilage treatment have increasingly focused on the promising technology of cell-assisted repair and proposing the use of autologous chondrocytes or other cell types to regenerate articular cartilage [10,11].…”

Section: Introductionmentioning

confidence: 99%