Potential Market for New Meniscus Repair Strategies – Evaluation of the MOON Cohort

TRIA Orthopaedic Center, Minneapolis, Minn, USA.
The journal of knee surgery (Impact Factor: 1.44). 08/2009; 22(3):180-6. DOI: 10.1055/s-0030-1247746
Source: PubMed


This study aimed to determine the incidence of meniscal tears and describe the tear morphology and selected treatment in patients undergoing anterior cruciate ligament (ACL) reconstruction. We also will discuss the potential market for future tissue engineering aimed at preserving meniscal function. A multicenter cohort of 1014 patients undergoing ACL reconstruction between January 2002 and December 2003 was evaluated. Data on patient demographics, presence of a meniscus tear at time of ACL reconstruction, tear morphology, and meniscal treatment were collected prospectively. Meniscal tears were categorized into 3 potential tissue engineering treatment strategies: all-biologic repair, advanced repair, and scaffold replacement. Of the knees, 36% had medial meniscal tears and 44% had lateral meniscal tears. Longitudinal tears were the most common tear morphology. The most frequent treatment method was partial meniscectomy. Thirty percent of medial meniscal tears and 10% of lateral meniscal tears are eligible for all-biologic repair; 35% of medial meniscal tears and 35% of lateral meniscal tears are eligible for an advanced repair technique; and 35% of medial meniscal tears and 55% of lateral meniscal tears are eligible for scaffold replacement. Although meniscal preservation is generally accepted in the treatment of meniscal tears, most tears in this cohort were not repairable, despite contemporary methods. The results of this cohort will hopefully stimulate and focus future research and development of new tissue engineering strategies for meniscus repair.

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    • "Knowing the risk for the onset of osteoarthritis after meniscectomy, the majority of meniscus tears are still treated with partial meniscectomy as shown in a huge cohort of more than 1000 young patients undergoing anterior cruciate ligament reconstruction (Fetzer et al. 2009). Therefore, the main goal of every meniscus treatment should be the maintenance of as much meniscus tissue as possible (Fetzer et al. 2009; Starke et al. 2009; Stein et al. 2010; Abrams et al. 2013). This includes repair of meniscus tears and regeneration of meniscus defects after meniscectomy with regenerative treatment approaches. "
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    ABSTRACT: Meniscus integrity is the key for joint health of the knee. Therefore, the main goal of every meniscus treatment should be the maintenance of as much meniscus tissue as possible. Repair of meniscus tears can be achieved by meniscus suture. However, in a recently published meta-analysis, the long-term outcome of meniscus repair showed a mean failure rate of 24%. In a preclinical trial, locally applied mesenchymal stem cells produced differentiated meniscus-like tissue in meniscus tears indicating that mesenchymal-based cells, harvested from the bone marrow, enhance meniscus healing in critical-size meniscus tears. Symptomatic meniscus defects offer the option for meniscus transplantation with porous cell free biomaterials, when a complete meniscus rim is available. Cell-free biomaterials, which are actually in clinical application, reveal variable outcome in mid-term results from complete failure to regeneration with meniscus-like tissue. In several preclinical studies with different critical-size defects in the meniscus, the application of mesenchymal stem cells could significantly enhance meniscus regeneration compared to empty defects or to cell-free biomaterials. Regenerative treatment of meniscus with mesenchymal stem cells seems to be a promising approach to treat meniscal tears and defects. However it is still not clear, whether the stem cell effect is a direct action of the mesenchymal-based cells or is rather mediated by secretion of certain stimulating factors. The missing knowledge of the underlying mechanism is one of the reasons for regulatory burdens to permit these stem cell-based strategies in clinical practice. Other limitations are the necessity to expand cells prior to transplantation resulting in high treatment costs. Alternative treatment modalities, which use growth factors concentrated from peripheral blood aspirates or mononucleated cells concentrated from bone marrow aspirates, are currently in development in order to allow an attractive one-step procedure without the need for cell expansion in cultures and thus lower efforts and costs. In summary, Tissue Engineering of meniscus with mesenchymal based cells seems to be a promising approach to treat meniscal tears and defects in order to restore native meniscus tissue. However, advances of the technology are necessary to allow clinical application of this modern regenerative therapy.
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    ABSTRACT: This article proposes a "bedside-to-bench" approach as a model to improve clinical outcomes for patients through functional tissue engineering (TE). The link between the highest level of clinical research and evaluation criteria for musculoskeletal TE is in identifying clinically proven predictors that are amenable to functional TE. The TE solutions developed in the laboratory should then be tested in translational models to evaluate efficacy and safety prior to controlled clinical trials. The best available evidence for potentially decreasing the incidence of radiographically confirmed osteoarthritis after anterior cruciate ligament injury is preservation of meniscus function. Meniscus tears occur concurrently in approximately 50% of anterior cruciate ligament tears. TE could promote repair of torn meniscus and/or replacement of meniscus loss because meniscus tear is a proven predictor of clinically relevant outcomes (such as osteoarthritis) in patients and is amenable to a potential TE solution.
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