Comparison of meniscal allograft transplantation techniques using a preclinical canine model

Abstract

Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with meniscocapsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibialosteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with meniscotibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.

Isolation and Characterization of Multipotent Canine Urine-Derived Stem Cells

“…In addition, dogs have good compliance and response to learned behaviors, such as treadmill exercise; it was used to evaluate new therapies for cardiovascular and orthopedic diseases [ 25 , 26 ]. Based on these benefits, the preclinical canine models in osteoarthritis, anterior cruciate ligament reconstruction, rotator cuff repair, meniscal injury, and nonunion fracture have been developed and described in recent articles [ 27 – 33 ], which can be used to bridge the gap from rodents to humans. Although USCs have been successfully isolated in humans, no report has described the protocol of isolating USCs from canine (cUSCs).…”

Outcomes Associated With Osteochondral Allograft Transplantation in Dogs

“…One humeral head OCD lesion was treated with a 25 mm diameter OCA plug (∼7 mm depth) All other defects were treated using custom-cut patient-specific shell (5-7 mm thick) OCAs stabilized with 0.045", 0.062" Kirschner wires, 2.0 mm cortical screws, bioabsorbable pins (Arthrex, Inc., Naples, FL, USA), or bioabsorbable nails (ConMed Linvatec, Utica, NY, USA) (Figures 3-5). Fresh meniscal allograft transplants, if performed in conjunction with femoral condyle or tibial plateau resurfacing, were performed either using a bone plug technique with suspensory fixation or included as part of the tibial OCA transplant (34). Immediately prior to implantation, OCA bone was irrigated with isotonic saline to dilute marrow elements.…”

Fresh Osteochondral Allograft Transplants in the Knee: Bipolar and Beyond

“…• soaking the OCA cancellous bone with autologous bone marrow aspirate concentrate (BMAC); • stabilizing the grafts using bioabsorbable pins and nails; and • prescribed and monitored patient-specific rehabilitation protocols. [6][7][8] Patients are placed supine on a radiolucent table. A midline approach is made with either a medial or lateral parapatellar arthrotomy depending upon the articular surfaces in the knee being treated.…”

“…The meniscotibial allografts we use retain the meniscotibial ligament, which we believe is crucial to success. 7 We then place the arthroscope into the knee and assess the meniscal stability. If necessary, we place an "all inside" suture posteriorly or "inside-out" sutures more anteriorly.…”