Abstract:Purpose
The purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states.
Methods
A dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy - MOWHTO) left human cadaveric knee joints. The knee joint… Show more
“…The NUsurface free-floating meniscus implant does not require fixation, but the surgical technique is complicated by the use of trial implants in combination with intra-operative imaging [ 56 •]. Moreover, the notchplasty that is frequently required significantly affects the extent and the difficulty of the surgical procedure [ 55 ]. The Artimis meniscus prosthesis does not require capsular fixation or notchplasty [ 59 ].…”
Section: Discussionmentioning
confidence: 99%
“…However, due to the lack of fixation, an intact peripheral meniscus rim of at least 2mm is necessary to prevent dislocation [ 54 ]. Additionally, a notchplasty of the lateral side of the medial femoral condyle is sometimes required to avoid impingement on the lateral edge of this medial meniscus replacement [ 55 ]. Fig.…”
Purpose of Review
The field of meniscus replacement is changing continuously, with new devices emerging and others disappearing from the market. With the current tendency to preserve the knee joint, meniscus implants may become more relevant than ever. The purpose of this review is to provide an overview of the current state of partial and total meniscus replacements that have been developed beyond the academic phase. The available clinical and pre-clinical data is evaluated, and omissions are identified.
Recent Findings
Recent systematic reviews have shown a lack of homogenous clinical data on the CMI and Actifit meniscal scaffolds, especially regarding long-term performance without concomitant surgical interventions. Clinical studies on the medial total meniscus prostheses NUsurface and Artimis are ongoing, with the NUsurface being several years ahead. New techniques for meniscus replacement are rapidly developing, including the Artimis lateral meniscus prosthesis and the MeniscoFix 3D-printed scaffold.
Summary
All evaluated clinical studies point towards improved clinical outcomes after implantation of partial and total meniscus replacements. Long-term data on survival and performance is of low quality for CMI and Actifit and is unavailable yet for NUsurface and Artimis. It is of major importance that future research focuses on optimizing fixation methods and identifying the optimal treatment strategy for each patient group. New techniques for total and partial replacement of the medial and lateral meniscus will be followed with interest.
“…The NUsurface free-floating meniscus implant does not require fixation, but the surgical technique is complicated by the use of trial implants in combination with intra-operative imaging [ 56 •]. Moreover, the notchplasty that is frequently required significantly affects the extent and the difficulty of the surgical procedure [ 55 ]. The Artimis meniscus prosthesis does not require capsular fixation or notchplasty [ 59 ].…”
Section: Discussionmentioning
confidence: 99%
“…However, due to the lack of fixation, an intact peripheral meniscus rim of at least 2mm is necessary to prevent dislocation [ 54 ]. Additionally, a notchplasty of the lateral side of the medial femoral condyle is sometimes required to avoid impingement on the lateral edge of this medial meniscus replacement [ 55 ]. Fig.…”
Purpose of Review
The field of meniscus replacement is changing continuously, with new devices emerging and others disappearing from the market. With the current tendency to preserve the knee joint, meniscus implants may become more relevant than ever. The purpose of this review is to provide an overview of the current state of partial and total meniscus replacements that have been developed beyond the academic phase. The available clinical and pre-clinical data is evaluated, and omissions are identified.
Recent Findings
Recent systematic reviews have shown a lack of homogenous clinical data on the CMI and Actifit meniscal scaffolds, especially regarding long-term performance without concomitant surgical interventions. Clinical studies on the medial total meniscus prostheses NUsurface and Artimis are ongoing, with the NUsurface being several years ahead. New techniques for meniscus replacement are rapidly developing, including the Artimis lateral meniscus prosthesis and the MeniscoFix 3D-printed scaffold.
Summary
All evaluated clinical studies point towards improved clinical outcomes after implantation of partial and total meniscus replacements. Long-term data on survival and performance is of low quality for CMI and Actifit and is unavailable yet for NUsurface and Artimis. It is of major importance that future research focuses on optimizing fixation methods and identifying the optimal treatment strategy for each patient group. New techniques for total and partial replacement of the medial and lateral meniscus will be followed with interest.
“…The vast range of themes covered ranges from basic science topics like aggrecan, the major proteoglycan in the articular cartilage [ 17 ], biomaterials for osteochondral regeneration [ 12 ] to the kinematics of a medial meniscus replacement [ 19 ]. Without doubt, evolution of a journal involves changes.…”
PurposeThe aim of this study was to investigate the influence of medial meniscus posterior root avulsion (MMPRA) before and after surgical treatment on the biomechanics of the knee joint, including suture repair forces during daily and crutch‐assisted gait movements.MethodsMMPRA were investigated in eight human cadaver knee joint specimens by a dynamic knee joint simulator with daily (normal gait, gait with additional rotational movement, standing up, sitting down) and rehabilitation‐associated movements (crutch‐assisted gait with limited flexion range of motion [30°] and 30% [toe‐touch weight‐bearing, TTWB] and 50% of body weight [partial weight‐bearing, PWB]) with simulated physiologic muscle forces. Each specimen was tested in intact, torn and repaired (transtibial suture) state. The biomechanical parameters were: medial mean contact pressure and area, knee joint kinematics, medial displacement of the posterior meniscus horn and loading on the anchoring suture.ResultsSignificant reduction of the contact area due to the avulsion was observed in all movements except for PWB and sitting down. MMPRA repair significantly increased the contact areas during all movements, bringing them to levels statistically indistinguishable from the initial state. MMPRA resulted in a medial displacement up to 12.8 mm (sitting down) and could be reattached with a residual displacement ranging from 0.7 mm (PWB) to 5.7 mm (standing up), all significantly (p < 0.001) reduced compared to the torn state. The mean peak anchoring suture load increased from TTWB (77 N), PWB (91 N) to normal gait (194 N), gait rotation (207 N), sitting (201 N; p < 0.01) and to standing up (232 N; p = 0.03).ConclusionSurgical treatment of MMPRA allows restoration of physiological knee joint biomechanics. Crutch‐assisted movements reduce the loading of the repair suture, thus likewise the risk for failure. From a biomechanical point of view, crutch‐assisted movements are recommended for the early rehabilitation phase after MMPRA repair.Level of EvidenceLevel V.
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