Initial clinical outcomes comparing frozen versus fresh meniscus allograft transplants

Schreiner, Anna J.; Stannard, James P.; Cook, Cristi R.; Oladeji, Lasun O.; Smith, Patrick A.; Rucinski, Kylee; Cook, James L.

doi:10.1016/j.knee.2020.09.015

Cited by 15 publications

(38 citation statements)

References 57 publications

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“…A very similar treatment algorithm is followed for meniscal pathology at our center, wherein meniscal repair is performed immediately prior to PCL reconstruction when indicated, and meniscal allograft transplantation is subsequently performed based on documentation of irreparable meniscus deficiency, insurance preauthorization, and graft availability. 40,41 If staged ACL reconstruction and/or realignment osteotomy is required, the timing for these subsequent procedures is coordinated accordingly. 40,42 The other key factor in successfully managing these cases is the postoperative rehabilitation process.…”

Section: Treatmentmentioning

confidence: 99%

Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee

2021

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Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.

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Section: Treatmentmentioning

confidence: 99%

Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee

2021

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“…8,11,23,25,52 Reoperation rates after fresh-frozen MAT can be as high as 32%. 8,11,23,25,52 As such, fresh (viable) MAT implanted with or without attached tibial plateau osteochondral allograft has been evaluated in preclinical and clinical studies, which support their use as safe and effective MAT options with potential advantages over fresh-frozen MAT grafts and surgical techniques. 51,52 However, further study is required to delineate definitive and clinically relevant differences among graft types and implantation techniques based on mechanistic data that determine success or failure with respect to functional MAT survivorship.…”

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confidence: 99%

“…Meniscal allograft transplantation (MAT) has been developed as a meniscal restoration technique that has been successfully implemented using allografts preserved via several methods. 25,52 Currently, MAT is most often performed using fresh-frozen meniscal allografts transplanted via a variety of surgical techniques. 25,52 Outcomes for fresh-frozen MAT have been largely positive across techniques, consistently improving patient-reported outcome measures and resulting in average graft survivorship of approximately 75% at 10 years.…”

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confidence: 99%

“…25,52 Outcomes for fresh-frozen MAT have been largely positive across techniques, consistently improving patient-reported outcome measures and resulting in average graft survivorship of approximately 75% at 10 years. 8,11,23,25,52 Despite these outcomes, MAT is associated with complications such as graft tearing, extrusion, shrinkage and/or degeneration, arthrofibrosis, tibiofemoral articular cartilage deterioration, and failure to restore knee function. 8,11,23,25,52 Reoperation rates after fresh-frozen MAT can be as high as 32%.…”

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confidence: 99%

“…8,11,23,25,52 Despite these outcomes, MAT is associated with complications such as graft tearing, extrusion, shrinkage and/or degeneration, arthrofibrosis, tibiofemoral articular cartilage deterioration, and failure to restore knee function. 8,11,23,25,52 Reoperation rates after fresh-frozen MAT can be as high as 32%. 8,11,23,25,52 As such, fresh (viable) MAT implanted with or without attached tibial plateau osteochondral allograft has been evaluated in preclinical and clinical studies, which support their use as safe and effective MAT options with potential advantages over fresh-frozen MAT grafts and surgical techniques.…”

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confidence: 99%

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Treatment-Monitoring Capabilities of Serum and Urine Biomarkers for Meniscal Allograft Transplantation in a Preclinical Canine Model

et al. 2022

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Background: Meniscal allograft transplantation (MAT) has been developed as a treatment for meniscal deficiency. Despite promising outcomes, there are no real-time methods to evaluate graft survivorship and predict functional outcomes. Hypothesis: Assessment of serum and urine biomarkers could be used to develop biomarker panels—prognostic (1- and 3-month postsurgical time points) and diagnostic (6-month time point)—based on strong associations with clinically relevant outcome metrics obtained 6 months after surgery. Study Design: Descriptive laboratory study. Methods: Twelve adult purpose-bred research hounds were included and underwent medial meniscal release to induce meniscal deficiency. Three months after meniscal release surgery, medial menisci were replaced with fresh-frozen meniscus (n = 4), fresh meniscus (n = 4), or fresh meniscotibial osteochondral allograft (n = 4) such that a spectrum of pain and functional outcomes could be anticipated. Serum and urine from all dogs were collected preoperatively and at 1, 3, and 6 months after MAT surgery. Dogs were assessed for pain-related and functional outcomes at the same time points. To develop a prognostic panel of biomarkers, biomarker data from the 1- and 3-month post-MAT surgery time points were used to model 6-month clinical outcomes. A diagnostic panel of biomarkers was developed using data from the 6-month post-MAT surgery to model 6-month clinical outcomes. Primary outcomes for pain and function were visual analog scale (VAS) and operated limb percentage total pressure index (%TPI), respectively. Using random subject effects, linear mixed models were used to develop prognostic biomarker panels, and linear fixed-effect models were used to develop diagnostic biomarker panels, with variance explained for each panel reported ( R2) along with individual biomarker relationships. Results: Across prognostic biomarker panels, a panel including serum IL-6, IL-8, IL-10, and IL-18 was fit for the primary functional outcome, operated limb %TPI ( R2 = 0.450), whereas a panel including serum CTX-II and OPG was fit for the primary pain-related outcome, VAS ( R2 = 0.516). Across diagnostic biomarker panels, a panel including serum MMP-1 and MMP-3 and urine PINP and TIMP-1 was fit for %TPI ( R2 = 0.863). Separately, a panel including urine CTX-I, CTX-II, IL-8, MMP-2, and TIMP-1 was fit as diagnostic biomarkers for the VAS for pain ( R2 = 0.438). Conclusion: Biomarker panels of selected serum and/or urine proteins can model clinically relevant metrics for function and pain in a preclinical model of MAT. Clinical Relevance: Biomarker panels could be used to provide real-time diagnostic and prognostic data regarding outcomes after MAT.

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Viable Vitreous Grafts of Whole Porcine Menisci for Transplant in the Knee and Temporomandibular Joints

Wang,

Mueller,

Chen

et al. 2024

Adv Healthcare Materials

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The shortage of suitable donor meniscus grafts from the knee and temporomandibular joint (TMJ) impedes treatments for millions of patients. Vitrification offers a promising solution by transitioning these tissues into a vitreous state at cryogenic temperatures, protecting them from ice crystal damage using high concentrations of cryoprotectant agents (CPAs). However, vitrification's success is hindered for larger tissues (>3 ml) due to challenges in CPA penetration. Dense avascular meniscus tissues require extended CPA exposure for adequate penetration; however, prolonged exposure becomes cytotoxic. Balancing penetration and reducing cell toxicity is required. To overcome this hurdle, a simulation‐based optimization approach was developed by combining computational modeling with microcomputed tomography (μCT) imaging to predict three‐dimensional CPA distributions within tissues over time accurately. This approach minimized CPA exposure time, resulting in 85% viability in 4‐ml meniscal specimens, 70% in 10‐ml whole knee menisci, and 85% in 15‐ml whole TMJ menisci (i.e., TMJ disc) post‐vitrification, outperforming slow‐freezing methods (20%–40%). The extracellular matrix (ECM) structure and biomechanical strength of vitreous tissues remained largely intact. Vitreous meniscus grafts demonstrated clinical‐level viability (≥70%), closely resembling the material properties of native tissues, with long‐term availability for transplantation. The enhanced vitrification technology opens new possibilities for other avascular grafts.This article is protected by copyright. All rights reserved

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Initial clinical outcomes comparing frozen versus fresh meniscus allograft transplants

Cited by 15 publications

References 57 publications

Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee

Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee

Treatment-Monitoring Capabilities of Serum and Urine Biomarkers for Meniscal Allograft Transplantation in a Preclinical Canine Model

Viable Vitreous Grafts of Whole Porcine Menisci for Transplant in the Knee and Temporomandibular Joints

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