Meniscal Replacement With a Silk Fibroin Scaffold Reduces Contact Stresses in the Human Knee

Stein, Susanne; Höse, Sabrina; Warnecke, Daniela; Gentilini, Cristina; Skaer, Nick; Walker, Robert; Kessler, Oliver; Ignatius, Anita; Dürselen, Lutz

doi:10.1002/jor.24437

Cited by 16 publications

(15 citation statements)

References 33 publications

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“…That is, the contact area and the pressure distribution were inversely related to each other due to the excision of the meniscus. These results were similar to those of previous reports and are consistent with reports that meniscectomy leads to an increased risk of developing osteoarthritis [ 9 , 14 , 15 , 19 ]. Based on the current study, radial tears should be treated with sutures to obtain the hoop function before the meniscus degeneration in the high-pressure area progresses.…”

Section: Discussionsupporting

confidence: 93%

Development of a Pressure-Sensitive Conductive Rubber Sensor for Analyzing Meniscal Injury in Porcine Models

Sezaki

Otsuki

Ikeda

et al. 2021

Applied Bionics and Biomechanics

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The assessment of the distribution of contact pressure on the meniscus is important in the elucidation of kinematics, etiology of joint diseases, and establishment of treatment methods. Compared with sensors widely used in recent years, pressure-sensitive conductive rubber sensors are easy to mold, flexible, durable, and resistant to shearing forces. This study is aimed at developing a rubber sensor for meniscal research and evaluating the pressure distribution after meniscal injury using porcine models. After confirming the reliability of the rubber sensor, contact pressure was obtained from the rubber sensor using the medial meniscus and femur of the porcine knee. Three test conditions of intact meniscus, radial tear, and meniscectomy were prepared, and a compressive load of 100 N was applied. After confirming the high reliability of the rubber sensor, the intact meniscus had the most uniform pressure distribution map, while the pressure in the meniscectomy model was concentrated in the resection region. The high-pressure region was significantly smaller in the intact group than in the radial tear models after 80 and 100 N ( P < 0.05 ). The rubber sensor captured the pressure concentration specific to each examination group and was useful for evaluating the relationship between the pattern of meniscal injury and changes in the biomechanical condition of the knee.

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Section: Discussionsupporting

confidence: 93%

Development of a Pressure-Sensitive Conductive Rubber Sensor for Analyzing Meniscal Injury in Porcine Models

Sezaki

Otsuki

Ikeda

et al. 2021

Applied Bionics and Biomechanics

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“…Stein et al investigated the use of a biocompatible silk fibroin meniscal replacement ( Stein et al, 2019 ). A partial meniscectomy, leaving a 4 mm peripheral meniscal rim and both meniscal horns intact, was performed and replaced by the implant.…”

Section: Resultsmentioning

confidence: 99%

“…With a flexion angle of 60°, an increase of approximately 140% could be calculated. Subsequently, the initial intact peak CP could be achieved by using replacements ( Wang et al, 2015 ; Stein et al, 2019 ). Huang et al examined how different levels of compressive load (400 vs. 1,200 N) affect the CP outcomes after autograft procedures ( Huang et al, 2003 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the outer third zone—the so-called vascularized, “red” zone—the gold standard of meniscal tear treatment is suturing ( Rankin et al, 2002 ; Makris et al, 2011 ), while repair in the avascular, “white” zone is commonly not indicated, because of a poor healing potential. Therefore, tears that are localized in this avascular zone are predominantly treated by (partial) meniscectomy ( Makris et al, 2011 ) or being replaced using different substitutes ( Linke et al, 2006 ; de Groot, 2010 ; Stein et al, 2019 ). In more severe cases, like permeating root or radial tears, which are described to be biomechanically equivalent to a total meniscectomy, the major function of the meniscus is completely lost ( Allaire et al, 2008 ).…”

Section: Introductionmentioning

confidence: 99%

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Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review

Sukopp

Schall

Hacker

et al. 2021

Front. Bioeng. Biotechnol.

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Purpose: Menisci transfer axial loads, while increasing the load-bearing tibiofemoral contact area and decreasing tibiofemoral contact pressure (CP). Numerous clinical and experimental studies agree that an increased CP is one predominant indicator for post-traumatic osteoarthritis (PTOA) of the knee joint. However, due to the immense variability in experimental test setups and wide range of treatment possibilities in meniscus surgery, it is difficult to objectively assess their impact on the CP determination, which is clearly crucial for knee joint health. Therefore, the aim of this systematic review is to investigate the influence of different meniscal injuries and their associated surgical treatments on the CP. Secondly, the influence of different test setups on CP measurements is assessed. On the basis of these results, we established the basis for recommendations for future investigations with the aim to determine CPs under different meniscal states.Methods: This review was conducted in accordance with the PRISMA guidelines. Studies were identified through a systematic literature search in Cochrane, PubMed and Web of Science databases. Literature was searched through pre-defined keywords and medical subject headings.Results: This review indicates a significant increase of up to 235% in peak CP when comparing healthy joints and intact menisci with impaired knee joints, injured or resected menisci. In addition, different test setups were indicated to have major influences on CP: The variety of test setups ranged from standard material testing machines, including customized setups via horizontal and vertical knee joint simulators, through to robotic systems. Differences in applied axial knee joint loads ranged from 0 N up to 2,700 N and resulted unsurprisingly in significantly different peak CPs of between 0.1 and 12.06 MPa.Conclusion: It was shown that untreated traumatic meniscal tears result in an increased CP. Surgical repair intervention were able to restore the CP comparable to the healthy, native condition. Test setup differences and particularly axial joint loading variability also led to major CP differences. In conclusion, when focusing on CP measurements in the knee joint, transparent and traceable in vitro testing conditions are essential to allow researchers to make a direct comparison between future biomechanical investigations.

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“…Meniscal repair is favorable, however, not always achievable. Different implants have been suggested to substitute a removed meniscus [37,38]. Despite promising early results [11,41], scaffolds are not widely used today.…”

Section: Introductionmentioning

confidence: 99%

Autologous semitendinosus tendon graft could function as a meniscal transplant

Rönnblad

Rotzius

Eriksson

2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Meniscectomy results in poor knee function and increased risk for osteoarthritis. Meniscal allograft transplantation is not widely used due to costs and availability. The semitendinosus tendon (ST) has the potential to remodel and revascularize in an intraarticular environment, such as ACL reconstruction. The objective for this pilot study was to investigate whether the ST graft could function as a meniscal transplant. Methods The ST was doubled and sutured with running sutures and pull-out sutures in each end. Bone tunnels were used for root anchorage and the graft was sutured with allinside, inside-out and outside-in technique. The pull-out sutures were fixed over a button. Partial weight bearing was allowed with limited range of motion in a brace for the first 6 weeks. Evaluation was assessed using clinical examination, radiology and patient reported outcome. Results A total of seven patients have been included between January 2018 and June 2020. Six medial transplants and one lateral transplant were performed. Mean age was 29 years. Four patients had completed the 12-month follow-up. Improvements were noted for IKDC Global Score, KOOS pain subscale and Lysholm. MRI indicated that the transplant become more wedge-like with visible roots and minor protrusion. Conclusions Even though this is primarily a technical report the follow-up data indicate that the transplant survives and adapts in shape and capabilities to an original meniscus. There were no adverse events and the patients seem to improve in terms of pain and quality of life.

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Meniscal Replacement With a Silk Fibroin Scaffold Reduces Contact Stresses in the Human Knee

Cited by 16 publications

References 33 publications

Development of a Pressure-Sensitive Conductive Rubber Sensor for Analyzing Meniscal Injury in Porcine Models

Development of a Pressure-Sensitive Conductive Rubber Sensor for Analyzing Meniscal Injury in Porcine Models

Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review

Autologous semitendinosus tendon graft could function as a meniscal transplant

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