Meniscal Scaffolds - Preclinical Evidence to Support their Use: A Systematic Review

Abstract

Arthroscopic meniscal treatment is the most common procedure performed in the orthopedic practice. Current management of meniscal pathology relies on different therapeutic options, ranging from selective meniscectomy, suturing, and to meniscal replacement by using either allografts or scaffolds. The progresses made in the field of regenerative medicine and biomaterials allowed to develop several meniscal substitutes, some of those currently used in the clinical practice. Before reaching the clinical application, these devices necessarily undergo accurate testing in the animal model: the aim of the present manuscript is to systematically review the scientific evidence derived by animal model results for the use of meniscal scaffolds, in order to understand the current state of research in this particular field and to identify the trends at preclinical level that may influence in the near future the clinical practice.Thirty-four papers were included in the present analysis. In 12 cases the meniscal scaffolds were used with cells to further stimulate tissue regeneration. With the exception of some negative reports regarding dacron-based scaffolds, the majority of the trials highlighted that biomaterials and bio-engineered scaffolds are safe and could play a beneficial role in stimulating meniscal healing and in chondral protection. With regard to the benefits of cell augmentation, the evidence is limited to a small number of studies and no conclusive evidence is available. However, preclinical evidence seems to suggest that cells could enhance tissue regeneration with respect to the use of biomaterials alone, and further research should confirm the translational potential of cell-based approach.

Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold

“…5,6 However, there are multiple drawbacks to meniscal allograft transplantation, such as limits in tissue availability, the risk of mismatch and immunoreactivity, impaired cellular infiltration and remodelling capacity, and suboptimal prognosis with results worsening over time. 7,8 To overcome the limitations of allografts, several scaffolds have been developed, 9 but, despite promising preclinical findings, only two cell-free meniscal substitutes have reached clinical practice and been used to address partial meniscus defects: one collagen-based meniscal implant and one consisting of polyurethane and polycaprolactone. 10 Safety and positive clinical results have been reported for both scaffolds, with imaging and, in some cases, arthroscopic evaluation confirming the potential of these bio-engineered devices to stimulate meniscal tissue regeneration, albeit not completely.…”

Meniscus ECM‐functionalised hydrogels containing infrapatellar fat pad‐derived stem cells for bioprinting of regionally defined meniscal tissue

“…Of relevance, the GFs connective tissue growth factor (CTGF) and hepatocyte growth factor have been shown to stimulate the formation of the outer meniscus region and to improve vascularization essential for a vital peripheral zone of the meniscus, whereas the GFs platelet‐derived growth factor‐BB and insulin‐like growth factor‐1 have been shown to support development of the inner part of the meniscus (Lee, Moioli, & Mao, ; Park & Na, ). A variety of scaffolds have also been developed to provide an appropriate environment for meniscal repair (Di Matteo et al, ; Fisher et al, ; Fisher, Henning, Söegaard, Esterhai, & Mauck, ; Lee et al, ; Vrancken, Buma, & Van Tienen, ). In recent years, there has been an increased interest in the use of natural ECM‐derived biomaterials to support tissue regeneration (Almeida et al; ; Almeida et al, ; Visser et al, ; Wolf et al, ).…”

Künstlicher Meniskusersatz

“…In gleicher Weise reihen sich auch die Ergebnisse von Filardo et al [22] Ein direkter Vergleich beider Implantate existiert kaum [27]. In dieser Über-…”