Prospective Long-Term Outcomes of the Medial Collagen Meniscus Implant Versus Partial Medial Meniscectomy

Zaffagnini, Stefano; Muccioli, Giulio Maria Marcheggiani; Lopomo, N.; Bruni, Danilo; Giordano, Giovanni; Ravazzolo, Giovanni; Molinari, Massimo; Marcacci, Maurilio

doi:10.1177/0363546510391179

Cited by 189 publications

(247 citation statements)

References 41 publications

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“…Zaffagnini et al [11] compared the CMI to partial meniscectomy in 33 patients. The choice of the procedure was decided by the patients.…”

Section: Resultsmentioning

confidence: 99%

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Meniscal Scaffolds: a Mini Review

Koukoulias¹

2015

J Surg Surgical Res

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Partial meniscal defects can be the cause of knee joint line pain. Synthetic meniscal scaffolds have been used as substitutes for the meniscal defect. CMI (Collagen Meniscus Implant, Ivy Sports Medicine, Gräfelfing, Germany) was the first product designed and Actifit (Orteq Bioengineering, London, United Kingdom), a polyurethane scaffold, is a more recent one. Both implants have been proven safe and clinically efficient so far. The indications, surgical technique, postoperative regime, results and complications are discussed.scaffolds that have been used in vivo and investigated for their clinical and radiographic outcomes. CMI is a collagen matrix implant comprised of bovine type I collagen and Actifit is a polyurethane highly interconnected porous implant. IndicationsThe use of meniscal scaffolds is mainly indicated in the postmeniscectomy knee joint line pain. Patients with traumatic or iatrogenic meniscal tissue loss of more than 25% with normal articular cartilage or minimal chondral lesions (Kallgren-Lawrence grade I, II, Outbridge I, II) are suitable for meniscal scaffold transplantation [5].Intact anterior-posterior horn attachments and a circumferential rim are prerequisites for the implantation. As a result, patients with previous total meniscectomy do not meet the criteria for this treatment.As with all implants, allergy to the scaffold materials is a possible side effect and should be kept in mind. Surgical TechniqueThe procedure could be completed fully arthroscopically using the two standard anteromedial and anterolateral portals. Enlargement of the anteromedial or anterolateral portal, for medial or lateral meniscus implant, allows easier passage of the scaffold. The location of the portals should be low and adjacent to the patellar tendon lateral margins in order to obtain optimal angle of suture insertion [5,6]. An accessory portal 2-3 cm lateral to the medial or lateral portal can be useful if the implantation is to be at the anterior third of the meniscus.The procedure [7,8] begins with a complete diagnostic arthroscopy. In medial meniscus implantation, many surgeons suggest MCL release in order to improve the view of the affected medial compartment and protect the healthy articular cartilage. After all, this is chondro-protective procedure. The release is carried out only to the extent that is needed, in order to obtain the desired access to the medial meniscus. The meniscus is thoroughly evaluated and the presence of intact anterior-posterior horn attachments and a circumferential rim is confirmed. Other concomitant intra-articular lesions are recognized and treated accordingly. Preparation of the meniscus consists of removing any flaps, loose or degenerative tissue. The goal is to leave healthy and uniform meniscal rim. The anterior and posterior attachment points are trimmed in order to have a square shape, thus allowing precise fit of the scaffold. In order to

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“…Zaffagnini et al [11] compared the CMI to partial meniscectomy in 33 patients. The choice of the procedure was decided by the patients.…”

Section: Resultsmentioning

confidence: 99%

“…Many authors [7,10,11,13] reported that there was no progression of the articular cartilage degeneration after the scaffold implantation. Joint space narrowing was prevented, quality of cartilage did not change significantly and ICRS and Outerbridge scores did not deteriorate over time.…”

Section: Discussionmentioning

confidence: 99%

Meniscal Scaffolds: a Mini Review

Koukoulias¹

2015

J Surg Surgical Res

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“…Unique in their clinical evaluation of the CMI® are the data on joint space narrowing. The considerable difference between the implant group and the non-treated controls suggests that the implant decreases the risk of degenerative changes in the knee [26].…”

Section: Partial Meniscal Substitutesmentioning

confidence: 98%

“…Zaffagnini and colleagues combined several clinical measures with radiographic and MRI evaluation to compare the CMI® to partial meniscectomy at a minimum follow-up of ten years [26]. The patients were not randomised between treatment groups and the outcome of acute and chronic tears was not separately analysed.…”

Section: Partial Meniscal Substitutesmentioning

confidence: 99%

“…Firstly, the size of the CMI® reduced during follow-up [27][28][29]. Secondly, the signal intensity does not resemble that of the native meniscus, either for short follow-up [27,28] or for follow-up periods exceeding ten years [26,29]. Figure 1c and d show a representative MRI of a CMI® implanted knee 12 months post-surgery.…”

Section: Partial Meniscal Substitutesmentioning

confidence: 99%

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Synthetic meniscus replacement: a review

Vrancken

Buma

Tienen

2012

International Orthopaedics (SICOT)

103

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Current Concepts in Meniscus Tissue Engineering and Repair

Bilgen

Jayasuriya

Owens

2018

Adv Healthcare Materials

101

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The meniscus is the most commonly injured structure in the human knee. Meniscus deficiency has been shown to lead to advanced osteoarthritis (OA) due to abnormal mechanical forces, and replacement strategies for this structure have lagged behind other tissue engineering endeavors. The challenges include the complex 3D structure with individualized size parameters, the significant compressive, tensile and shear loads encountered, and the poor blood supply. In this progress report, a review of the current clinical treatments for different types of meniscal injury is provided. The state-of-the-art research in cellular therapies and novel cell sources for these therapies is discussed. The clinically available cell-free biomaterial implants and the current progress on cell-free biomaterial implants are reviewed. Cell-based tissue engineering strategies for the repair and replacement of meniscus are presented, and the current challenges are identified. Tissue-engineered meniscal biocomposite implants may provide an alternative solution for the treatment of meniscal injury to prevent OA in the long run, because of the limitations of the existing therapies.

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Prospective Long-Term Outcomes of the Medial Collagen Meniscus Implant Versus Partial Medial Meniscectomy

Abstract: Pain, activity level, and radiological outcomes are significantly improved with use of the MCMI at a minimum 10-year follow-up compared with PMM alone. Randomized controlled trials on a larger population are necessary to confirm MCMI benefits at long term.

Cited by 189 publications

References 41 publications

Meniscal Scaffolds: a Mini Review

Meniscal Scaffolds: a Mini Review

Synthetic meniscus replacement: a review

Current Concepts in Meniscus Tissue Engineering and Repair

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