Successful Treatment of Painful Irreparable Partial Meniscal Defects With a Polyurethane Scaffold

Verdonk, Peter; Beaufils, Philippe; Bellemans, Johan; Djian, P.; Heinrichs, Eva-Lisa; Huysse, Wouter; Laprell, H.; Siebold, Rainer; Verdonk, René

doi:10.1177/0363546511433032

Cited by 187 publications

(149 citation statements)

References 46 publications

(53 reference statements)

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“…The results of the Actifit implant were first reported in a multicenter study by Verdonk et al [13]. They reported 9 failures out of 52 patients (17.3%).…”

Section: Resultsmentioning

confidence: 92%

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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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“…The results of the Actifit implant were first reported in a multicenter study by Verdonk et al [13]. They reported 9 failures out of 52 patients (17.3%).…”

Section: Resultsmentioning

confidence: 92%

“…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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“…Damage to the meniscus exposes articular surfaces to excessive peak stresses and predisposes them to cartilage degeneration and progressive osteoarthritis (2,3). In pursuit of a feasible clinical substitute for damaged meniscus, clinical evidence supports the use of fresh frozen allografts (4)(5)(6) or as an alternative, synthetic meniscus replacements such as the Collagen Meniscus Implant (Ivy Sports Medicine) (7)(8)(9) or Actifit® (a polyurethane meniscus implant; Orteq) (10). This polyurethane scaffold, through its unique combination of a porous structure and polymer strength, promotes ingrowth of new tissue (11) and has been shown to relieve pain and symptoms.…”

Section: Introductionmentioning

confidence: 99%

Chondrocyte-based intraoperative processing strategies for the biological augmentation of a polyurethane meniscus replacement

Vedicherla

Romanazzo

Kelly

et al. 2017

Connective Tissue Research

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Purpose/Aim of Study: Menisectomies account for over 1.5 million surgical interventions in Europe annually and there is a growing interest in regenerative strategies to improve outcomes in meniscal replacement. The overall objective of this study was to evaluate the role of intraoperatively applied fresh chondrocyte isolates compared to minced cartilage fragments, used without cell isolation, to improve bioactivity and tissue integration when combined with a polyurethane replacement. Materials and Methods:Firstly, to optimise the intraoperative cell isolation protocol, caprine articular cartilage biopsies were digested with 750 U/ml or 3000 U/ml collagenase type II (ratio of 10 ml per g of tissue) for 30 min, 1 h or 12 hrs with constant agitation and compared to culture expanded chondrocytes in terms of matrix deposition when cultured on polyurethane scaffolds. Finally, fresh chondrocytes and minced cartilage augmented polyurethane scaffolds were evaluated in a caprine meniscal explant model to assess the potential enhancements on tissue integration strength.Results: Adequate numbers of fresh chondrocytes were harvested using a 30 min chondrocyte isolation protocol and demonstrated improved matrix deposition compared to standard culture expanded cells in vitro. Upon evaluation in a meniscus explant defect model, both fresh chondrocytes and minced cartilage showed improved matrix deposition at the tissue scaffold interface and enhanced push-out strength, 4 fold and 2.5 fold respectively compared with the acellular implant. Conclusions:Herein, we have demonstrated a novel approach that could be applied intraoperatively using fresh chondrocytes or minced cartilage for improved tissue integration with a polyurethane meniscal replacement.

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“…Polyurethane (PU) has been reported in a variety of processing biomedical devices such as artificial hearts [1,2], cardiovascular biomaterials [3][4][5], and scaffolds [6,7] for over four decades. This synthetic polymer contains soft and hard segments which contributes to different degree of micro-phase separation, consequently affects its physical and mechanical properties.…”

Section: Introductionmentioning

confidence: 99%

Hemocompatibility Evaluation of Polyurethane Film with Surface-Grafted Sugar- Based Amphipathic Compounds

Xin¹,

Du²,

Wang³

et al. 2017

J Anal Bioanal Tech

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Sugar-based amphipathic compounds (BA-CnAG) were successfully prepared. Polyurethane (PU) was grafted with glycidyl methacrylate (GMA) by the means of UV irradiation, and further modified with the BA-CnAG based on the ring opening of the epoxy groups. The surface graft polymerization was confirmed by ATR-FTIR and XPS. Water contact angle, protein adsorption, and platelet adhesion measurements were used to evaluate the hydrophilicity and hemocompatibility of the films. The results demonstrated that amphiphilic surfactant-containing polymer surfaces presented protein-resistant behavior and anti-platelet adhesion after functionalization with BA-CnAG. Besides, the hemocompatibility of the modified surface deteriorated as the length of hydrophobic chain of BA-CnAG increased. glycidyl methacrylate (GMA) were obtained from Shanghai Aladdin Chemicals (China). Benzophenone (BP) was supplied by Peking Ruichen Chemicals (China). Bovine serum albumin (BSA), sodium dodecyl sulfate (SDS) and phosphate buffered solution (PBS, 0.01 mol/L, pH=7.4) were provided by Dingguo Bio-technology (China). Micro BCATM protein assay reagent kits were purchased from Boster Biological Technology (AR1110, China). The platelet-rich plasma (PRP) was obtained from the fresh rabbit blood by centrifugation at 1000 rpm for 15 min. The other solvents and reagents were AR grade chemicals and used without further purification. Preparation and characterization of sugar-based amphipathic compoundsSynthesis of Boc-Asp: To a solution of Asp (10 mmol) in acetone/ ultrapure water (10:1, 44 mL), was added triethylamine (20 mmol), and the resulting solution was stirred in an ice-water bath. (B OC ) 2 O (11 mmol) was added dropwise, stirred for 3 h. The solution was concentrated under reduced pressure, diluted with H 2 O (20 mL), Scheme 2: Schematics of the PU surface modified with sugar-based amphipathic compounds.

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Successful Treatment of Painful Irreparable Partial Meniscal Defects With a Polyurethane Scaffold

Abstract: At 2 years after implantation, safety and clinical outcome data from this study support the use of the polyurethane scaffold for the treatment of irreparable, painful, partial meniscal defects.

Cited by 187 publications

References 46 publications

Meniscal Scaffolds: a Mini Review

Meniscal Scaffolds: a Mini Review

Chondrocyte-based intraoperative processing strategies for the biological augmentation of a polyurethane meniscus replacement

Hemocompatibility Evaluation of Polyurethane Film with Surface-Grafted Sugar- Based Amphipathic Compounds

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