The magnetic resonance aspect of a polyurethane meniscal scaffold is worse in advanced cartilage defects without deterioration of clinical outcomes after a minimum two-year follow-up

Gelber, Pablo Eduardo; Petrica, Alexandru Mihai; Isart, Anna; Marí-Molina, Raquel; Monllau, Juan Carlos

doi:10.1016/j.knee.2015.01.008

Cited by 28 publications

(23 citation statements)

References 21 publications

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“…The mean average value of implant extrusion was similar to other reports in the literature. 20,21 This high rate of imaging alterations in our series is also in concordance to an observation done by Gelber et al 22 The same authors 23 published inferior results in the most extruded meniscal scaffolds using the (Western Ontario Meniscal Evaluation Tool) WOMET score. 24 The small numbers in our study preclude a specific analysis regarding the results of meniscal extrusion, however, there were two patients that presented no improvement of the clinical outcomes at follow-up, both presenting high meniscal scaffold extrusion values in the follow-up MRI (5 mm and 6 mm).…”

Section: Discussionsupporting

confidence: 91%

“…11,12,25e27 However, most of the patients included in our study required chondral repair procedures as an addition to the PU meniscal scaffold. Gelber et al 22 described that substitution of the meniscal tissue with a PU scaffold significantly improved pain relief and function regardless of the presence of advanced cartilage injuries after a minimum two-year follow-up. Kon et al 27 described in their series of 18 patients that those with combined surgery, including cartilage procedures for high-grade lesions, tended to present a slower recovery during the first year, but eventually reached good functional results comparable to the group of patients without combined procedures.…”

Section: Discussionmentioning

confidence: 99%

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Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up

Figueroa

Calvo

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: The aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. Methods: Prospective study in patients with PU meniscal scaffolds implanted during 2014e2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Postoperative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. Results: Fourteen patients with an average age of 25.8 years (range: 17e47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39e66) months. Postoperative mean clinical outcomes scores showed significantly improved results compared to the preoperative scores. Lysholm scores increased from 62.4 to 80.2 (P ¼ 0.0023), KOOS from 68.9 to 80 (P ¼ 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P ¼ 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3e6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. Conclusion:The use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. Level of evidence: IV. Case series.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up

Figueroa

Calvo

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…For Patient B, treated with CACAMI and Actifit ® , postoperative MRI at 5-month follow up demonstrated no obvious signal for the presence of the scaffold or new meniscal tissue, indicating possible resorption of the scaffold. In comparison, Gelber et al reported that patients with no chondral injuries showed an improved size and morphology of transplanted Actifit ® scaffolds using MRI at a median follow up of 39 months (range 25-63) 33 .…”

Section: Discussionmentioning

confidence: 98%

Combined Autologous Chondrocyte and Bone Marrow Mesenchymal Stromal Cell Implantation in the Knee: An 8-year Follow Up of Two First-In-Man Cases

et al. 2019

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Autologous chondrocyte implantation (ACI) has been used to treat cartilage defects for >20 years, with promising clinical outcomes. Here, we report two first-in-man cases (patient A and B) treated with combined autologous chondrocyte and bone marrow mesenchymal stromal cell implantation (CACAMI), with 8-year follow up. Two patients with International Cartilage Repair Society (ICRS) grade III–IV cartilage lesions underwent a co-implantation of autologous chondrocytes and bone marrow-derived mesenchymal stromal cells (BM-MSCs) between February 2008 and October 2009. In brief, chondrocytes and BM-MSCs were separately isolated and culture-expanded in a good manufacturing practice laboratory for a period of 2–4 weeks. Cells were then implanted in combination into cartilage defects and patients were clinically evaluated preoperatively and postoperatively, using the self-reported Lysholm knee score and magnetic resonance imaging (MRI). Postoperative Lysholm scores were compared with the Oswestry risk of knee arthroplasty (ORKA) scores. Patient A also had a second-look arthroscopy, at which time a biopsy of the repair site was taken. Both patients demonstrated a significant long-term improvement in knee function, with postoperative Lysholm scores being consistently higher than ORKA predictions. The most recent Lysholm scores, 8 years after surgery were 100/100 (Patient A) and 88/100 (Patient B), where 100 represents a fully functioning knee joint. Bone marrow lesion (BML) volume was shown to decrease on postoperative MRIs in both patients. Cartilage defect area increased in patient A, but declined initially for patient B, slightly increasing again 2 years after treatment. The repair site biopsy taken from patient A at 14 months postoperatively, demonstrated a thin layer of fibrocartilage covering the treated defect site. The use of a combination of cultured autologous chondrocytes and BM-MSCs appears to confer long-term benefit in this two-patient case study. Improvements in knee function perhaps relate to the observed reduction in the size of the BML.

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“…6) of the scaffold has been a matter of growing debate and concern. 101 Nevertheless, the clinical outcome does not completely correlate with the imaging findings, with patients’ satisfaction and clinical scores being reported has higher than for imaging assessment and outcome. 98…”

Section: Meniscus Scaffold Replacement (Msr)mentioning

confidence: 98%

Meniscal allograft transplants and new scaffolding techniques

Pereira

Cengiz

Gomes³

et al. 2019

EFORT Open Reviews

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Clinical management of meniscal injuries has changed radically in recent years. We have moved from the model of systematic tissue removal (meniscectomy) to understanding the need to preserve the tissue. Based on the increased knowledge of the basic science of meniscal functions and their role in joint homeostasis, meniscus preservation and/or repair, whenever indicated and possible, are currently the guidelines for management. However, when repair is no longer possible or when facing the fact of the previous partial, subtotal or total loss of the meniscus, meniscus replacement has proved its clinical value. Nevertheless, meniscectomy remains amongst the most frequent orthopaedic procedures. Meniscus replacement is currently possible by means of meniscal allograft transplantation (MAT) which provides replacement of the whole meniscus with or without bone plugs/slots. Partial replacement has been achieved by means of meniscal scaffolds (mainly collagen or polyurethane-based). Despite the favourable clinical outcomes, it is still debatable whether MAT is capable of preventing progression to osteoarthritis. Moreover, current scaffolds have shown some fundamental limitations, such as the fact that the newly formed tissue may be different from the native fibrocartilage of the meniscus. Regenerative tissue engineering strategies have been used in an attempt to provide a new generation of meniscal implants, either for partial or total replacement. The goal is to provide biomaterials (acellular or cell-seeded constructs) which provide the biomechanical properties but also the biological features to replace the loss of native tissue. Moreover, these approaches include possibilities for patient-specific implants of correct size and shape, as well as advanced strategies combining cells, bioactive agents, hydrogels or gene therapy. Herein, the clinical evidence and tips concerning MAT, currently available meniscus scaffolds and future perspectives are discussed. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180103

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The magnetic resonance aspect of a polyurethane meniscal scaffold is worse in advanced cartilage defects without deterioration of clinical outcomes after a minimum two-year follow-up

Cited by 28 publications

References 21 publications

Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up

Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up

Combined Autologous Chondrocyte and Bone Marrow Mesenchymal Stromal Cell Implantation in the Knee: An 8-year Follow Up of Two First-In-Man Cases

Meniscal allograft transplants and new scaffolding techniques

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