Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 19, Issue 2, pp 255–263 | Cite as

Chondroprotective effects of a polycarbonate-urethane meniscal implant: histopathological results in a sheep model

  • Gal Zur
  • Eran Linder-GanzEmail author
  • Jonathan J. Elsner
  • Jonathan Shani
  • Ori Brenner
  • Gabriel Agar
  • Elliott B. Hershman
  • Steven P. Arnoczky
  • Farshid Guilak
  • Avi Shterling



Injury or loss of the meniscus generally leads to degenerative osteoarthritic changes in the knee joint. However, few surgical options exist for meniscal replacement. The goal of this study was to examine the ability of a non-degradable, anatomically shaped artificial meniscal implant, composed of Kevlar®-reinforced polycarbonate-urethane (PCU), to prevent progressive cartilage degeneration following complete meniscectomy.


The artificial meniscus was implanted in the knees of mature female sheep following total medial meniscectomy, and the animals were killed at 3- and 6-months post-surgery. Macroscopic analysis and semi-quantitative histological analysis were performed on the cartilage of the operated knee and unoperated contralateral control joint.


The PCU implants remained well secured throughout the experimental period and showed no signs of wear or changes in structural or material properties. Histological analysis showed relatively mild cartilage degeneration that was dominated by loss of proteoglycan content and cartilage structure. However, the total osteoarthritis score did not significantly differ between the control and operated knees, and there were no differences in the severity of degenerative changes between 3 and 6 months post-surgery.


Current findings provide preliminary evidence for the ability of an artificial PCU meniscal implant to delay or prevent osteoarthritic changes in knee joint following complete medial meniscectomy.


Meniscus Synthetic Meniscectomy Animal model Allograft 



We would like to thank Shannon O’Connor, Holly Leddy, and Bridgette Furman for their assistance with the histological analysis and grading.

Conflict of interest statement

This work was supported by Active Implants Corporation.


  1. 1.
    Aagaard H, Jörgensen U, Bojsen-Möller F (1999) Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep. Knee Surg Sports Traumatol Arthrosc 7:184–191CrossRefPubMedGoogle Scholar
  2. 2.
    Adams M, Hukins D (1992) The extracellular matrix of the meniscus. In: Mow VC, Arnoczky S, Jackson D (eds) Knee meniscus: basic and clinical foundations. Raven Press, New York, NY, pp 15–28Google Scholar
  3. 3.
    Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br 66:666–671PubMedGoogle Scholar
  4. 4.
    Appleyard RC, Burkhardt D, Ghosh P, Read R, Cake M, Swain MV, Murrell GA (2003) Topographical analysis of the structural, biochemical and dynamic biomechanical properties of cartilage in an ovine model of osteoarthritis. Osteoarthr Cartil 11:65–77CrossRefPubMedGoogle Scholar
  5. 5.
    Bigsby RJA, Auger DD, Jin ZM, Dowson D, Hardaker CS, Fisher JA (1998) Comparative tribological study of the wear of composite cushion cups in a physiological hip joint simulator. J Biomechanics 32:363–369CrossRefGoogle Scholar
  6. 6.
    Brophy RH, Cottrell J, Rodeo SA, Wright TM, Warren RF, Maher SA (2009) Implantation of a synthetic meniscal scaffold improves joint contact mechanics in a partial meniscectomy cadaver model. J Biomed Mater Res A 92:1154–1161Google Scholar
  7. 7.
    Buma P, van Tienen T, Veth R (2007) The collagen meniscus implant. Expert Rev Med Devices 4:507–516CrossRefPubMedGoogle Scholar
  8. 8.
    Burger C, Kabir K, Mueller M, Rangger C, Minor T, Tolba RH (2006) Retropatellar chondromalacia associated with medial osteoarthritis after meniscus injury. One year of observations in sheep. Eur Surg Res 38:102–108CrossRefPubMedGoogle Scholar
  9. 9.
    Burger C, Mueller M, Wlodarczyk P, Goost H, Tolba RH, Rangger C, Kabir K, Weber O (2007) The sheep as a knee osteoarthritis model: early cartilage changes after meniscus injury and repair. Lab Anim 41:420–431CrossRefPubMedGoogle Scholar
  10. 10.
    Carlson CS, Guilak F, Vail TP, Gardin JF, Kraus VB (2002) Synovial fluid biomarker levels predict articular cartilage damage following complete medial meniscectomy in the canine knee. J Orthop Res 20:92–100CrossRefPubMedGoogle Scholar
  11. 11.
    Chiari C, Koller U, Dorotka R, Eder C, Plasenzotti R, Lang S et al (2006) A tissue engineering approach to meniscus regeneration in a sheep model. Osteoarthr Cartil 14:1056–1065CrossRefPubMedGoogle Scholar
  12. 12.
    Cole BJ, Carter TR, Rodeo SA (2002) Allograft meniscal transplantation: background, techniques, and results. J Bone Joint Surg Am 84:1236–1250Google Scholar
  13. 13.
    Elleuch R, Elleuch K, Salah B, Zahouani H (2007) Tribological behavior of thermoplastic polyurethane elastomers. Mater Des 28:824–830CrossRefGoogle Scholar
  14. 14.
    Elliott DM, Jones R 3rd, Setton LA, Scully SP, Vail TP, Guilak F (2002) Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage. Knee Surg Sports Traumatol Arthrosc 10:109–118CrossRefPubMedGoogle Scholar
  15. 15.
    Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50:2811–2819CrossRefPubMedGoogle Scholar
  16. 16.
    Haut Donahue TL, Hull ML, Rashid MM, Jacobs CR (2003) How the stiffness of meniscal attachments and meniscal material properties affect tibio-femoral contact pressure computed using a validated Finite Element Model of the human knee joint. J Biomech 36:19–34CrossRefPubMedGoogle Scholar
  17. 17.
    Kelly BT, Robertson W, Potter HG, Deng XH, Turner AS, Lyman S et al (2007) Hydrogel meniscal replacement in the sheep knee: preliminary evaluation of chondroprotective effects. Am J Sports Med 35:43–52CrossRefPubMedGoogle Scholar
  18. 18.
    Khan I, Smith N, Jones E, Finch DS, Cameron RE (2005) Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part II: in vivo investigation. Biomaterials 26:633–643CrossRefPubMedGoogle Scholar
  19. 19.
    Kobayashi M, Toguchida J, Oka M (2003) Preliminary study of polyvinyl alcohol-hydrogel (PVA-H) artificial meniscus. Biomaterials 24:639–647CrossRefPubMedGoogle Scholar
  20. 20.
    Kohn D, Rudert M, Wirth CJ, Plitz W, Reiss G, Maschek H (1997) Medial meniscus replacement by a fat pad autograft. An experimental study in sheep. Int Orthop 21:232–238CrossRefPubMedGoogle Scholar
  21. 21.
    Kon E, Chiari C, Marcacci M, Delcogliano M, Salter DM, Martin I et al (2008) Tissue engineering for total meniscal substitution: animal study in sheep model. Tiss Eng 14:1067–1080CrossRefGoogle Scholar
  22. 22.
    LeRoux MA, Arokoski J, Vail TP, Guilak F, Hyttinen MM, Kiviranta I, Setton LA (2000) Simultaneous changes in the mechanical properties, quantitative collagen organization, and proteoglycan concentration of articular cartilage following canine meniscectomy. J Orthop Res 18:383–392CrossRefPubMedGoogle Scholar
  23. 23.
    Little C, Smith S, Ghosh P, Bellenger C (1997) Histomorphological and immunohistochemical evaluation of joint changes in a model of osteoarthritis induced by lateral meniscectomy in sheep. J Rheumatol 24:2199–2209PubMedGoogle Scholar
  24. 24.
    Martinek V, Ueblacker P, Braun K, Nitschke S, Mannhardt R, Specht K et al (2006) Second generation of meniscus transplantation: in vivo study with tissue engineered meniscus replacement. Arch Orthop Trauma Surg 126:228–234CrossRefPubMedGoogle Scholar
  25. 25.
    McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88:1549–1556PubMedGoogle Scholar
  26. 26.
    McNickle AG, Wang VM, Shewman EF, Cole BJ, Williams JM (2009) Performance of a sterile meniscal allograft in an ovine model. Clin Orthop Relat Res 467:1868–1876CrossRefPubMedGoogle Scholar
  27. 27.
    Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13:1–11CrossRefPubMedGoogle Scholar
  28. 28.
    Noyes FR, Barber-Westin SD, Rankin M (2004) Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 86:1392–1404PubMedGoogle Scholar
  29. 29.
    Oakley SP, Lassere MN, Portek I, Szomor Z, Ghosh P, Kirkham BW, Murrell GA, Wulf S, Appleyard RC (2004) Biomechanical, histologic and macroscopic assessment of articular cartilage in a sheep model of osteoarthritis. Osteoarthr Cartil 12:667–679CrossRefPubMedGoogle Scholar
  30. 30.
    Pritzker KPH, Gay S, Jimenez SA, Ostergaard K, Pelletier JP et al (2006) Osteoarthritis cartilage histopathology: grading and staging. Osteoarthr Cartil 14:13–29CrossRefPubMedGoogle Scholar
  31. 31.
    Scholes SC, Burgess IC, Marsden HR, Unsworth A, Jones E, Smith N (2006) Compliant layer acetabular cups: friction testing of a range of materials and designs for a new generation of prosthesis that mimics the natural joint. Proc Inst Mech Eng [H] 220:583–596Google Scholar
  32. 32.
    Scholes SC, Unsworth A, Blamey JM, Burgess IC, Jones E, Smith N (2006) Design aspects of compliant, soft layer bearings for an experimental hip prosthesis. Proc Inst Mech Eng [H] 219:79–87Google Scholar
  33. 33.
    Scholes SC, Unsworth A, Jones E (2007) Polyurethane unicondylar knee prostheses: simulator wear tests and lubrication studies. Phys Med Biol 52:197–212CrossRefPubMedGoogle Scholar
  34. 34.
    Smith RA, Hallab NJ (2010) In vitro macrophage response to polyethylene and polycarbonate-urethane particles. J Biomed Mater Res Part A 93:347–355Google Scholar
  35. 35.
    Smith RA, Maghsoodpour A, Hallab NJ (2010) In vivo response to cross-linked polyethylene and polycarbonate-urethane particles. J Biomed Mater Res Part A 93:227–234Google Scholar
  36. 36.
    Szomor ZL, Martin TE, Bonar F, Murrell GAC (2000) The protective effects of meniscal transplantation on cartilage. J Bone Joint Surg Am 82:80–88PubMedGoogle Scholar
  37. 37.
    Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Schouten AJ, Veth RP et al (2006) Replacement of the knee meniscus by a porous polymer implant: a study in dogs. Am J Sports Med 34:64–71CrossRefPubMedGoogle Scholar
  38. 38.
    Unsworth A, Roberts BJ, Thompson JC (1981) The application of soft layered lubrication to hip prostheses. J Bone Joint Surg 63B:297Google Scholar
  39. 39.
    van Arkel ER, de Boer HH (2002) Survival analysis of human meniscal transplantations. J Bone Joint Surg Br 84:227–231CrossRefPubMedGoogle Scholar
  40. 40.
    Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2005) Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am 87:715–724CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Gal Zur
    • 1
  • Eran Linder-Ganz
    • 1
    Email author
  • Jonathan J. Elsner
    • 1
  • Jonathan Shani
    • 1
  • Ori Brenner
    • 1
  • Gabriel Agar
    • 2
  • Elliott B. Hershman
    • 3
  • Steven P. Arnoczky
    • 4
  • Farshid Guilak
    • 5
  • Avi Shterling
    • 1
  1. 1.Research and Development CenterActive Implants CorporationNetanyaIsrael
  2. 2.Department of Orthopedic SurgeryAssaf Harofe Medical CenterZeriffinIsrael
  3. 3.Department of Orthopaedic SurgeryLenox Hill HospitalNew YorkUSA
  4. 4.Laboratory for Comparative Orthopaedic Research, College of Veterinary MedicineMichigan State UniversityEast LansingUSA
  5. 5.Departments of Surgery and Biomedical EngineeringDuke University Medical CenterDurhamUSA

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