One-year clinical and MR imaging outcome after partial meniscal replacement in stabilized knees using a collagen meniscus implant

  • M. T. HirschmannEmail author
  • L. Keller
  • A. Hirschmann
  • L. Schenk
  • R. Berbig
  • U. Lüthi
  • F. Amsler
  • N. F. Friederich
  • M. P. Arnold



The purpose of the study was to evaluate the clinical and radiological outcomes after medial/lateral collagen meniscus substitution (CMI) at 12 months postoperatively.


Sixty-seven patients (m:f = 47:20, mean age 36 ± 10 years) underwent arthroscopic CMI after previous subtotal medial (n = 55) or lateral meniscectomy (n = 12) due to persistent joint line pain (n = 25) or to prophylactic reasons (n = 42). Clinical follow-up consisted of IKDC score, Tegner score, Lysholm score, and visual analog scale for pain and satisfaction (preinjury, preoperatively, and 12 months postoperatively; follow-up rate 90 %). MRI scans were analyzed according to the Genovese criteria.


Nineteen patients (29 %) showed a normal (A), 35 nearly normal (B), 5 abnormal (C), and 1 patient severely abnormal total IKDC score (D). The median Tegner preinjury score was 7 (range 2–10) and at follow-up 6 (range 2–10). The mean Lysholm score before surgery was 68 ± 20 and 93 ± 9 at follow-up. Preoperatively, the mean VAS pain was 4.4 ± 3.1 and 2.0 ± 1.0 at follow-up. Clinical failure of the CMI occurred in 3 patients (n = 1 infection, n = 1 failure of the implant, n = 1 chronic synovitis). On MRI, the CMI was completely resorbed in 3 patients (5 %), partially resorbed in 55 (92 %), and entirely preserved in 3 (5 %) patients. In 5 patients (8 %) the CMI was isointense, in 54 (90 %) slightly and 1 (2 %) highly hyperintense. 43 (72 %) patients showed an extrusion of the CMI implant of more than 3 mm.


Significant pain relief and functional improvement throughout all scores at 1 year was noted. The CMI undergoes significant remodeling, degradation, resorption, and extrusion in most of the patients. No difference in outcomes between the medial and lateral CMI was observed.

Level of evidence

Prospective therapeutic study, Level IV.


Collagen meniscus implant Meniscal substitution Outcomes MRI Cartilage Extrusion IKDC Lysholm Tegner 



This study was supported by a financial grant from Ivy Sports Medicine, Baar, Switzerland for statistical analysis.


  1. 1.
    Adams JG, McAlindon T, Dimasi M, Carey J, Eustace S (1999) Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. Clin Radiol 54:502–506PubMedCrossRefGoogle Scholar
  2. 2.
    Arnold MP, Hirschmann MT, Verdonk PC (2012) See the whole picture: knee preserving therapy needs more than surface repair. Knee Surg Sports Traumatol Arthrosc 20:195–196PubMedCrossRefGoogle Scholar
  3. 3.
    Bulgheroni P, Murena L, Ratti C, Bulgheroni E, Ronga M, Cherubino P (2010) Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Knee 17:224–229PubMedCrossRefGoogle Scholar
  4. 4.
    Genovese E, Angeretti MG, Ronga M, Leonardi A, Novario R, Callegari L, Fugazzola C (2007) Follow-up of collagen meniscus implants by MRI. Radiol Med 112:1036–1048PubMedCrossRefGoogle Scholar
  5. 5.
    Hannink G, van Tienen TG, Schouten AJ, Buma P (2011) Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant. Knee Surg Sports Traumatol Arthrosc 20:1881–1882CrossRefGoogle Scholar
  6. 6.
    Harston A, Nyland J, Brand E, McGinnis M, Caborn DN (2012) Collagen meniscus implantation: a systematic review including rehabilitation and return to sports activity. Knee Surg Sports Traumatol Arthrosc 20:135–146PubMedCrossRefGoogle Scholar
  7. 7.
    Kim JM, Lee BS, Kim KH, Kim KA, Bin SI (2012) Results of meniscus allograft transplantation using bone fixation: 110 cases with objective evaluation. Am J Sports Med 40:1027–1034PubMedCrossRefGoogle Scholar
  8. 8.
    Lee DH, Lee BS, Chung JW, Kim JM, Yang KS, Cha EJ, Bin SI (2011) Changes in magnetic resonance imaging signal intensity of transplanted meniscus allografts are not associated with clinical outcomes. Arthroscopy 27:1211–1218PubMedCrossRefGoogle Scholar
  9. 9.
    Linke RD, Ulmer M, Imhoff AB (2006) Replacement of the meniscus with a collagen implant (CMI). Oper Orthop Traumatol 18:453–462PubMedCrossRefGoogle Scholar
  10. 10.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRefGoogle Scholar
  11. 11.
    Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Bonanzinga T, Nitri M, Bondi A, Molinari M, Rimondi E (2012) Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study. Am J Sports Med 40:395–403PubMedCrossRefGoogle Scholar
  12. 12.
    Monllau JC, Gelber PE, Abat F, Pelfort X, Abad R, Hinarejos P, Tey M (2011) Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years’ follow-up. Arthroscopy 27:933–943PubMedCrossRefGoogle Scholar
  13. 13.
    Puig L, Monllau JC, Corrales M, Pelfort X, Melendo E, Caceres E (2006) Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings. Knee Surg Sports Traumatol Arthrosc 14:394–398PubMedCrossRefGoogle Scholar
  14. 14.
    Rodkey WG, DeHaven KE, Montgomery WH III, Baker CL Jr, Beck CL Jr, Hormel SE, Steadman JR, Cole BJ, Briggs KK (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am 90:1413–1426PubMedCrossRefGoogle Scholar
  15. 15.
    Rodkey WG, Steadman JR, Li ST (1999) A clinical study of collagen meniscus implants to restore the injured meniscus. Clin Orthop Relat Res 367:S281–S292PubMedCrossRefGoogle Scholar
  16. 16.
    Ronga M, Grassi FA, Bulgheroni P (2004) Arthroscopic autologous chondrocyte implantation for the treatment of a chondral defect in the tibial plateau of the knee. Arthroscopy 20:79–84PubMedCrossRefGoogle Scholar
  17. 17.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMedGoogle Scholar
  18. 18.
    Verdonk P, Beaufils P, Bellemans J, Djian P, Heinrichs EL, Huysse W, Laprell H, Siebold R, Verdonk R (2012) Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: two-year safety and clinical outcomes. Am J Sports Med 40:844–853PubMedCrossRefGoogle Scholar
  19. 19.
    Zaffagnini S, Giordano G, Vascellari A, Bruni D, Neri MP, Iacono F, Kon E, Presti ML, Marcacci M (2007) Arthroscopic collagen meniscus implant results at 6 to 8 years follow up. Knee Surg Sports Traumatol Arthrosc 15:175–183PubMedCrossRefGoogle Scholar
  20. 20.
    Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Bonanzinga T, Filardo G, Canales Passalacqua A, Marcacci M (2011) Arthroscopic lateral collagen meniscus implant in a professional soccer player. Knee Surg Sports Traumatol Arthrosc 19:1740–1743PubMedCrossRefGoogle Scholar
  21. 21.
    Zaffagnini S, Marcheggiani Muccioli GM, Lopomo N, Bruni D, Giordano G, Ravazzolo G, Molinari M, Marcacci M (2011) Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10-year follow-up study. Am J Sports Med 39:977–985PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • M. T. Hirschmann
    • 1
    Email author
  • L. Keller
    • 1
  • A. Hirschmann
    • 2
  • L. Schenk
    • 1
  • R. Berbig
    • 3
  • U. Lüthi
    • 3
  • F. Amsler
    • 4
  • N. F. Friederich
    • 1
  • M. P. Arnold
    • 1
  1. 1.Department of Orthopaedic Surgery and TraumatologyKantonsspital BruderholzBruderholzSwitzerland
  2. 2.Department of RadiologyBalgristZürichSwitzerland
  3. 3.SportClinicZurichSwitzerland
  4. 4.Amsler ConsultingBaselSwitzerland

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