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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 6, pp 1931–1938 | Cite as

Tissue healing following segmental meniscal allograft transplantation: a pilot study

  • Eric Strauss
  • David N. M. Caborn
  • John NylandEmail author
  • Sonida Horng
  • Madeleine Chagnon
  • David Wilke
KNEE
  • 160 Downloads

Abstract

Purpose

This in vivo histological study using an ovine model evaluated the 90–day healing of unilateral segmental meniscal allograft transplantation.

Methods

Fresh-frozen medial menisci were transplanted to replace the right medial meniscus of six female sheep. Tissue healing was evaluated using semi-quantitative, descriptive methods. Formalin-fixed meniscal, distal femur and proximal tibia tissues were evaluated using Rodeo (cellularity/collagen), Ishida (reparative bonding), Collagen I IHC (collagen I), and Mankin (cartilage organization) scores at the medial femoral condyle (MFC) and medial tibial plateau (MTP). Meniscocapsular evaluations were performed at the: (a) peripheral junction; (b) posterior sector-native meniscus junction; (c) anterior sector-native meniscus junction; (d) posterior horn internal control; and (e) anterior horn internal control.

Results

Three animals were euthanized at 39 ± 2.6 days post-surgery because of their knee condition. These animals had moderate Rodeo scores, low Ishida scores, and high Collagen I staining scores indicating moderately high fibrocartilaginous changes, mild or minimal healing and high collagen I content. Cartilage scores were low in the MFC and moderately high in the MTP, indicating mild MFC cartilage changes and moderately high MTP cartilage changes. Full-term (90 day) euthanized animals (n = 3) displayed improving Rodeo scores with mean scores of 3.3 and 3.6 at junctions (B) and (C), respectively. Ishida scores displayed similar improvements at all sectors. Collagen I staining revealed strong (grade 5) levels in all sections, with mean collagen I scores of 5, 5 and 4 for the peripheral (A), posterior (B) and anterior (C) junctions, respectively. Improved healing was observed at each segmental meniscus sector in terminally euthanized animals.

Conclusions

Segmental meniscal allograft transplantation displayed partial healing to remnant meniscal tissue. Further study is needed to better delineate the time needed for complete healing and the joint-loading progression that may enhance it.

Keywords

Meniscectomy Meniscus allograft Histology 

Notes

Funding

The study was supported by JRF Ortho, 6746 S. Revere Parkway, Suite B-125, Centennial, CO, USA, 80112.

Compliance with ethical standards

Conflict of interest

The JRF Ortho, 6746 S. Revere Parkway, Suite B-125, Centennial, CO, USA, 80112 provided financial support for this research project (Sponsor Number: SM-002) which was performed at AccelLab Inc., 1635 Lionel-Bertrand Blvd., Boisbriand, Quebec, Canada J7H 1N8; Study Number: 1832-307N.

Ethical approval

The protocol was reviewed and approved by the Comité institutionnel de protection des animaux d’AccelLAB [the Testing Facility’s Institutional Animal Care and Use Committee (IACUC)]. The review insured compliance with Canadian Council on Animal Care regulations including housing, food and water, care and final disposition.

References

  1. 1.
    Aagaard H, Jorgensen U, Bojsen-Moller F (2003) Immediate versus delayed meniscal allograft transplantation in sheep. Clin Orthop Relat Res 406:218–227CrossRefGoogle Scholar
  2. 2.
    Aagaard H, Jorgensen U, Bojsen-Moller F (1999) Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep. Knee Surg Sports Traumatol Arthrosc 7:184–191CrossRefPubMedGoogle Scholar
  3. 3.
    Arnoczky SP, Cook JL, Carter T, Turner AS (2010) Translational models for studying meniscal repair and replacement: what they can and cannot tell us. Tissue Eng Part B Rev 16:31–39CrossRefPubMedGoogle Scholar
  4. 4.
    Arnoczky SP, Warren RF, McDevitt CA (1990) Meniscal replacement using a cryopreserved allograft. An experimental study in the dog. Clin Orthop Relat Res 252:121–128Google Scholar
  5. 5.
    Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 14:270–275CrossRefPubMedGoogle Scholar
  6. 6.
    Beamer BS, Masoudi A, Walley KC et al (2015) Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears. Arthroscopy 31:293–298CrossRefPubMedGoogle Scholar
  7. 7.
    Brindle T, Nyland J, Johnson DL (2001) The meniscus: review of basic principles with application to surgery and rehabilitation. J Athl Train 36:160–169PubMedPubMedCentralGoogle Scholar
  8. 8.
    Brophy RH, Matava MJ (2012) Surgical options for meniscal replacement. J Am Acad Orthop Surg 20:265–272CrossRefPubMedGoogle Scholar
  9. 9.
    Choi NH, Kim TH, Son KM, Victoroff BN (2010) Meniscal repair for radial tears of the midbody of the lateral meniscus. Am J Sports Med 38:2472–2476CrossRefPubMedGoogle Scholar
  10. 10.
    Cummins JF, Mansour JN, Howe Z, Allan DG (1997) Meniscal transplantation and degenerative articular change: an experimental study in the rabbit. Arthroscopy 13:485–491CrossRefPubMedGoogle Scholar
  11. 11.
    Dangelmajer S, Familiari F, Simonetta R, Kaymakoglu M, Huri G (2017) Meniscal transplants and scaffolds: a systematic review of the literature. Knee Surg Relat Res 29:3–10CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    DeCoons RM, Shah RP, Gee AO, Baker BM, Guevara JL, Modesto RB, Schaer TP, Mauck RL (2010) In vivo meniscus repair with anatomic nanofibrous scaffolds: a preliminary report. Poster #1308 at 56th Annual Meeting of the Orthopaedic Research Society, March 2010, New Orleans, LA, USAGoogle Scholar
  13. 13.
    Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19:147–157CrossRefPubMedGoogle Scholar
  14. 14.
    Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30:664–670CrossRefGoogle Scholar
  15. 15.
    Hoser C, Fink C, Brown C, Reichkendler M, Hackl W, Bartlett J (2001) Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage. J Bone Joint Surg Br 83:513–516CrossRefPubMedGoogle Scholar
  16. 16.
    Houck DA, Kraeutler MJ, Belk JW, McCarty EC, Bravman JT (2018) Similar clinical outcomes following collagen or polyurethance meniscal scaffold implantation: a systematic review. Knee Surg Sports Traumatol Arthrosc 26:2259–2269CrossRefPubMedGoogle Scholar
  17. 17.
    Jackson DW, McDevitt CA, Simon TM, Arnoczky SP, Atwell EA, Silvino NJ (1992) Meniscal transplantation using fresh and cryopreserved allografts. An experimental study in goats. Am J Sports Med 20:644–656CrossRefPubMedGoogle Scholar
  18. 18.
    Jackson DW, Whelan J, Simon TM (1993) Cell survival after transplantation of fresh meniscal allografts. DNA probe analysis in a goat model. Am J Sports Med 21:540–550CrossRefPubMedGoogle Scholar
  19. 19.
    Lee SJ, Aadalen KJ, Malaviya P et al (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34:1334–1344CrossRefPubMedGoogle Scholar
  20. 20.
    Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V (2013) Histological scoring systems for tissue-engineered, ex vivo and degenerative meniscus. Knee Surg Sports Traumatol Arthrosc 21:1569–1576CrossRefPubMedGoogle Scholar
  21. 21.
    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
  22. 22.
    Mora G, Alvarez E, Ripalda P, Forriol F (2003) Articular cartilage degeneration after frozen meniscus and Achilles tendon allograft transplantation: experimental study in sheep. Arthroscopy 19:833–841CrossRefPubMedGoogle Scholar
  23. 23.
    Northmore-Ball MD, Dandy DJ (1982) Long-term results of arthroscopic partial meniscectomy. Clin Orthop Relat Res 167:34–42Google Scholar
  24. 24.
    Nyland J, Campbell K, Kalloub A, Strauss EJ, Kuban K, Caborn DNM (2018) Medial meniscus grafting restores normal tibiofemoral contact pressures. Arch Orthop Trauma Surg 138:361–367CrossRefPubMedGoogle Scholar
  25. 25.
    Rongen JJ, Hannink G, van Tienen TG, van Luijk J, Hooijmans CR (2015) The protective effect of meniscus allograft transplantation on articular cartilage: a systematic review of animal studies. Osteoarthr Cartilage 23:1242–1253CrossRefGoogle Scholar
  26. 26.
    Sgaglione NA, Steadman JR, Shaffer B et al (2003) Current concepts in meniscus surgery: resection to replacement. Arthroscopy 19(Suppl 1):161–188CrossRefPubMedGoogle Scholar
  27. 27.
    Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 24:2923–2935CrossRefPubMedGoogle Scholar
  28. 28.
    Soballe K, Hansen AJ (1987) Late results after meniscectomy in children. Injury 18:182–184CrossRefPubMedGoogle Scholar
  29. 29.
    Song HS, Bae TY, Park BY, Shim J, In Y (2014) Repair of a radial tear in the posterior horn of the lateral meniscus. Knee 21:1185–1190CrossRefPubMedGoogle Scholar
  30. 30.
    Tapper EM, Hoover NW (1969) Late results after meniscectomy. J Bone Joint Surg Am 51:517–526CrossRefPubMedGoogle Scholar
  31. 31.
    Tarafder S, Gulko J, Sim KH, Yang J, Cook JL, Lee CH (2018) Engineered healing of avascular meniscus tears by stem cell recruitment. Sci Rep 8:8150CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Verma NN, Kolb E, Cole BJ et al (2008) The effects of medial meniscal transplantation techniques on intra-articular contact pressures. J Knee Surg 21:20–26CrossRefPubMedGoogle Scholar
  33. 33.
    Wroble RR, Henderson RC, Campion ER et al (1992) Meniscectomy in children and adolescents. A long-term follow-up study. Clin Orthop Relat Res 279:180–189Google Scholar
  34. 34.
    Yocum LA, Kerlan RK, Jobe FW et al (1979) Isolated lateral meniscectomy. A study of twenty-six patients with isolated tears. J Bone Joint Surg Am 61:338–342CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Eric Strauss
    • 1
  • David N. M. Caborn
    • 2
  • John Nyland
    • 2
    Email author
  • Sonida Horng
    • 3
  • Madeleine Chagnon
    • 3
  • David Wilke
    • 4
  1. 1.NYU Center for Musculoskeletal CareNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of LouisvilleLouisvilleUSA
  3. 3.AccelLab Inc.BoisbriandCanada
  4. 4.JRF OrthoCentennialUSA

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