Advertisement

Augmentation techniques for isolated meniscal tears

  • Samuel A. TaylorEmail author
  • Scott A. Rodeo
Knee (SL Sherman, Section editor)

Abstract

Meniscal tears are relatively common injuries sustained by athletes and non-athletes alike and have far reaching functional and financial implications. Studies have clearly demonstrated the important biomechanical role played by the meniscus. Long-term follow-up studies of post-menisectomy patients show a predisposition toward the development of degenerative arthritic changes. As such, substantial efforts have been made by researchers and clinicians to understand the cellular and molecular basis of meniscal healing. Proinflammatory cytokines have been shown to have a catabolic effect on meniscal healing. In vitro and some limited in vivo studies have shown a proliferative and anabolic response to various growth factors. Surgical techniques that have been developed to stimulate a healing response include mechanical abrasion, fibrin clot application, growth factor application, and attempts at meniscal neovascularization. This article discusses various augmentation techniques for meniscal repair and reviews the current literature with regard to fibrin clot, platelet rich plasma, proinflammatory cytokines, and application of growth factors.

Keywords

Meniscus Platelet rich plasma Repair Augmentation 

Notes

Conflict of interest

SA Taylor declares no conflicts of interest. SA Rodeo: Consultant for Smith and Nephew; declares no conflicts of interest.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD. Epidemiology of knee injuries among US high school athletes, 2005/06-2010/11. Med Sci Sports Exerc. 2013;45(3):462–9.Google Scholar
  2. 2.
    Hede A, Jensen DB, Blyme P, Sonne-Holm S. Epidemiology of meniscal lesions in the knee. 1215 open operations in Copenhagen 1982-84. Acta Orthop Scand. 1990;61:435–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee. 2006;13:184–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Nielsen AB, Yde J. Epidemiology of acute knee injuries: a prospective hospital investigation. J Trauma. 1991;31:1644–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Shoemaker SC, Markolf KL. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee: effects of partial vs total excision. J Bone Joint Surg Am. 1986;68:71–9.PubMedGoogle Scholar
  6. 6.
    Radin EL, de Lamotte F, Maquet P. Role of the menisci in the distribution of stress in the knee. Clin Orthop Relat Res. 1984;185(185):290–4.Google Scholar
  7. 7.
    Voloshin AS, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng. 1983;5:157–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. basic science and evaluation. J Am Acad Orthop Surg. 2002;10:168–76.PubMedGoogle Scholar
  9. 9.
    Lee SJ, Aadalen KJ, Malaviya P, et al. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med. 2006;34:1334–44.PubMedCrossRefGoogle Scholar
  10. 10.
    Walker EA, Davis D, Mosher TJ. Rapidly progressive osteoarthritis: biomechanical considerations. Magn Reson Imag Clin N Am. 2011;19:283–94.CrossRefGoogle Scholar
  11. 11.
    Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30B:664–70.PubMedGoogle Scholar
  12. 12.
    Wroble RR, Henderson RC, Campion ER, el-Khoury GY, Albright JP. Meniscectomy in children and adolescents. A long-term follow-up study. Clin Orthop Relat Res. 1992;279(279):180–9.Google Scholar
  13. 13.
    Jorgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A. Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br. 1987;69:80–3.PubMedGoogle Scholar
  14. 14.
    Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after 21 years, compared with matched controls. Arthritis Rheum. 1998;41:687–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Englund M, Roos EM, Lohmander LS. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a 16-year follow-up of meniscectomy with matched controls. Arthritis Rheum. 2003;48:2178–87.PubMedCrossRefGoogle Scholar
  16. 16.
    Englund M, Lohmander LS. Risk factors for symptomatic knee osteoarthritis 15 to 22 years after meniscectomy. Arthritis Rheum. 2004;50:2811–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than 5 years: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94:2222–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:90–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Zhang Z, Arnold JA, Williams T, McCann B. Repairs by trephination and suturing of longitudinal injuries in the avascular area of the meniscus in goats. Am J Sports Med. 1995;23:35–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Zhang ZN, Tu KY, Xu YK, Zhang WM, Liu ZT, Ou SH. Treatment of longitudinal injuries in avascular area of meniscus in dogs by trephination. Arthroscopy. 1988;4:151–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Ritchie JR, Miller MD, Bents RT, Smith DK. Meniscal repair in the goat model. The use of healing adjuncts on central tears and the role of magnetic resonance arthrography in repair evaluation. Am J Sports Med. 1998;26:278–84.PubMedGoogle Scholar
  22. 22.
    Fox JM, Rintz KG, Ferkel RD. Trephination of incomplete meniscal tears. Arthroscopy. 1993;9:451–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Freedman KB, Nho SJ, Cole BJ. Marrow stimulating technique to augment meniscus repair. Arthroscopy. 2003;19:794–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Tetik O, Kocabey Y, Johnson DL. Synovial abrasion for isolated, partial thickness, undersurface, medial meniscus tears. Orthopedics. 2002;25:675–8.PubMedGoogle Scholar
  25. 25.
    Okuda K, Ochi M, Shu N, Uchio Y. Meniscal rasping for repair of meniscal tear in the avascular zone. Arthroscopy. 1999;15:281–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Ochi M, Uchio Y, Okuda K, Shu N, Yamaguchi H, Sakai Y. Expression of cytokines after meniscal rasping to promote meniscal healing. Arthroscopy. 2001;17:724–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Arnoczky SP, Warren RF, Spivak JM. Meniscal repair using an exogenous fibrin clot: an experimental study in dogs. J Bone Joint Surg Am. 1988;70:1209–17.PubMedGoogle Scholar
  28. 28.
    Henning CE, Lynch MA, Yearout KM, Vequist SW, Stallbaumer RJ, Decker KA. Arthroscopic meniscal repair using an exogenous fibrin clot. Clin Orthop Relat Res. 1990;252(252):64–72.Google Scholar
  29. 29.
    van Trommel MF, Simonian PT, Potter HG, Wickiewicz TL. Arthroscopic meniscal repair with fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. Arthroscopy. 1998;14:360–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Ra HJ, Ha JK, Jang SH, Lee DW, Kim JG. Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot. Knee Surg Sports Traumatol Arthrosc. 2012. doi: 10.1007/s00167-012-2191-3
  31. 31.
    Webber RJ, Harris MG, Hough Jr AJ. Cell culture of rabbit meniscal fibrochondrocytes: proliferative and synthetic response to growth factors and ascorbate. J Orthop Res. 1985;3:36–42.PubMedCrossRefGoogle Scholar
  32. 32.
    Hennerbichler A, Moutos FT, Hennerbichler D, Weinberg JB, Guilak F. Interleukin-1 and tumor necrosis factor alpha inhibit repair of the porcine meniscus in vitro. Osteoarthr Cartil. 2007;15:1053–60.PubMedCrossRefGoogle Scholar
  33. 33.
    McNulty AL, Estes BT, Wilusz RE, Weinberg JB, Guilak F. Dynamic loading enhances integrative meniscal repair in the presence of interleukin-1. Osteoarthr Cartil. 2010;18:830–8.PubMedCrossRefGoogle Scholar
  34. 34.
    McNulty AL, Moutos FT, Weinberg JB, Guilak F. Enhanced integrative repair of the porcine meniscus in vitro by inhibition of interleukin-1 or tumor necrosis factor alpha. Arthritis Rheum. 2007;56:3033–42.PubMedCrossRefGoogle Scholar
  35. 35.
    McNulty AL, Weinberg JB, Guilak F. Inhibition of matrix metalloproteinases enhances in vitro repair of the meniscus. Clin Orthop Relat Res. 2009;467:1557–67.PubMedCrossRefGoogle Scholar
  36. 36.
    Cao M, Stefanovic-Racic M, Georgescu HI, Miller LA, Evans CH. Generation of nitric oxide by lapine meniscal cells and its effect on matrix metabolism: stimulation of collagen production by arginine. J Orthop Res. 1998;16:104–11.PubMedCrossRefGoogle Scholar
  37. 37.
    Wilusz RE, Weinberg JB, Guilak F, McNulty AL. Inhibition of integrative repair of the meniscus following acute exposure to interleukin-1 in vitro. J Orthop Res. 2008;26:504–12.PubMedCrossRefGoogle Scholar
  38. 38.
    Hulth A, Johnell O, Miyazono K, Lindberg L, Heinegard D, Heldin CH. Effect of transforming growth factor-β and platelet-derived growth factor-BB on articular cartilage in rats. J Orthop Res. 1996;14:547–53.PubMedCrossRefGoogle Scholar
  39. 39.
    Finesmith TH, Broadley KN, Davidson JM. Fibroblasts from wounds of different stages of repair vary in their ability to contract a collagen gel in response to growth factors. J Cell Physiol. 1990;144:99–107.PubMedCrossRefGoogle Scholar
  40. 40.
    Letson AK, Dahners LE. The effect of combinations of growth factors on ligament healing. Clin Orthop Relat Res. 1994;308(308):207–12.Google Scholar
  41. 41.
    Tumia NS, Johnstone AJ. Regional regenerative potential of meniscal cartilage exposed to recombinant insulin-like growth factor-I in vitro. J Bone Joint Surg Br. 2004;86:1077–81.PubMedCrossRefGoogle Scholar
  42. 42.
    Tumia NS, Johnstone AJ. Promoting the proliferative and synthetic activity of knee meniscal fibrochondrocytes using basic fibroblast growth factor in vitro. Am J Sports Med. 2004;32:915–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Tumia NS, Johnstone AJ. Platelet derived growth factor-AB enhances knee meniscal cell activity in vitro. Knee. 2009;16:73–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Riera KM, Rothfusz NE, Wilusz RE, Weinberg JB, Guilak F, McNulty AL. Interleukin-1, tumor necrosis factor-alpha, and transforming growth factor-β1 and integrative meniscal repair: influences on meniscal cell proliferation and migration. Arthritis Res Ther. 2011;13:R187.PubMedCrossRefGoogle Scholar
  45. 45.
    Ionescu LC, Lee GC, Huang KL, Mauck RL. Growth factor supplementation improves native and engineered meniscus repair in vitro. Acta Biomater. 2012;8:3687–94.PubMedCrossRefGoogle Scholar
  46. 46.
    • Narita A, Takahara M, Sato D, et al. Biodegradable gelatin hydrogels incorporating fibroblast growth factor 2 promote healing of horizontal tears in rabbit meniscus. Arthroscopy. 2012;28:255–63. The authors evaluated the impact of FGF-2 impregnated gelatin hydrogels on meniscal healing in a rabbit model. Horizontal tears were made in the medial meniscus of 64 skeletally mature rabbits. Histologic evaluation revealed significantly higher cell density and number of proliferating cells in the group treated with FGF impregnated gelatin hydrogels compared with controls, suggesting that FGF-2 may have a role in enhancement of meniscal healing.PubMedCrossRefGoogle Scholar
  47. 47.
    He W, Liu YJ, Wang ZG, Guo ZK, Wang MX, Wang N. Enhancement of meniscal repair in the avascular zone using connective tissue growth factor in a rabbit model. Chin Med J. 2011;124:3968–75.PubMedGoogle Scholar
  48. 48.
    • Kopf S, Birkenfeld F, Becker R, et al. Local treatment of meniscal lesions with vascular endothelial growth factor. J Bone Joint Surg Am. 2010;92:2682–91. The authors used a sheep model (n = 18) to investigate the role of vascular endothelial growth factor (VEGF)and its ability to induce vascular proliferation and improve healing in vivo. They found no significant improvement in meniscal healing. A longitudinal meniscal tear was made in the avascular region, which was subsequently repaired with sutures of various coating — uncoated, coated with VEGF and its carrier Poly (D,L-lactide), and coated with carrier Poly (D,L-lactide) alone. Macroscopic, microscopic, and molecular analysis failed to show improvement in healing parameters or an induction of meniscal angiogenesis.PubMedCrossRefGoogle Scholar
  49. 49.
    Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114:1502–8.PubMedGoogle Scholar
  50. 50.
    Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009;17:602–8.PubMedGoogle Scholar
  51. 51.
    Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91:4–15.PubMedGoogle Scholar
  52. 52.
    Fufa D, Shealy B, Jacobson M, Kevy S, Murray MM. Activation of platelet-rich plasma using soluble type I collagen. J Oral Maxillofac Surg. 2008;66:684–90.PubMedCrossRefGoogle Scholar
  53. 53.
    Scordino LE, Deberardino TM. Biologic enhancement of meniscus repair. Clin Sports Med. 2012;31:91–100.PubMedCrossRefGoogle Scholar
  54. 54.
    Li XH, Zhou X, Zeng S, et al. Effects of intramyocardial injection of platelet-rich plasma on the healing process after myocardial infarction. Coron Artery Dis. 2008;19:363–70.PubMedCrossRefGoogle Scholar
  55. 55.
    Slesaczeck T, Paetzold H, Nanning T, et al. Autologous derived, platelet-rich plasma gel in the treatment of nonhealing diabetic foot ulcer: a case report. Ther Adv Endocrinol Metab. 2012;3:75–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Kim KM, Shin YT, Kim HK. Effect of autologous platelet-rich plasma on persistent corneal epithelial defect after infectious keratitis. Jpn J Ophthalmol. 2012;56:544–50.PubMedCrossRefGoogle Scholar
  57. 57.
    Kim JG, Lee YS, Bae TS, et al. Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc. 2012. doi: 10.1007/s00167-012-2182-4
  58. 58.
    Anitua E, Andia I, Sanchez M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005;23:281–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Aspenberg P, Virchenko O. Platelet concentrate injection improves Achilles tendon repair in rats. Acta Orthop Scand. 2004;75:93–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Lyras DN, Kazakos K, Verettas D, et al. The effect of platelet-rich plasma gel in the early phase of patellar tendon healing. Arch Orthop Trauma Surg. 2009;129:1577–82.PubMedCrossRefGoogle Scholar
  61. 61.
    de Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ. Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. Am J Sports Med. 2012;40:1282–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Krogh TP, Bartels EM, Ellingsen T, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2012. doi: 10.1177/0363546512458237
  63. 63.
    Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma vs autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011;39:2130–4.PubMedCrossRefGoogle Scholar
  64. 64.
    Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma vs corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38:255–62.PubMedCrossRefGoogle Scholar
  65. 65.
    de Jonge S, de Vos RJ, Weir A, et al. One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med. 2011;39:1623–9.PubMedCrossRefGoogle Scholar
  66. 66.
    de Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303:144–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multi-center randomized controlled trial. BMC Musculoskelet Disord. 2010;11:69.PubMedCrossRefGoogle Scholar
  68. 68.
    Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med. 2012;40:1234–41.PubMedCrossRefGoogle Scholar
  69. 69.
    Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg. 2011;20:518–28.PubMedCrossRefGoogle Scholar
  70. 70.
    Jo CH, Kim JE, Yoon KS, et al. Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. Am J Sports Med. 2011;39:2082–90.PubMedCrossRefGoogle Scholar
  71. 71.
    Castricini R, Longo UG, De Benedetto M, et al. Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med. 2011;39:258–65.PubMedCrossRefGoogle Scholar
  72. 72.
    Delos D, Rodeo SA. Enhancing meniscal repair through biology: platelet-rich plasma as an alternative strategy. Instr Course Lect. 2011;60:453–60.PubMedGoogle Scholar
  73. 73.
    Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH. A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears. Med Sci Mon. 2012;18:HY47–50.CrossRefGoogle Scholar
  74. 74.
    • Ishida K, Kuroda R, Miwa M, et al. The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng. 2007;13:1103–12. The authors found mitogenic effects of PRP on monolayer meniscal cell cultures such as increased fibrocartilage-related messenger RNA expression using real-time polymerase chain reaction. They then evaluated PRP in vivo using a rabbit model in which a 1.5 mm diameter full-thickness defect was created in the inner avascular meniscal zone. Their experimental groups included PRP in a hydrogel delivery vehicle, platelet-poor plasma with hydrogel delivery, and hydrogel only as control. Histology and molecular evaluation suggested superior results in those treated with PRP.PubMedCrossRefGoogle Scholar
  75. 75.
    Piontek T, Ciemniewska-Gorzela K, Szulc A, Slomczykowski M, Jakob R. All-arthroscopic technique of biological meniscal tear therapy with collagen matrix. Pol Orthop Traumatol. 2012;77:39–45.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA

Personalised recommendations