Treatments of Meniscus Lesions of the Knee: Current Concepts and Future Perspectives

  • Ibrahim Fatih Cengiz
  • Hélder Pereira
  • Joao Espregueira-Mendes
  • Joaquim Miguel Oliveira
  • Rui L. Reis
Review

Abstract

The present preference in the clinical management of meniscus lesions is to preserve it by repairing whenever possible or substituting the tissue. Still, meniscectomy continues to be one of the most frequent orthopedic procedures regardless of the fact that it may lead to a series of early degenerative events in the knee. Surgical and technological advances enabled to extend the indications for meniscus repair. The outcome of meniscus repair is influenced by several factors. Classification of meniscus lesions remains a challenge while there have been some attempts in building consensus around it. Substitution of meniscus tissue has been performed to avoid or minimize the possible degenerative effects occurring in the absence of meniscus. Meniscus allograft transplantation has demonstrated its use as a replacement strategy of large lesions. In partial lesions, the use of acellular scaffolds has provided an improved clinical outcome when the insertional horns and the peripheral rim are preserved. However, the current scaffolds have shown some limitations, and the neotissue is different from the native meniscus. Tissue engineers thus envision going beyond the partial meniscus regeneration. Nowadays, it is aimed to develop a new generation of meniscal implants for total meniscus regeneration, which not only meet the biomechanical requirements but also the biological requirements both in the short- and long-term. Moreover, these might be patient/injury-specific regarding the size and shape as well as being cultivated with autologous cells and biologically enhanced. Herein, the clinical management of meniscus lesions and advanced tissue engineering strategies are reviewed.

Lay Summary

Meniscus injuries are the most frequent injuries in the knee. Given the increased understanding of the consequences of meniscectomy, which is still one of the most frequent orthopedic procedures, the clinical management of meniscus changed towards favoring repair or substitution. The future of meniscus substitution and regeneration is strongly supported by the clinical need. This study reviews the current concepts and provides future perspectives on the clinical management of meniscus lesions, and tissue engineering and regenerative medicine strategies to update and guide researchers and surgeons.

Keywords

Meniscus,  Meniscus repair,  Meniscus lesion,  Meniscus tear,  Scaffold,  Tissue engineering 

Notes

Acknowledgements

This article is a result of the project FROnTHERA (NORTE-01-0145-FEDER-000023), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). I. F. Cengiz thanks the Portuguese Foundation for Science and Technology (FCT) for the Ph.D. scholarship (SFRH/BD/99555/2014). J. M. Oliveira also thanks the FCT for the funds provided under the program Investigador FCT 2012 and 2015 (IF/00423/2012 and IF/01285/2015).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

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© The Regenerative Engineering Society 2017

Authors and Affiliations

  • Ibrahim Fatih Cengiz
    • 1
    • 2
  • Hélder Pereira
    • 1
    • 2
    • 3
    • 4
  • Joao Espregueira-Mendes
    • 2
    • 3
    • 5
    • 6
    • 7
  • Joaquim Miguel Oliveira
    • 1
    • 2
  • Rui L. Reis
    • 1
    • 2
  1. 1.3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, University of MinhoHeadquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineBarco, GuimarãesPortugal
  2. 2.ICVS/3B’s–PTGovernment Associate LaboratoryBraga/GuimarãesPortugal
  3. 3.Ripoll y De Prado Sports ClinicMurcia-Madrid FIFA Medical Centre of ExcellenceMurciaSpain
  4. 4.Orthopedic Department Centro Hospitalar Póvoa de VarzimVila do CondePortugal
  5. 5.Clínica do DragãoEspregueira-Mendes Sports Centre – FIFA Medical Centre of ExcellencePortoPortugal
  6. 6.Dom Henrique Research CentrePortoPortugal
  7. 7.Orthopedic Department of Minho UniversityBragaPortugal

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