Skip to main content

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

Knee Surgery, Sports Traumatology, Arthroscopy volume 19, pages 255–263 (2011)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  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 7:184–191

    CAS  Article  PubMed  Google Scholar 

  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 15–28

    Google Scholar 

  3. Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br 66:666–671

    CAS  PubMed  Google Scholar 

  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 11:65–77

    CAS  Article  PubMed  Google Scholar 

  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 32:363–369

    Article  Google Scholar 

  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 92:1154–1161

    Google Scholar 

  7. Buma P, van Tienen T, Veth R (2007) The collagen meniscus implant. Expert Rev Med Devices 4:507–516

    Article  PubMed  Google Scholar 

  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 38:102–108

    CAS  Article  PubMed  Google Scholar 

  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 41:420–431

    CAS  Article  PubMed  Google Scholar 

  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 20:92–100

    Article  PubMed  Google Scholar 

  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 14:1056–1065

    CAS  Article  PubMed  Google Scholar 

  12. Cole BJ, Carter TR, Rodeo SA (2002) Allograft meniscal transplantation: background, techniques, and results. J Bone Joint Surg Am 84:1236–1250

    Google Scholar 

  13. Elleuch R, Elleuch K, Salah B, Zahouani H (2007) Tribological behavior of thermoplastic polyurethane elastomers. Mater Des 28:824–830

    CAS  Article  Google Scholar 

  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 10:109–118

    Article  PubMed  Google Scholar 

  15. Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50:2811–2819

    CAS  Article  PubMed  Google Scholar 

  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 36:19–34

    Article  PubMed  Google Scholar 

  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 35:43–52

    Article  PubMed  Google Scholar 

  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 26:633–643

    CAS  Article  PubMed  Google Scholar 

  19. Kobayashi M, Toguchida J, Oka M (2003) Preliminary study of polyvinyl alcohol-hydrogel (PVA-H) artificial meniscus. Biomaterials 24:639–647

    CAS  Article  PubMed  Google Scholar 

  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 21:232–238

    CAS  Article  PubMed  Google Scholar 

  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 14:1067–1080

    CAS  Article  Google Scholar 

  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 18:383–392

    CAS  Article  PubMed  Google Scholar 

  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 24:2199–2209

    CAS  PubMed  Google Scholar 

  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 126:228–234

    CAS  Article  PubMed  Google Scholar 

  25. McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88:1549–1556

    CAS  PubMed  Google Scholar 

  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 467:1868–1876

    Article  PubMed  Google Scholar 

  27. Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13:1–11

    CAS  Article  PubMed  Google Scholar 

  28. Noyes FR, Barber-Westin SD, Rankin M (2004) Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 86:1392–1404

    PubMed  Google Scholar 

  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 12:667–679

    CAS  Article  PubMed  Google Scholar 

  30. Pritzker KPH, Gay S, Jimenez SA, Ostergaard K, Pelletier JP et al (2006) Osteoarthritis cartilage histopathology: grading and staging. Osteoarthr Cartil 14:13–29

    CAS  Article  PubMed  Google Scholar 

  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] 220:583–596

    Google Scholar 

  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] 219:79–87

    Google Scholar 

  33. Scholes SC, Unsworth A, Jones E (2007) Polyurethane unicondylar knee prostheses: simulator wear tests and lubrication studies. Phys Med Biol 52:197–212

    CAS  Article  PubMed  Google Scholar 

  34. Smith RA, Hallab NJ (2010) In vitro macrophage response to polyethylene and polycarbonate-urethane particles. J Biomed Mater Res Part A 93:347–355

    Google Scholar 

  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 93:227–234

    Google Scholar 

  36. Szomor ZL, Martin TE, Bonar F, Murrell GAC (2000) The protective effects of meniscal transplantation on cartilage. J Bone Joint Surg Am 82:80–88

    CAS  PubMed  Google Scholar 

  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 34:64–71

    Article  PubMed  Google Scholar 

  38. Unsworth A, Roberts BJ, Thompson JC (1981) The application of soft layered lubrication to hip prostheses. J Bone Joint Surg 63B:297

    Google Scholar 

  39. van Arkel ER, de Boer HH (2002) Survival analysis of human meniscal transplantations. J Bone Joint Surg Br 84:227–231

    Article  PubMed  Google Scholar 

  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 87:715–724

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Research and Development Center, Active Implants Corporation, P.O. Box 8395, 42505, Netanya, Israel

    Gal Zur, Eran Linder-Ganz, Jonathan J. Elsner, Jonathan Shani, Ori Brenner & Avi Shterling

  2. Department of Orthopedic Surgery, Assaf Harofe Medical Center, Zeriffin, Israel

    Gabriel Agar

  3. Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA

    Elliott B. Hershman

  4. Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA

    Steven P. Arnoczky

  5. Departments of Surgery and Biomedical Engineering, Duke University Medical Center, Durham, NC, USA

    Farshid Guilak

Authors
  1. Gal Zur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eran Linder-Ganz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan J. Elsner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Shani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ori Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gabriel Agar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elliott B. Hershman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven P. Arnoczky
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Farshid Guilak
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Avi Shterling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eran Linder-Ganz.

Additional information

G. Zur and E. Linder-Ganz contributed equally to this work.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zur, G., Linder-Ganz, E., Elsner, J.J. et al. Chondroprotective effects of a polycarbonate-urethane meniscal implant: histopathological results in a sheep model. Knee Surg Sports Traumatol Arthrosc 19, 255–263 (2011). https://doi.org/10.1007/s00167-010-1210-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1210-5

Keywords

  • Meniscus
  • Synthetic
  • Meniscectomy
  • Animal model
  • Allograft