Polyurethane scaffold implants for partial meniscus lesions: delayed intervention leads to an inferior outcome

Abstract

Purpose

The purpose of this study was to assess the clinical outcomes of the implantation of an aliphatic polyurethane scaffold for the treatment of partial loss of meniscal tissue at a mean follow-up of 36 months.

Methods

A retrospective review on prospectively collected data was performed on patients who underwent implantation of an aliphatic polyurethane-based synthetic meniscal scaffold. Patients were evaluated for demographics data, lesion and implant characteristics (sizing, type and number of meniscal sutures), previous and combined surgeries and complications. Clinical parameters were rated using NRS, IKDC subjective, Lysholm, KOOS, and Tegner activity score, both preoperatively and at final follow-up.

Results

Sixty-seven patients were evaluated at a mean follow-up of 36 months (48 M and 19 F; mean age 40.8 ± 10.6 years; mean BMI 25.4 ± 4.3). The scaffold was implanted on the medial side in 54 cases, and on the lateral one in 13. Forty-seven patients had undergone previous surgical treatment at the same knee and 45 required combined surgical procedures. All evaluated scores improved significantly from the baseline. Among possible prognostic factors, a delayed scaffold implantation had lower post-operative clinical scores: IKDC subjective (P = 0.049), KOOS Sport (P = 0.044), KOOS total (p = 0.011), and Tegner (P = 0.03) scores at follow-up.

Conclusions

The polyurethane meniscal scaffold implantation led to a significant clinical benefit in a large number of patients. A delayed intervention correlated with worse results.

Level of evidence

IV.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Bulgheroni E, Grassi A, Bulgheroni P, Marcheggiani Muccioli GM, Zaffagnini S, Marcacci M (2015) Long-term outcomes of medial CMI implant versus partial medial meniscectomy in patients with concomitant ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 23:3221–3227

    Article  Google Scholar 

  2. 2.

    Dhollander A, Verdonk P, Verdonk R (2016) Treatment of painful, irreparable partial meniscal defects with a polyurethane scaffold: midterm clinical outcomes and survival analysis. Am J Sports Med 44:2615–2621

    Article  Google Scholar 

  3. 3.

    Efe T, Getgood A, Schofer MD, Fuchs-Winkelmann S, Mann D, Paletta JR et al (2012) The safety and short-term efficacy of a novel polyurethane meniscal scaffold for the treatment of segmental medial meniscus deficiency. Knee Surg Sports Traumatol Arthrosc 20:1822–1830

    Article  Google Scholar 

  4. 4.

    Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum 48:2178–2187

    CAS  Article  Google Scholar 

  5. 5.

    Filardo G, Andriolo L, Kon E, de Caro F, Marcacci M (2015) Meniscal scaffolds: results and indications. A systematic literature review. Int Orthop 39:35–46

    Article  Google Scholar 

  6. 6.

    Filardo G, Kon E, Andriolo L, Di Matteo B, Balboni F, Marcacci M (2014) Clinical profiling in cartilage regeneration: prognostic factors for midterm results of matrix-assisted autologous chondrocyte transplantation. Am J Sports Med 42:898–905

    Article  Google Scholar 

  7. 7.

    Filardo G, Kon E, Perdisa F, Sessa A, Di Martino A, Busacca M et al (2017) Polyurethane-based cell-free scaffold for the treatment of painful partial meniscus loss. Knee Surg Sports Traumatol Arthrosc 25:459–467

    CAS  Article  Google Scholar 

  8. 8.

    Heijink A, Gomoll AH, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J et al (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:423–435

    Article  Google Scholar 

  9. 9.

    Hirschmann MT, Keller L, Hirschmann A, Schenk L, Berbig R, Luthi U et al (2013) One-year clinical and MR imaging outcome after partial meniscal replacement in stabilized knees using a collagen meniscus implant. Knee Surg Sports Traumatol Arthrosc 21:740–747

    CAS  Article  Google Scholar 

  10. 10.

    Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL et al (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675–1684

    CAS  Article  Google Scholar 

  11. 11.

    Kon E, Filardo G, Zaffagnini S, Di Martino A, Di Matteo B, Marcheggiani Muccioli GM et al (2014) Biodegradable polyurethane meniscal scaffold for isolated partial lesions or as combined procedure for knees with multiple comorbidities: clinical results at 2 years. Knee Surg Sports Traumatol Arthrosc 22:128–134

    Article  Google Scholar 

  12. 12.

    Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J et al (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34:1334–1344

    Article  Google Scholar 

  13. 13.

    Monllau JC, Poggioli F, Erquicia J, Ramirez E, Pelfort X, Gelber P et al (2018) Magnetic resonance imaging and functional outcomes after a polyurethane meniscal scaffold implantation: minimum 5-year follow-up. Arthroscopy 34:1621–1627

    Article  Google Scholar 

  14. 14.

    Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27:1275–1288

    Article  Google Scholar 

  15. 15.

    Rodkey WG, DeHaven KE, Montgomery WH 3rd, Baker CL Jr, Beck CL Jr, Hormel SE et al (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am 90:1413–1426

    Article  Google Scholar 

  16. 16.

    Schuttler KF, Haberhauer F, Gesslein M, Heyse TJ, Figiel J, Lorbach O et al (2016) Midterm follow-up after implantation of a polyurethane meniscal scaffold for segmental medial meniscus loss: maintenance of good clinical and MRI outcome. Knee Surg Sports Traumatol Arthrosc 24:1478–1484

    Article  Google Scholar 

  17. 17.

    Scotti C, Hirschmann MT, Antinolfi P, Martin I, Peretti GM (2013) Meniscus repair and regeneration: review on current methods and research potential. Eur Cell Mater 26:150–170

    CAS  Article  Google Scholar 

  18. 18.

    Verdonk P, Beaufils P, Bellemans J, Djian P, Heinrichs EL, Huysse W et al (2012) Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: two-year safety and clinical outcomes. Am J Sports Med 40:844–853

    Article  Google Scholar 

  19. 19.

    Verdonk R, Verdonk P, Huysse W, Forsyth R, Heinrichs EL (2011) Tissue ingrowth after implantation of a novel, biodegradable polyurethane scaffold for treatment of partial meniscal lesions. Am J Sports Med 39:774–782

    Article  Google Scholar 

  20. 20.

    Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc 23:164–170

    Article  Google Scholar 

  21. 21.

    Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Bonanzinga T, Nitri M, Raggi F et al (2015) MRI evaluation of a collagen meniscus implant: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:3228–3237

    Article  Google Scholar 

  22. 22.

    Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Holsten D, Bulgheroni P, Monllau JC et al (2015) Two-year clinical results of lateral collagen meniscus implant: a multicenter study. Arthroscopy 31:1269–1278

    Article  Google Scholar 

Download references

Funding

No specific funding were received concerning this paper.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Francesco Perdisa.

Ethics declarations

Conflict of interes

The authors declare they have no conflict of interests regarding the present work.

Ethical approval

This study was approved by the Ethical Committee of “Province di Verona e Rovigo, Azienda Universitaria integrata di Verona, Italy”, with Protocol number 64215, date 03/10/2018.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Condello, V., Dei Giudici, L., Perdisa, F. et al. Polyurethane scaffold implants for partial meniscus lesions: delayed intervention leads to an inferior outcome. Knee Surg Sports Traumatol Arthrosc 29, 109–116 (2021). https://doi.org/10.1007/s00167-019-05760-4

Download citation

Keywords

  • Meniscal scaffold
  • Meniscal replacement
  • Meniscal treatment
  • Meniscal salvage
  • Meniscal arthroscopy