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Meniscal scaffolds: results and indications. A systematic literature review

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Abstract

Purpose

The aim of this systematic review was to document the available clinical evidence to support meniscal scaffold implantation, analysing results and indications for the treatment of meniscal loss.

Methods

The systematic review of the literature was performed searching three medical electronic databases: PubMed, Scopus, and the Cochrane Collaboration. The guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) were used. Relevant data were then extracted and collected in a unique database with consensus of two observers. To assess the methodological quality of the collected data, the subscales of a modified Coleman methodology score (CMS) were determined.

Results

A total of 23 studies on two scaffolds (CMI®, Ivy Sports Medicine GmbH, Germany; Actifit, Orteq, United Kingdom) met the inclusion criteria and were used for the final analysis, of which more than half have been published in the last three years. Good clinical results have been documented in 613 patients, mainly young men affected by symptomatic chronic lesions, with a cumulative failure rate of 6.1 % and presence of newly formed tissue documented both at histological and MRI evaluation in most cases. However, there is a lack of comparative trials and the average study quality is low.

Conclusion

An increase in publications regarding this topic has been seen recently, due to the introduction in the clinical practice of the second synthetic scaffold. Safety and positive results have been shown for both scaffolds. Although, literature lacks randomized trials at long-term follow-up to confirm real potential and most appropriate indications of meniscal scaffold implantation.

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References

  1. Di Matteo B, Tarabella V, Filardo G, Vigano A, Tomba P, Marcacci M (2013) Thomas Annandale: the first meniscus repair. Knee Surg Sports Traumatol Arthrosc 21(9):1963–1966. doi:10.1007/s00167-013-2490-3

    Article  PubMed  Google Scholar 

  2. Heijink A, Gomoll AH, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J, Van Dijk CN (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):423–435. doi:10.1007/s00167-011-1818-0

    Article  PubMed Central  PubMed  Google Scholar 

  3. Pengas IP, Assiotis A, Nash W, Hatcher J, Banks J, McNicholas MJ (2012) Total meniscectomy in adolescents: a 40-year follow-up. J Bone Joint Surg (Br) 94(12):1649–1654. doi:10.1302/0301-620X.94B12.30562

    Article  CAS  Google Scholar 

  4. Wang Y, Dempsey AR, Lloyd DG, Mills PM, Wrigley T, Bennell KL, Metcalf B, Hanna F, Cicuttini FM (2012) Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 20(5):970–978. doi:10.1007/s00167-011-1681-z

    Article  PubMed  Google Scholar 

  5. Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41(10):2333–2339. doi:10.1177/0363546513495641

    Article  PubMed  Google Scholar 

  6. Lyman S, Hidaka C, Valdez AS, Hetsroni I, Pan TJ, Do H, Dunn WR, Marx RG (2013) Risk factors for meniscectomy after meniscal repair. Am J Sports Med 41(12):2772–2778. doi:10.1177/0363546513503444

    Article  PubMed  Google Scholar 

  7. Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J, Kang RW, Cole BJ (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34(8):1334–1344. doi:10.1177/0363546506286786

    Article  PubMed  Google Scholar 

  8. Jones RS, Keene GC, Learmonth DJ, Bickerstaff D, Nawana NS, Costi JJ, Pearcy MJ (1996) Direct measurement of hoop strains in the intact and torn human medial meniscus. Clin Biomech (Bristol, Avon) 11(5):295–300

    Article  Google Scholar 

  9. Cox JS, Nye CE, Schaefer WW, Woodstein IJ (1975) The degenerative effects of partial and total resection of the medial meniscus in dogs’ knees. Clin Orthop Relat Res 109:178–183

    Article  PubMed  Google Scholar 

  10. Newman AP, Anderson DR, Daniels AU, Dales MC (1989) Mechanics of the healed meniscus in a canine model. Am J Sports Med 17(2):164–175

    Article  CAS  PubMed  Google Scholar 

  11. Paletta GA Jr, Manning T, Snell E, Parker R, Bergfeld J (1997) The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med 25(5):692–698

    Article  PubMed  Google Scholar 

  12. Spang JT, Dang AB, Mazzocca A, Rincon L, Obopilwe E, Beynnon B, Arciero RA (2010) The effect of medial meniscectomy and meniscal allograft transplantation on knee and anterior cruciate ligament biomechanics. Arthroscopy 26(2):192–201. doi:10.1016/j.arthro.2009.11.008

    Article  PubMed  Google Scholar 

  13. Szomor ZL, Martin TE, Bonar F, Murrell GA (2000) The protective effects of meniscal transplantation on cartilage. An experimental study in sheep. J Bone Joint Surg Am 82(1):80–88

    CAS  PubMed  Google Scholar 

  14. Cook JL, Fox DB, Malaviya P, Tomlinson JL, Kuroki K, Cook CR, Kladakis S (2006) Long-term outcome for large meniscal defects treated with small intestinal submucosa in a dog model. Am J Sports Med 34(1):32–42. doi:10.1177/0363546505278702

    Article  PubMed  Google Scholar 

  15. Hansen R, Bryk E, Vigorita V (2013) Collagen scaffold meniscus implant integration in a canine model: a histological analysis. J Orthop Res 31(12):1914–1919. doi:10.1002/jor.22456

    Article  CAS  PubMed  Google Scholar 

  16. Kohn D, Wirth CJ, Reiss G, Plitz W, Maschek H, Erhardt W, Wulker N (1992) Medial meniscus replacement by a tendon autograft. Experiments in sheep. J Bone Joint Surg (Br) 74(6):910–917

    CAS  Google Scholar 

  17. Kon E, Filardo G, Tschon M, Fini M, Giavaresi G, Marchesini Reggiani L, Chiari C, Nehrer S, Martin I, Salter DM, Ambrosio L, Marcacci M (2012) Tissue engineering for total meniscal substitution: animal study in sheep model—results at 12 months. Tissue Eng Part A 18(15–16):1573–1582. doi:10.1089/ten.TEA.2011.0572

    Article  CAS  PubMed  Google Scholar 

  18. Shemesh M, Asher R, Zylberberg E, Guilak F, Linder-Ganz E, Elsner JJ (2014) Viscoelastic properties of a synthetic meniscus implant. J Mech Behav Biomed Mater 29:42–55. doi:10.1016/j.jmbbm.2013.08.021

    Article  CAS  PubMed  Google Scholar 

  19. van der Wal RJ, Thomassen BJ, van Arkel ER (2009) Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med 37(11):2134–2139. doi:10.1177/0363546509336725

    Article  PubMed  Google Scholar 

  20. Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, Puddu G, Rodkey WG, Verdonk P, Verdonk R, Zaffagnini S, Marcacci M (2012) Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc 20(3):468–486. doi:10.1007/s00167-011-1714-7

    Article  CAS  PubMed  Google Scholar 

  21. Cole BJ, Dennis MG, Lee SJ, Nho SJ, Kalsi RS, Hayden JK, Verma NN (2006) Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Am J Sports Med 34(6):919–927. doi:10.1177/0363546505284235

    Article  PubMed  Google Scholar 

  22. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, Bonanzinga T, Iacono F, Filardo G (2013) Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc 21(11):2509–2517. doi:10.1007/s00167-013-2388-0

    Article  CAS  PubMed  Google Scholar 

  23. Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Bonanzinga T, Nitri M, Bondi A, Molinari M, Rimondi E (2012) Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study. Am J Sports Med 40(2):395–403. doi:10.1177/0363546511424688

    Article  PubMed  Google Scholar 

  24. Verdonk PC, Verstraete KL, Almqvist KF, De Cuyper K, Veys EM, Verbruggen G, Verdonk R (2006) Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc 14(8):694–706. doi:10.1007/s00167-005-0033-2

    Article  PubMed  Google Scholar 

  25. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. doi:10.1136/bmj.b2535

    Article  PubMed Central  PubMed  Google Scholar 

  26. Kon E, Verdonk P, Condello V, Delcogliano M, Dhollander A, Filardo G, Pignotti E, Marcacci M (2009) Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med 37(Suppl 1):156S–166S. doi:10.1177/0363546509351649

    Article  PubMed  Google Scholar 

  27. Fetzer GB, Spindler KP, Amendola A, Andrish JT, Bergfeld JA, Dunn WR, Flanigan DC, Jones M, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Wolcott M, Vidal A, Wolf BR, Wright RW (2009) Potential market for new meniscus repair strategies: evaluation of the MOON cohort. J Knee Surg 22(3):180–186

    Article  PubMed Central  PubMed  Google Scholar 

  28. Ayala Mejias JD, Sciamanna RC, Muniesa MP, Perez-Espana LA (2013) A case report of semitendinosus tendon autograft for reconstruction of the meniscal wall supporting a collagen implant. BMC Sports Sci Med Rehabil 5:4. doi:10.1186/2052-1847-5-4

    PubMed Central  PubMed  Google Scholar 

  29. De Coninck T, Huysse W, Willemot L, Verdonk R, Verstraete K, Verdonk P (2013) Two-year follow-up study on clinical and radiological outcomes of polyurethane meniscal scaffolds. Am J Sports Med 41(1):64–72. doi:10.1177/0363546512463344

    Article  PubMed  Google Scholar 

  30. Hirschmann MT, Keller L, Hirschmann A, Schenk L, Berbig R, Luthi U, Amsler F, Friederich NF, Arnold MP (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(3):740–747. doi:10.1007/s00167-012-2259-0

    Article  CAS  PubMed  Google Scholar 

  31. Kon E, Filardo G, Zaffagnini S, Di Martino A, Di Matteo B, Marcheggiani Muccioli GM, Busacca M, Marcacci M (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(1):128–134. doi:10.1007/s00167-012-2328-4

    Article  PubMed  Google Scholar 

  32. Zaffagnini S, Marcheggiani Muccioli GM, Bulgheroni P, Bulgheroni E, Grassi A, Bonanzinga T, Kon E, Filardo G, Busacca M, Marcacci M (2012) Arthroscopic collagen meniscus implantation for partial lateral meniscal defects: a 2-year minimum follow-up study. Am J Sports Med 40(10):2281–2288. doi:10.1177/0363546512456835

    Article  PubMed  Google Scholar 

  33. Spencer SJ, Saithna A, Carmont MR, Dhillon MS, Thompson P, Spalding T (2012) Meniscal scaffolds: early experience and review of the literature. Knee 19(6):760–765. doi:10.1016/j.knee.2012.01.006

    Article  CAS  PubMed  Google Scholar 

  34. Verdonk P, Beaufils P, Bellemans J, Djian P, Heinrichs EL, Huysse W, Laprell H, Siebold R, Verdonk R (2012) Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: two-year safety and clinical outcomes. Am J Sports Med 40(4):844–853. doi:10.1177/0363546511433032

    Article  PubMed  Google Scholar 

  35. Efe T, Getgood A, Schofer MD, Fuchs-Winkelmann S, Mann D, Paletta JR, Heyse TJ (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(9):1822–1830. doi:10.1007/s00167-011-1779-3

    Article  PubMed  Google Scholar 

  36. Monllau JC, Gelber PE, Abat F, Pelfort X, Abad R, Hinarejos P, Tey M (2011) Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years’ follow-up. Arthroscopy 27(7):933–943. doi:10.1016/j.arthro.2011.02.018

    Article  PubMed  Google Scholar 

  37. Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Bonanzinga T, Filardo G, Canales Passalacqua A, Marcacci M (2011) Arthroscopic lateral collagen meniscus implant in a professional soccer player. Knee Surg Sports Traumatol Arthrosc 19(10):1740–1743. doi:10.1007/s00167-011-1538-5

    Article  PubMed  Google Scholar 

  38. 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(4):774–782. doi:10.1177/0363546511398040

    Article  PubMed  Google Scholar 

  39. Zaffagnini S, Marcheggiani Muccioli GM, Lopomo N, Bruni D, Giordano G, Ravazzolo G, Molinari M, Marcacci M (2011) Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10-year follow-up study. Am J Sports Med 39(5):977–985. doi:10.1177/0363546510391179

    Article  PubMed  Google Scholar 

  40. Bulgheroni P, Murena L, Ratti C, Bulgheroni E, Ronga M, Cherubino P (2010) Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Knee 17(3):224–229. doi:10.1016/j.knee.2009.08.011

    Article  PubMed  Google Scholar 

  41. Rodkey WG, DeHaven KE, Montgomery WH 3rd, Baker CL Jr, Beck CL Jr, Hormel SE, Steadman JR, Cole BJ, Briggs KK (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am 90(7):1413–1426. doi:10.2106/JBJS.G.00656

    Article  PubMed  Google Scholar 

  42. Genovese E, Angeretti MG, Ronga M, Leonardi A, Novario R, Callegari L, Fugazzola C (2007) Follow-up of collagen meniscus implants by MRI. Radiol Med 112(7):1036–1048. doi:10.1007/s11547-007-0204-y

    Article  CAS  PubMed  Google Scholar 

  43. Zaffagnini S, Giordano G, Vascellari A, Bruni D, Neri MP, Iacono F, Kon E, Presti ML, Marcacci M (2007) Arthroscopic collagen meniscus implant results at 6 to 8 years follow up. Knee Surg Sports Traumatol Arthrosc 15(2):175–183. doi:10.1007/s00167-006-0144-4

    Article  PubMed  Google Scholar 

  44. Linke RD, Ulmer M, Imhoff AB (2006) Replacement of the meniscus with a collagen implant (CMI). Oper Orthop Traumatol 18(5–6):453–462. doi:10.1007/s00064-006-1188-9

    Article  PubMed  Google Scholar 

  45. Ronga M, Grassi FA, Manelli A, Bulgheroni P (2006) Tissue engineering techniques for the treatment of a complex knee injury. Arthroscopy 22(5):576 e571-573. doi:10.1016/j.arthro.2005.12.050

    Article  Google Scholar 

  46. Reguzzoni M, Manelli A, Ronga M, Raspanti M, Grassi FA (2005) Histology and ultrastructure of a tissue-engineered collagen meniscus before and after implantation. J Biomed Mater Res B Appl Biomater 74(2):808–816. doi:10.1002/jbm.b.30314

    Article  PubMed  Google Scholar 

  47. Steadman JR, Rodkey WG (2005) Tissue-engineered collagen meniscus implants: 5- to 6-year feasibility study results. Arthroscopy 21(5):515–525. doi:10.1016/j.arthro.2005.01.006

    Article  PubMed  Google Scholar 

  48. Ronga M, Bulgheroni P, Manelli A, Genovese E, Grassi F, Cherubino P (2003) Short-term evaluation of collagen meniscus implants by MRI and morphological analysis. J Orthop Traum 4(1):5–10

    Article  Google Scholar 

  49. Rodkey WG, Steadman JR, Li ST (1999) A clinical study of collagen meniscus implants to restore the injured meniscus. Clin Orthop Relat Res (367 Suppl):S281–S292

  50. Stone KR, Steadman JR, Rodkey WG, Li ST (1997) Regeneration of meniscal cartilage with use of a collagen scaffold. Analysis of preliminary data. J Bone Joint Surg Am 79(12):1770–1777

    CAS  PubMed  Google Scholar 

  51. Vascellari A, Rebuzzi E, Schiavetti S, Coletti N (2012) All-inside meniscal repair using the FasT-Fix meniscal repair system: is still needed to avoid weight bearing? A systematic review. Musculoskelet Surg 96(3):149–154. doi:10.1007/s12306-012-0209-0

    Article  PubMed  Google Scholar 

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Acknowledgments

A. Di Martino, F. Perdisa, B. Di Matteo, M. Ciancio, N. Kim: II Clinic—Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.

Conflict of interest

L. Andriolo and F. Balboni declare that they have no conflict of interest.

G. Filardo is a consultant and receives institutional support from Finceramica Faenza Spa (Italy), Fidia Farmaceutici Spa (Italy), and CartiHeal (2009) Ltd (Israel). He is a consultant for EON Medica SRL (Italy). He receives institutional support from IGEA Clinical Biophysics (Italy), BIOMET (USA) and Kensey Nash (USA).M. Marcacci receives royalties and research institutional support from Fin-Ceramica Faenza SpA (Italy). He receives institutional support from Fidia Farmaceutici Spa (Italy), CartiHeal (2009) Ltd (Israel), IGEA Clinical Biophysics (Italy), BIOMET (USA) and Kensey Nash (USA).E. Kon is a consultant for CartiHeal (2009) Ltd (Israel) and has stocks of CartiHeal (2009) Ltd (Israel). She is a consultant and receives institutional support from Finceramica Faenza Spa (Italy). She receives institutional support from Fidia Farmaceutici Spa (Italy), IGEA Clinical Biophysics (Italy), BIOMET (USA) and Kensey Nash (USA).

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Authors and Affiliations

  1. II Clinic - Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy

    Giuseppe Filardo, Luca Andriolo, Elizaveta Kon & Maurilio Marcacci

  2. University Hospital of Parma, Parma, Italy

    Francesca de Caro

Authors
  1. Giuseppe Filardo
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  2. Luca Andriolo
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  3. Elizaveta Kon
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  4. Francesca de Caro
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  5. Maurilio Marcacci
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Correspondence to Giuseppe Filardo.

Additional information

The study was performed at the Rizzoli Orthopaedic Institute, Bologna, Italy.

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Filardo, G., Andriolo, L., Kon, E. et al. Meniscal scaffolds: results and indications. A systematic literature review. International Orthopaedics (SICOT) 39, 35–46 (2015). https://doi.org/10.1007/s00264-014-2415-x

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