Future Trends in the Treatment of Meniscus Lesions: From Repair to Regeneration

  • H. Pereira
  • J. Silva-Correia
  • J. M. Oliveira
  • R. L. Reis
  • J. Espregueira-Mendes


“Nothing has changed so much in knee treatment and surgery as meniscal treatment algorithms”—This statement from Verdonk [1] condenses the overturn occurred in recent years concerning the approach of meniscus lesions.


  1. 1.
    Verdonk R (2011) The meniscus: past, present and future. Knee Surg Sports Traumatol Arthrosc 19:145–146PubMedCrossRefGoogle Scholar
  2. 2.
    Verdonk PC, Forsyth RG, Wang J et al (2005) Characterisation of human knee meniscus cell phenotype. Osteoarthritis Cartilage 13:548–560PubMedCrossRefGoogle Scholar
  3. 3.
    Pereira H, Frias A, Caridade S et al (2011) Cellular and biomechanical segmental characterization of human meniscus. Osteoarthritis Cartilage 19:S205Google Scholar
  4. 4.
    Lubowitz JH, Poehling GG (2011) Save the meniscus. Arthroscopy 27:301–302PubMedCrossRefGoogle Scholar
  5. 5.
    Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19:147–157 (Official journal of the ESSKA)PubMedCrossRefGoogle Scholar
  6. 6.
    Garrett WE Jr, Swiontkowski MF, Weinstein JN et al (2006) American board of orthopaedic surgery practice of the orthopaedic surgeon: part-II, certification examination case mix. J Bone Joint Surg Am 88:660–667PubMedCrossRefGoogle Scholar
  7. 7.
    Fayard JM, Pereira H, Servien E, Lustig S, Neyret P (2010) Meniscectomy global results-complications. Springer-Verlag, Berlin HeidelbergGoogle Scholar
  8. 8.
    Jackson DW (2001) The orthopaedic clinician-scientist. J Bone Joint Surg Am 83-A:131-5Google Scholar
  9. 9.
    Monllau JC, González-Lucena G, Gelber PE, Pelfort X (2010) Allograft meniscus transplantation: a current review. Tech Knee Surg 9:107–113CrossRefGoogle Scholar
  10. 10.
    Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13:1–11PubMedCrossRefGoogle Scholar
  11. 11.
    Harris JD, Cavo M, Brophy R, Siston R, Flanigan D (2011) Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy J Arthroscopic Relat Surg 27:409–418 (Official publication of the Arthroscopy Association of North America and the International Arthroscopy Association)CrossRefGoogle Scholar
  12. 12.
    Pereira H, Frias AM, Oliveira JM, Espregueira-Mendes J, Reis RL (2011) Tissue engineering and regenerative medicine strategies in meniscus lesions. J Arthroscopic Related Surg 27:1706–1719 (Official publication of the Arthroscopy Association of North America and the International Arthroscopy Association)CrossRefGoogle Scholar
  13. 13.
    Annandale T (1885) An operation for displaced semilunar cartilage. Br Med J 1:779PubMedCrossRefGoogle Scholar
  14. 14.
    Starke C, Kopf S, Petersen W, Becker R (2009) Meniscal repair. Arthroscopy J Arthroscopic Rel Surg 25:1033–1044 (Official publication of the Arthroscopy Association of North America and the International Arthroscopy Association)CrossRefGoogle Scholar
  15. 15.
    Logan M, Watts M, Owen J, Myers P (2009) Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med 37:1131–1134PubMedCrossRefGoogle Scholar
  16. 16.
    Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy J Arthroscopic Rel Surg 27:1275–1288 (Official publication of the Arthroscopy Association of North America and the International Arthroscopy Association)CrossRefGoogle Scholar
  17. 17.
    Muriuki MG, Tuason DA, Tucker BG, Harner CD (2011) Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Joint Surg Am 93:1089–1095PubMedCrossRefGoogle Scholar
  18. 18.
    Verdonk P, Beaufils P, Bellemans J 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 40:844–853PubMedCrossRefGoogle Scholar
  19. 19.
    Hirschmann MT, Keller L, Hirschmann A et al (2012) One-year clinical and MR imaging outcome after partial meniscal replacement in stabilized knees using a collagen meniscus implant. Knee Surg Sports Traumatol Arthrosc, Oct 30 2012 [Epub ahead of print]Google Scholar
  20. 20.
    Monllau JC, Gelber PE, Abat F et al (2011) Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years’ follow-up. Arthroscopy J Arthroscopic Rel Surg 27:933–943 (Official publication of the Arthroscopy Association of North America and the International Arthroscopy Association)CrossRefGoogle Scholar
  21. 21.
    Zaffagnini S, Marcheggiani, Muccioli GM, Lopomo N et al (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):977–985PubMedCrossRefGoogle Scholar
  22. 22.
    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 17:224–229PubMedCrossRefGoogle Scholar
  23. 23.
    Rodkey WG, DeHaven KE, Montgomery WH 3rd et al (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am 90:1413–1426PubMedCrossRefGoogle Scholar
  24. 24.
    Zaffagnini S, Giordano G, Vascellari A et al (2007) Arthroscopic collagen meniscus implant results at 6–8 years follow up. Knee Surg Sports Traumatol Arthrosc 15:175–183 (Official journal of the ESSKA)PubMedCrossRefGoogle Scholar
  25. 25.
    Linke RD, Ulmer M, Imhoff AB (2006) Replacement of the meniscus with a collagen implant (CMI). Oper Orthop Traumatol 18:453–462PubMedCrossRefGoogle Scholar
  26. 26.
    Genovese E, Angeretti MG, Ronga M et al (2007) Follow-up of collagen meniscus implants by MRI. Radiol Med 112:1036–1048PubMedCrossRefGoogle Scholar
  27. 27.
    Zaffagnini S, Marcheggiani, Muccioli GM, Bulgheroni P et al (2012) Arthroscopic collagen meniscus implantation for partial lateral meniscal defects: a 2-year minimum follow-up study. Am J Sports Med 40:2281–2288PubMedCrossRefGoogle Scholar
  28. 28.
    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 39:774–782PubMedCrossRefGoogle Scholar
  29. 29.
    Efe T, Getgood A, Schofer MD 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 (Official journal of the ESSKA)PubMedCrossRefGoogle Scholar
  30. 30.
    Yan LP, Oliveira JM, Oliveira AL, Caridade SG, Mano JF, Reis RL (2012) Macro/microporous silk fibroin scaffolds with potential for articular cartilage and meniscus tissue engineering applications. Acta Biomater 8:289–301PubMedCrossRefGoogle Scholar
  31. 31.
    Kon E, Chiari C, Marcacci M et al (2008) Tissue engineering for total meniscal substitution: animal study in sheep model. Tissue Eng Part A 14:1067–1080PubMedCrossRefGoogle Scholar
  32. 32.
    Welsing RT, van Tienen TG, Ramrattan N et al (2008) Effect on tissue differentiation and articular cartilage degradation of a polymer meniscus implant: a 2-year follow-up study in dogs. Am J Sports Med 36:1978–1989PubMedCrossRefGoogle Scholar
  33. 33.
    Kang SW, Son SM, Lee JS et al (2006) Regeneration of whole meniscus using meniscal cells and polymer scaffolds in a rabbit total meniscectomy model. J Biomed Mater Res A 78:659–671PubMedGoogle Scholar
  34. 34.
    Moroni L, de Wijn JR, van Blitterswijk CA (2006) 3D fiber-deposited scaffolds for tissue engineering: Influence of pores geometry and architecture on dynamic mechanical properties. Biomaterials 27:974–985PubMedCrossRefGoogle Scholar
  35. 35.
    Liulan L, Qingxi H, Xianxu H, Gaochun X (2007) Design and fabrication of bone tissue engineering scaffolds via rapid prototyping and CAD. J Rare Earths 25(Supplement 2):379–383CrossRefGoogle Scholar
  36. 36.
    Angele P, Johnstone B, Kujat R et al (2008) Stem cell based tissue engineering for meniscus repair. J Biomed Mater Res A 85:445–455PubMedGoogle Scholar
  37. 37.
    Scotti C, Pozzi A, Mangiavini L et al (2009) Healing of meniscal tissue by cellular fibrin glue: an in vivo study. Knee Surg Sports Traumatol Arthrosc 17:645–651PubMedCrossRefGoogle Scholar
  38. 38.
    Weinand C, Xu JW, Peretti GM, Bonassar LJ, Gill TJ (2009) Conditions affecting cell seeding onto three-dimensional scaffolds for cellular-based biodegradable implants. J Biomed Mater Res B Appl Biomater 91:80–87PubMedGoogle Scholar
  39. 39.
    Yamasaki T, Deie M, Shinomiya R, Yasunaga Y, Yanada S, Ochi M (2008) Transplantation of meniscus regenerated by tissue engineering with a scaffold derived from a rat meniscus and mesenchymal stromal cells derived from rat bone marrow. Artif Organs 32:519–524PubMedCrossRefGoogle Scholar
  40. 40.
    Martinek V, Ueblacker P, Braun K et al (2006) Second generation of meniscus transplantation: in vivo study with tissue engineered meniscus replacement. Arch Orthop Trauma Surg 126:228–234PubMedCrossRefGoogle Scholar
  41. 41.
    Weinand C, Peretti GM, Adams SB Jr, Bonassar LJ, Randolph MA, Gill TJ (2006) An allogenic cell-based implant for meniscal lesions. Am J Sports Med 34:1779–1789PubMedCrossRefGoogle Scholar
  42. 42.
    Weinand C, Peretti GM, Adams SB Jr, Randolph MA, Savvidis E, Gill TJ (2006) Healing potential of transplanted allogeneic chondrocytes of three different sources in lesions of the avascular zone of the meniscus: a pilot study. Arch Orthop Trauma Surg 126:599–605PubMedCrossRefGoogle Scholar
  43. 43.
    Zhang H, Leng P, Zhang J (2009) Enhanced meniscal repair by overexpression of hIGF-1 in a full-thickness model. Clin Orthop Relat Res 467:3165–3174PubMedCrossRefGoogle Scholar
  44. 44.
    Kobayashi Y, Yasuda K, Kondo E et al (2010) Implantation of autogenous meniscal fragments wrapped with a fascia sheath enhances fibrocartilage regeneration in vivo in a large harvest site defect. Am J Sports Med 38:740–748PubMedCrossRefGoogle Scholar
  45. 45.
    Zellner J, Mueller M, Berner A et al (2010) Role of mesenchymal stem cells in tissue engineering of meniscus. J Biomed Mater Res A 94:1150–1161PubMedGoogle Scholar
  46. 46.
    Stapleton TW, Ingram J, Fisher J, Ingham E (2011) Investigation of the regenerative capacity of an acellular porcine medial meniscus for tissue engineering applications. Tissue Eng Part A 17:231–242PubMedCrossRefGoogle Scholar
  47. 47.
    Ishida K, Kuroda R, Miwa M et al (2007) The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng 13:1103–1112PubMedCrossRefGoogle Scholar
  48. 48.
    Kopf S, Birkenfeld F, Becker R et al (2010) Local treatment of meniscal lesions with vascular endothelial growth factor. J Bone Joint Surg Am 92:2682–2691PubMedCrossRefGoogle Scholar
  49. 49.
    Petersen W, Pufe T, Starke C et al (2007) The effect of locally applied vascular endothelial growth factor on meniscus healing: gross and histological findings. Arch Orthop Trauma Surg 127:235–240PubMedCrossRefGoogle Scholar
  50. 50.
    Kamimura T, Kimura M (2011) Repair of horizontal meniscal cleavage tears with exogenous fibrin clots. Knee Surg Sports Traumatol Arthrosc 19(7):1154–1157PubMedCrossRefGoogle Scholar
  51. 51.
    Abdel-Mohsen AM, Hrdina R, Burgert L et al (2012) Antibacterial activity and cell viability of hyaluronan fiber with silver nanoparticles. Carbohydrate Polymers 92:1177–1187Google Scholar
  52. 52.
    Baker BM, Nathan AS, Gee AO, Mauck RL (2010) The influence of an aligned nanofibrous topography on human mesenchymal stem cell fibrochondrogenesis. Biomaterials 31:6190–6200PubMedCrossRefGoogle Scholar
  53. 53.
    Horie M, Sekiya I, Muneta T et al (2009) Intra-articular Injected synovial stem cells differentiate into meniscal cells directly and promote meniscal regeneration without mobilization to distant organs in rat massive meniscal defect. Stem Cells 27:878–887PubMedCrossRefGoogle Scholar
  54. 54.
    Mizuno K, Muneta T, Morito T et al (2008) Exogenous synovial stem cells adhere to defect of meniscus and differentiate into cartilage cells. J Med Dent Sci 55:101–111PubMedGoogle Scholar
  55. 55.
    Agung M, Ochi M, Yanada S et al (2006) Mobilization of bone marrow-derived mesenchymal stem cells into the injured tissues after intraarticular injection and their contribution to tissue regeneration. Knee Surg Sports Traumatol Arthrosc 14:1307–1314PubMedCrossRefGoogle Scholar
  56. 56.
    Ochiai S, Mizuno T, Deie M, Igarashi K, Hamada Y, Ochi M (2008) Oxidative stress reaction in the meniscus of bach 1 deficient mice: potential prevention of meniscal degeneration. J Orthop Res 26:894–898PubMedCrossRefGoogle Scholar

Copyright information

© ISAKOS 2013

Authors and Affiliations

  • H. Pereira
    • 1
    • 2
  • J. Silva-Correia
    • 1
    • 2
  • J. M. Oliveira
    • 1
    • 2
  • R. L. Reis
    • 1
    • 2
  • J. Espregueira-Mendes
    • 1
    • 2
  1. 1.3B’s Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer EngineeringUniversity of MinhoGuimarãesPortugal
  2. 2.Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineGuimarãesPortugal

Personalised recommendations