Meniscus tear - Knowledge @ AMBOSS Rapid phenotypic changes in passaged articular chondrocyte subpopulations. Though processed whole tissues such as SIS display significant bioactivity and have been seen to induce some tissue regeneration, the resulting tissue mechanics may be insufficient, which subsequently compromises knee function. Our website services, content, and products are for informational purposes only. Tears in the avascular zone of the meniscus are generally more complex and broad, and are often associated with a poor prognosis following repair. Englund M, Niu J, Guermazi A, Roemer FW, Hunter DJ, Lynch JA, et al. Maher SA, Rodeo SA, Doty SB, Brophy R, Potter H, Foo LF, et al. Though such techniques undergo continuous development, surgical treatment approaches can be classified under four main categories: inside-out, outside-in, and all-inside arthroscopic techniques; and open repair [5, 6, 71]. It occurs at the posterior horn of the lateral meniscus, starting from the posterior root and extending anteriorly. A prospective randomized trial. Many hydrogels can also be synthesized from readily available reagents. Despite these results, none of the above techniques has been a recipient of general acceptance and application. Anterior view. Become a Gold Supporter and see no third-party ads. Since heterogeneous loading of the meniscus occurs every day in vivo, appropriate mechanical properties, tissue anisotropy, geometry [149], and lubrication are requirements of the mechanics criterion. Holloway JL, Lowman AM, Palmese GR. Pollo FE, Jackson RW, Kane RR, Chang HM, Zhang J, Dieterichs CP, et al. Much remains to be studied concerning biochemical stimuli used in tissue engineering the knee meniscus. In line with this, seeded cells must be encouraged to maintain their phenotype and synthetic capacity in a scaffold. Despite these results, significant scientific and clinical drawbacks associated with the collagen meniscus implant exist. The TGF- family, regarded as one of the most important for cartilage tissue engineering [246-248], has repeatedly demonstrated the ability to heighten meniscus cell synthesis of matrix proteins [102, 103, 232]. Using these tools, tissue engineering aims to regenerate or replace the meniscus. Synergistic action of transforming growth factor-beta and insulin-like growth factor-I induces expression of type II collagen and aggrecan genes in adult human articular chondrocytes. The menisci are attached to the femur bone by a strong tissue called the meniscofemoral ligament. Turek's orthopaedics. Veilleux N, Spector M. Effects of FGF-2 and IGF-1 on adult canine articular chondrocytes in type II collagen-glycosaminoglycan scaffolds in vitro. anterior and posterior tibial roots are very close to each other. Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions In a similar study, Kurosawa et al. It has been suggested that these cells are possibly specific progenitor cells with therapeutic and regenerative capabilities [29]. You have to take care of yourself, though. Yaeger PC, Masi TL, de Ortiz JL, Binette F, Tubo R, McPherson JM. Liu Tsang V, Chen AA, Cho LM, Jadin KD, Sah RL, DeLong S, et al. Comparison of the collagen meniscus implant with partial meniscectomy. Subsequent work demonstrated the use of a magnetic stir bar mixing bioreactor to produce constructs with a larger degree of homogeneity, higher equilibrium and tensile moduli, and greater ECM deposition, although detrimental effects were observed at higher stirring intensities [199]. In general, the current preferred intervention for the majority of surgeons is meniscectomy, either partial or total, depending on the degree of meniscal damage. Meniscus Tear of the Knee: Causes, Symptoms, and Diagnosis - Healthline The fact that no statistically significant therapeutic outcome was found between the two cell-based implants is of importance, as it suggests that the use of allogeneic cells is feasible [109]. Bulgheroni P, Murena L, Ratti C, Bulgheroni E, Ronga M, Cherubino P. Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Weinstabl R, Muellner T, Vecsei V, Kainberger F, Kramer M. Economic considerations for the diagnosis and therapy of meniscal lesions: can magnetic resonance imaging help reduce the expense? One potentially important function of growth factors may be to modulate matrix contraction. Lateral meniscus. A study comparing meniscus cells seeded in HYAFF-11 and collagen scaffolds (types I, II, and III) found no differences in GAG and collagen I synthesis [207]. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. Healthline Media does not provide medical advice, diagnosis, or treatment. [215] and decellularized meniscus [220], likely due to the dense matrix present even after processing. Following this time, their ability to produce GAGs and collagen types I, III, and VI was assayed, along with the presence of certain surface markers (CD105, CD44, SSEA, PDGFRa). Tissue engineering of the meniscus. A 15 year analysis of sports orthopedic ambulatory care]. Xie J, Li X, Lipner J, Manning CN, Schwartz AG, Thomopoulos S, et al. It has been found that aligned PCL scaffolds seeded with meniscus cells and cultured over 10 wks display a 7-fold greater increase in tensile modulus in the direction of alignment than corresponding non-aligned scaffolds [162]. Miller DB., Jr. Arthroscopic meniscus repair. In't Anker PS, Noort WA, Scherjon SA, Kleijburg-van der Keur C, Kruisselbrink AB, van Bezooijen RL, et al. The menisci are attached to each other via the transverse ligament. Assessment of a bovine co-culture, scaffold-free method for growing meniscus-shaped constructs. Weinand C, Peretti GM, Adams SB, Jr., Randolph MA, Savvidis E, Gill TJ. Lechner K, Hull ML, Howell SM. Kramer DE, Micheli LJ. Other research has been directed towards ECM molecule hydrogels, yielding studies on elastin-like polypeptide [200, 201] and collagen-mimetic peptide [202, 203] hydrogels. Lateral Meniscus Tear - Symptoms, Causes, Treatment & Rehabilitation However, monolayer expansion of meniscus cells leads to significant downregulation of ECM gene expression [104]. In vitro engineering of fibrocartilage using CDMP1 induced dermal fibroblasts and polyglycolide. The ideal meniscus construct will excel in three criteria: mechanics, bioactivity, and logistics (Table 4). Lateral menisci also cover a larger portion of the tibial plateau (75-93% laterally) in comparison to medial menisci (51-74% medially) [13]. However, hydrogels may hamper meniscus cell phenotype by preventing encapsulated cells from assuming their characteristic spread fibroblastic morphology [172, 173, 175]. Anterior view. Knee menisci | Radiology Reference Article | Radiopaedia.org Other work has shown that it is possible to remove the vast majority of cellular DNA as well as the primary xenogeneic epitope galactose--1,3-galactose, though significant GAG loss is also observed with this procedure [224]. A multi-center clinical trial of collagen meniscus implants showed greater tissue restoration 1 year after operation compared to partial meniscectomy; and activity levels also rose in chronic sufferers of meniscal problems 7 years after implantation [210]. Discoid meniscus most often affects the lateral meniscus, which is on the outside of the knee joint. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. Anterior view. Men are more prone to such injuries than women, with a male to female incidence ratio between 2.5:1 and 4:1, and overall incidence peaking at 20-29 years of age for both sexes [47, 49, 50]. Thus, the use of incorrect loading regimen parameters can lead to matrix and tissue degradation. Noyes FR, Barber-Westin SD. This work underscores the necessity of, and opportunities and challenges associated with, bringing together diverse tools (imaging modalities, processing methods, bioreactors) to successfully tissue engineer the knee meniscus. Collagen mimetic peptide-conjugated photopolymerizable PEG hydrogel. The meniscal surfaces are named according to a simple nomenclature which is particularly helpful when describing meniscal tears. Schoenfeld AJ, Landis WJ, Kay DB. The rubbery nature of the meniscus makes it susceptible to tears when it is twisted during an irregular movement. Suture techniques are determined based on the location and extent of peripheral tear . Arnoczky SP, Warren RF. One group of investigators recently reported the fabrication of a peptide scaffold sensitive to matrix metalloproteinase-2 (MMP-2) degradation [170]. Huey DJ, Athanasiou KA. Clark CR, Ogden JA. Integration of synthetic polymer tissue constructs with neighboring host tissue also remains an issue to tackle. For instance, leporine meniscal explants subjected to cyclic hydrostatic pressure at 1 MPa, 0.5 Hz, for 1 min on/14 min off over 4 hrs, have been shown to upregulate inflammatory factors and matrix degradation proteins [270]. Aufderheide AC, Athanasiou KA. Deep dissection. An analysis of isolated tears. First, MSCs have been observed to differentiate into many terminally-differentiated cells which synthesize mesenchymal tissue (i.e., cartilage, bone, ligaments, muscle, fat, dermal, and other connective tissue), and can therefore be used to engineer mesenchymal-derived tissue [126]. Knee menisci. Milachowski KA, Weismeier K, Wirth CJ. At the time the article was last revised Yoshi Yu had Afterwards, however, vascularization appears to subside. Improving the healing process in this type of injury is an ongoing challenge for clinicians and researchers. These studies are landmarks in understanding the anatomical and functional utility of the knee meniscus, and have since resulted in numerous investigations into different treatment approaches. Nanofiber alignment and direction of mechanical strain affect the ECM production of human ACL fibroblast. They will also consider the type, size, and location of the injury. A fibrous band of tissue, this ligament is both broad and flat in shape. Meniscus tears: diagnosis, repair techniques, clinical outcomes. Hanks GA, Gause TM, Sebastianelli WJ, O'Donnell CS, Kalenak A. The sensitivity of tibiofemoral contact pressure to the size and shape of the lateral and medial menisci. anterior meniscal roots anterior root of the medial meniscus has the biggest footprint of the four meniscal roots Cameron HU, Macnab I. Tissue engineering for total meniscal substitution: animal study in sheep model. The realization of the fact that the isolation of a sufficient number of healthy, undifferentiated meniscal cells extracted from an injured meniscus ranges from difficult to impossible, and the need for alternative cell sources, has led many researchers to use allogeneic cells for meniscus tissue engineering [25]. Diagnosis is dependent upon the presence of a complete medical history for the patient and a clinical examination. Tissue-derived materials include processed whole tissue such as small intestinal submucosa (SIS), decellularized tissue or ECM (dECM), and silk. Chondroitinase ABC treatment results in greater tensile properties of self-assembled tissue-engineered articular cartilage. Radiographics. Additionally, the reproducibility of engineered tissue needs to be established. Decellularization of human meniscus has also been performed [223]. The authors have no conflicts of interest to disclose. A crescent-shaped body. An approach that has been investigated by many researchers is in situ activation of the migration, proliferation, and differentiation of local MSCs. By contrast, the same study found that interleukin-1 decreased SZP protein content and gene expression [250]. Angele P, Johnstone B, Kujat R, Zellner J, Nerlich M, Goldberg V, et al. Athletic injuries: comparison by age, sport, and gender. After 8 wks follow-up, the investigators found that MSCs could survive and proliferate in the meniscal tears while also developing an extensive extracellular matrix, aiding the healing process in the avascular meniscus [139]. Human meniscus cell: characterization of the primary culture and use for tissue engineering. A torn meniscus is one of the most common knee injuries. PDGF-AB and HGF stimulated migration in cells from all three zones of the meniscus, while EGF, IGF-1, IL-1, and BMP-2 promoted cell migration only in specific zones of the meniscus (outer and inner, middle and inner, outer and middle, and only middle, respectively) [245]. Distribution of type I, II, III and V in the pepsin solubilized collagens in bovine menisci. The results from these studies point towards the possibility of using xenogeneic cell sources in meniscus tissue engineering, which is further supported by unpublished data from our lab based on both in vitro and in vivo studies. Rhee S, Grinnell F. P21-activated kinase 1: convergence point in PDGF- and LPA-stimulated collagen matrix contraction by human fibroblasts. Pangborn CA, Athanasiou KA. These advantages are countered by a central weaknessminimal intrinsic biomimetic and bioactive properties. An Overview of Lateral Meniscus Tears - m.aidmymeniscus.com Radiographic features MRI. Other researchers have shown that aggrecan surfaces are more effective in encouraging meniscus cell ECM deposition than collagen I surfaces [104]. The implant is not an option for patients who have undergone total meniscectomy. Meniscal Cysts: Symptoms, Causes, Diagnosis, and Treatment Bisson MA, Beckett KS, McGrouther DA, Grobbelaar AO, Mudera V. Transforming growth factor-beta1 stimulation enhances Dupuytren's fibroblast contraction in response to uniaxial mechanical load within a 3-dimensional collagen gel. The matrix surrounding these cells is mainly comprised of type I collagen, with small percentages of glycoproteins and collagen types III and V present [26, 27]. A preliminary report. Both TGF-1 and PDGF have been documented as growth factors involved in encouraging matrix contraction by meniscus cells, fibroblasts, and articular chondrocytes [232, 254-256]. Before Review of 132 menisci repaired by an arthroscopic inside-out technique. Even though the existing studies in meniscus tissue engineering show promising results, research needs to progress further. The meniscus withstands many different forces such as shear, tension, and compression. Mechanical stimulation of scaffold-free and self-assembled tissue has also shown promising results [229, 232, 238]. Duncan JB, Hunter R, Purnell M, Freeman J. Meniscal injuries associated with acute anterior cruciate ligament tears in alpine skiers. Paletta GA, Jr., Manning T, Snell E, Parker R, Bergfeld J. Directions for future research should also be guided by minimization of healthcare costs. Implantation in vivo may be substituted for, or performed subsequent to, bioreactor culture. Despite these positive findings, a 3-fold GAG loss and non-uniform cell distributions were observed within the re-seeded scaffolds [222]. The mean annual incidence of meniscal lesions has been reported to be 66 per 100,000 inhabitants, 61 of which result in meniscectomy [47, 48]. So far, different approaches and strategies have contributed to the in vitro generation of meniscus constructs, which are capable of restoring meniscal lesions to some extent, both functionally as well as anatomically. Nonetheless, the sensitivity and specificity of MRI for diagnosing meniscal lesions in children is considerably less than that for adults [92, 93]. Simonsen JL, Rosada C, Serakinci N, Justesen J, Stenderup K, Rattan SI, et al. Enhancement of the repair of meniscal wounds in the red-white zone (middle third) by the injection of bone marrow cells in canine animal model. Tumia NS, Johnstone AJ. Revell CM, Athanasiou KA. Kalpakci KN, Kim EJ, Athanasiou KA. Seedhom BB, Hargreaves DJ. Wrisberg rip | Radiology Reference Article | Radiopaedia.org Meniscal tearing during these sports is accompanied by anterior cruciate ligament (ACL) tearing in >80% of cases [52-58]. Variable cytocompatibility of six cell lines with photoinitiators used for polymerizing hydrogels and cell encapsulation. Simultaneously, the expansion in health services focused on child pathology, and the extensive use of highly specialized imaging techniques such as MRI, have aided in contributing to these diagnoses. Though the development of functional tissue-engineered meniscus constructs has advanced, important problems still persist. A torn meniscus can be sudden onset, acute knee injury, or it can develop gradually from wear and tear. Microvasculature of the human meniscus. Discoid lateral meniscus: importance, diagnosis, and treatment Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Cartilage-like tissue engineering using silk scaffolds and mesenchymal stem cells. The lack of acceptance and clinical application of the above methods is mainly due to a deficiency in long-term follow-up studies and replication of results, which could confirm these findings in a greater number of clinical cases. All rights reserved. Of these nine, b-FGF, PDGF-AB, EGF, and TGF- encouraged proliferation, with b-FGF inducing the greatest effect [241]. The lateral meniscus is on the outside of the knee. This characteristic is essential, since loading of the meniscus in vivo is highly non-uniform [38, 39]. Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. 2023 Healthline Media LLC. Some synthetic polymers may also inherently provide a more biomimetic environment than hydrogels for meniscus cells. The main stabilizing ligaments are the medial collateral ligament, the transverse ligament, the meniscofemoral ligaments, and attachments at the anterior and posterior horns (Figure 2) [8]. Meniscal roots in the knee refer to parts of the menisci which are critical attachment sites of the medial and lateral menisci to the central tibial plateau. Both fibroblasts [251] and articular chondrocytes [252] exert local contractile forces on their surrounding matrices. Hashimoto J, Kurosaka M, Yoshiya S, Hirohata K. Meniscal repair using fibrin sealant and endothelial cell growth factor. HYAFF-11 is another ECM component scaffold, made by modifying the glucoronic acid groups in hyaluronan. Baker BM, Mauck RL. The lateral meniscus is one of two semilunar fibrocartilaginous structures in the knee joint that act as shock absorbers, enhance joint stability, and aid in the distribution of synovial fluid. A third cell population has also been recognized in the superficial zone of the meniscus. Eiraku M, Takata N, Ishibashi H, Kawada M, Sakakura E, Okuda S, et al. The serial cultivation of human diploid cell strains. es 1. Effects of multiple chondroitinase ABC applications on tissue-engineered articular cartilage. The effect of cytokines on the proliferation and migration of bovine meniscal cells. Comparison of scaffolds and culture conditions for tissue engineering of the knee meniscus. Mesenchymal stem cells as trophic mediators. Knee joint. This C-shaped, rubbery, cartilage plays a key role in maintaining stability of the knee. If a meniscal tear is suspected following clinical examination, the application of an imaging technique should be pursued. Several investigations have demonstrated the comparatively high bioactivity of processed whole tissue scaffolds. Third, functional anisotropy must be manifest in an engineered meniscus. Meniscal repair using engineered tissue. Cells are then seeded in high density in a non-adherent biomaterial mold, secreting ECM that coalesces into a continuous tissue over several days. Herwig J, Egner E, Buddecke E. Chemical changes of human knee joint menisci in various stages of degeneration. Soppimath KS, Aminabhavi TM, Dave AM, Kumbar SG, Rudzinski WE. Local treatment of meniscal lesions with vascular endothelial growth factor. The outer one-third of the meniscus has a rich blood supply. Sixth, since self-assembled tissue has a continuous ECM, it may be more fully able to remodel itself in response to catabolic exogenous agents such as chondroitinase ABC (C-ABC). In general, most of these studies report that the overall success rate for meniscal repair in children appears analogous to that observed in adults, especially for cases of isolated tears [96-98]. Due to the large amount of variable parameters (method, time of application, magnitude, duration, and frequency of stimulation) the optimal and most dramatic combination of effects for mechanical stimuli likely remains undiscovered. Since the ECM largely confers the mechanical properties which underlie the primary functions of the knee meniscus, this is particularly salient. Zaleskas JM, Kinner B, Freyman TM, Yannas IV, Gibson LJ, Spector M. Growth factor regulation of smooth muscle actin expression and contraction of human articular chondrocytes and meniscal cells in a collagen-GAG matrix. Additionally, as this compression occurs, circumferential stress is created along the meniscus. Anderson DG, Risbud MV, Shapiro IM, Vaccaro AR, Albert TJ. Culture development for human embryonic stem cell propagation: molecular aspects and challenges. Cohen DL, Malone E, Lipson H, Bonassar LJ. Kurosaka M, Yoshiya S, Kuroda R, Matsui N, Yamamoto T, Tanaka J. Repeat tears of repaired menisci after arthroscopic confirmation of healing. J Athl Train. These techniques have been extensively described in the literature, along with their accompanying complications and appropriate rehabilitation programs, and will therefore not be largely discussed in the present review. TGF-1 has also been seen to up-regulate the expression and secretion of lubricin, or superficial zone protein (SZP) [250]. Shaffer B, Kennedy S, Klimkiewicz J, Yao L. Preoperative sizing of meniscal allografts in meniscus transplantation. Subsequent 3-D pellet culture of FGF-2 exposed meniscus cells revealed a 200-fold higher expression of collagen II and GAG than controls [258]. Yet, although these scaffolds are made of natural matrix, they may not completely recapitulate the cell microenvironment (i.e., the collagen VI pericellular matrix, collagen IX crosslinks, etc.).
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