Hydrogel meniscal replacement in the sheep knee - Preliminary evaluation of chondroprotective effects
Hydrogel meniscal replacement in the sheep knee - Preliminary evaluation of chondroprotective effects
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DOI：
10.1177/0363546506292848
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发表时间：
2007-01-01
影响因子：
4.8
通讯作者：
Rodeo, Scott A.
中科院分区：
文献类型：
--
作者：
Kelly, Bryan T.;Robertson, William;Rodeo, Scott A.
背景：半月板同种异体移植已成为部分半月板缺失或无法修复患者的一种可行的手术选择。主观结果令人鼓舞；但同种异体半月板移植的长期成功性、耐久性和安全性尚不确定。
目的：在绵羊模型中评估一种新型水凝胶半月板替代植入物，并使用几种经过验证的结果测量方法评估这种水凝胶半月板替代物的软骨保护作用。
研究设计：对照实验室研究。
方法：14只骨骼成熟的绵羊接受了水凝胶半月板替代；另外45只动物此前接受了以下3种手术中的1种：外侧半月板切除术（24只）、半月板同种异体移植（17只）和假手术（4只）。在2、4或12个月时处死动物。通过磁共振成像、大体检查、生物力学测试和半定量组织学分析对软骨进行评估。
结果：假手术组和未手术的对照肢体之间没有差异。与半月板切除术相比，水凝胶半月板替代在所有结果参数上均使软骨退变显著减少（P <.05）。与未手术的对照肢体相比，水凝胶半月板替代物在2个月时在任何类别中均无显著差异。到4个月时，水凝胶组肢体在所有类别中均显示出比未手术对照肢体更严重的软骨退变。与半月板同种异体移植动物相比，水凝胶半月板替代物在2个月时无差异，但在4个月时胫骨平台周边区域的软骨退变显著增加（P <.05）。在1年时，所有水凝胶植入物在植入物的后三分之一处都出现了完全的放射状裂缝。
结论：尽管在早期时间点水凝胶半月板替代显示出有希望的初步结果，但在1年时出现了显著的软骨退变和植入物失败，并且总体表现比同种异体移植更差。水凝胶材料性能和表面特性的改进以及更准确的尺寸匹配可能会改善结果。
临床相关性：水凝胶材料性能和表面特性的改进以及更准确的尺寸匹配可能会导致水凝胶植入物在人类中的应用。
Background: Meniscal allograft transplantation has become a viable surgical alternative for a select group of patients with deficient or irreparable menisci. Subjective results are encouraging; long-term success, durability, and safety of allograft meniscal transplantation are uncertain.Purposes: To evaluate a novel hydrogel meniscal replacement implant in an ovine model and assess chondroprotective effects of this hydrogel meniscal replacement using several validated outcome measures.Study Design: Controlled laboratory study.Methods: Fourteen skeletally mature sheep underwent hydrogel meniscal replacement; 45 additional animals had previously undergone 1 of 3 operations: lateral meniscectomy (24), meniscal allograft transplant (17), and sham (4). Animals were sacrificed at 2, 4, or 12 months. Cartilage was assessed by magnetic resonance imaging, gross inspection, biomechanical testing, and semiquantitative histological analysis.Results: There were no differences between the sham operation and nonoperated control limbs. Compared with meniscectomy, hydrogel meniscal replacement resulted in significantly decreased cartilage degeneration with all outcome parameters (P < .05). Compared with nonoperated control limbs, hydrogel meniscal replacements demonstrated no significant differences at 2 months in any category. By 4 months, hydrogel limbs demonstrated significantly greater cartilage degeneration than did nonoperated control limbs in all categories. Compared with meniscal allograft transplantation animals, hydrogel meniscal replacements demonstrated no differences at 2 months but had significantly increased cartilage degeneration in the peripheral zone of the tibial plateau at 4 months (P < .05). At 1 year, all hydrogel implants had developed complete radial splits in the posterior third of the implant.Conclusion: Although promising preliminary results for hydrogel meniscal replacement were seen at early time points, significant cartilage degeneration and implant failure were seen at 1 year, and overall performance was worse than was allograft transplantation. Improvements in hydrogel material properties and surface characteristics and more accurate size matching may improve outcomes.Clinical Relevance: Improvements in the hydrogel material properties and surface characteristics and more accurate size matching may lead to the use of hydrogel implants in humans.