One-Year Outcomes of Total Meniscus Reconstruction Using a Novel Fiber-Reinforced Scaffold in an Ovine Model
One-Year Outcomes of Total Meniscus Reconstruction Using a Novel Fiber-Reinforced Scaffold in an Ovine Model
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DOI：
10.1177/0363546515624913
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发表时间：
2016-04-01
影响因子：
4.8
通讯作者：
Dunn, Michael G.
中科院分区：
文献类型：
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作者：
Patel, Jay M.;Merriam, Aaron R.;Dunn, Michael G.
背景：半月板损伤和半月板切除会导致关节恶化，导致疼痛、不适和不稳定。目的：在绵羊半月板模型上评价新型可吸收聚合物纤维增强半月板重建支架的完整性、拉伸和压缩力学性能、细胞表型、基质组织和含量以及对关节软骨表面的保护作用。研究设计：对照实验室研究。方法：8只成年母羊在半月板全切除后植入纤维增强支架，另外2只动物接受半月板全切除手术。52周时处死动物，对植块和关节表面进行大体观察。外植体通过极限拉伸测试、限制性压缩蠕变测试以及生化、组织学和免疫组织化学分析进行表征。结果：1只绵羊因伸肌腱撕裂而退出研究；其余7只羊保持完好，并与骨隧道结合。所有的外植体都表现出功能性拉伸载荷、拉伸硬度和压缩模数。纤维软骨修复均观察到了1型和2型胶原，其基质组织和生化含量与天然组织相似。7个外植体中有5个出现体部狭窄。移植组的软骨损伤程度(股骨髁：3.43±0.79，胫骨平台：3.50±1.63)明显低于半月板切除组(股骨髁：8.50±/-3.54，胫骨平台：6.75+/-2.47)，并与之前报道的16周和32周时的Mankin评分相当。结论：可吸收纤维增强的半月板支架支持功能性新月板组织的形成，有可能防止通常发生在半月板全切除后的关节退变。临床相关性：半月板切除是一种非常常见的矫形手术，目前治疗严重的半月板组织丢失的选择很少。组织工程化半月板支架的成功开发可以大大减少半月板切除后关节退变的发生率，以及随后用于治疗的程序。
Background: Meniscus injuries and resulting meniscectomies lead to joint deterioration, causing pain, discomfort, and instability. Tissue-engineered devices to replace the meniscus have not shown consistent success with regard to function, mechanical integrity, or protection of cartilage.Purpose: To evaluate a novel resorbable polymer fiber-reinforced meniscus reconstruction scaffold in an ovine model for 52 weeks and assess its integrity, tensile and compressive mechanics, cell phenotypes, matrix organization and content, and protection of the articular cartilage surfaces.Study Design: Controlled laboratory study.Methods: Eight skeletally mature ewes were implanted with the fiber-reinforced scaffold after total meniscectomy, and 2 additional animals had untreated total meniscectomies. Animals were sacrificed at 52 weeks, and the explants and articular surfaces were analyzed macroscopically. Explants were characterized by ultimate tensile testing, confined compression creep testing, and biochemical, histological, and immunohistochemical analyses. Cartilage damage was characterized using the Mankin score on histologic slides from both the femur and tibia.Results: One sheep was removed from the study because of a torn extensor tendon; the remaining 7 explants remained fully intact and incorporated into the bone tunnels. All explants exhibited functional tensile loads, tensile stiffnesses, and compressive moduli. Fibrocartilagenous repair with both types 1 and 2 collagen were observed, with areas of matrix organization and biochemical content similar to native tissue. Narrowing in the body region was observed in 5 of 7 explants. Mankin scores showed less cartilage damage in the explant group (femoral condyle: 3.43 0.79, tibial plateau: 3.50 1.63) than in the meniscectomy group (femoral condyle: 8.50 +/- 3.54, tibial plateau: 6.75 +/- 2.47) and were comparable with Mankin scores at the previously reported 16- and 32-week time points.Conclusion: A resorbable fiber-reinforced meniscus scaffold supports formation of functional neomeniscus tissue, with the potential to prevent joint degeneration that typically occurs after total meniscectomy. Further studies with improvements to the initial mechanics of the scaffold and testing for longer time periods are warranted.Clinical Relevance: Meniscectomy is an extremely common orthopaedic procedure, and few options currently exist for the treatment of significant loss of meniscus tissue. Successful development of a tissue-engineered meniscus scaffold could substantially reduce the incidence of postmeniscectomy joint degeneration and the subsequent procedures used for its treatment.