Successful Total Meniscus Reconstruction Using a Novel Fiber-Reinforced Scaffold: A 16-and 32-Week Study in an Ovine Model
Successful Total Meniscus Reconstruction Using a Novel Fiber-Reinforced Scaffold: A 16-and 32-Week Study in an Ovine Model
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DOI：
10.1177/0363546515595065
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发表时间：
2015-10-01
影响因子：
4.8
通讯作者：
Dunn, Michael G.
中科院分区：
文献类型：
--
作者：
Merriam, Aaron R.;Patel, Jay M.;Dunn, Michael G.
背景：在美国，半月板损伤导致每年约85万例外科手术。虽然半月板切除术是最常见的骨科手术，但在半月板置换和再生方面进展甚微，目前还没有一种经美国食品和药物管理局批准的全半月板置换器械。假设：一种新型纤维增强半月板支架可用作功能性全半月板置换。研究设计：对照实验室研究。一种酪氨酸衍生的、聚合物纤维增强的胶原海绵半月板支架进行了力学评价（拉伸和压缩测试）和在绵羊全椎间盘切除术模型中植入16周和32周后的组织学结果（N = 20; 16例植入术加上4例盲肠切除术，在2个时间段内平均分配）。软骨损伤的程度也进行了测量胫骨平台上使用甲苯胺蓝表面染色和股骨髁上使用Mankin评分的组织学slide.Results：支架诱导形成的neomeniscus组织保持完整和功能，与断裂载荷接近250 N在16和32周相比，552 N的原生rabci。拉伸刚度值（16周和32周时分别为99和74 N/mm）也与自体半月板（147 N/mm）相当。与未植入（时间0）支架（0.15 MPa）相比，新半月板组织的压缩模量（16周和32周均为0.33 MPa）显著增加。有广泛的组织向内生长和细胞外基质沉积的组织学证据，I型和II型胶原的免疫组织化学证据。基于显著降低的表面损伤评分以及Mankin评分，与未处理的全椎间盘切除术相比，支架植入物提供了更好的关节软骨保护。这种新型纤维增强半月板支架可以作为功能性半月板置换物，其机械性能与天然半月板相似，同时保护膝关节软骨免受全膝关节切除术后的广泛损伤。临床意义：这种半月板置换支架有可能改善手术治疗，并为严重半月板损伤的患者提供更好的长期结局。
Background: Meniscus injuries in the United States result in an estimated 850,000 surgical procedures each year. Although meniscectomies are the most commonly performed orthopaedic surgery, little advancement has been made in meniscus replacement and regeneration, and there is currently no total meniscus replacement device approved by the Food and Drug Administration.Hypothesis: A novel fiber-reinforced meniscus scaffold can be used as a functional total meniscus replacement.Study Design: Controlled laboratory study.Methods: A tyrosine-derived, polymer fiber-reinforced collagen sponge meniscus scaffold was evaluated mechanically (tensile and compressive testing) and histologically after 16 and 32 weeks of implantation in an ovine total meniscectomy model (N = 20; 16 implants plus 4 meniscectomies, divided equally over the 2 time periods). The extent of cartilage damage was also measured on tibial plateaus by use of toluidine blue surface staining and on femoral condyles by use of Mankin scores on histological slides.Results: Scaffolds induced formation of neomeniscus tissue that remained intact and functional, with breaking loads approximating 250 N at both 16 and 32 weeks compared with 552 N for native menisci. Tensile stiffness values (99 and 74 N/mm at 16 and 32 weeks, respectively) were also comparable with those of the native meniscus (147 N/mm). The compressive modulus of the neomeniscus tissue (0.33 MPa at both 16 and 32 weeks) was significantly increased compared with unimplanted (time 0) scaffolds (0.15 MPa). There was histological evidence of extensive tissue ingrowth and extracellular matrix deposition, with immunohistochemical evidence of types I and II collagen. Based on significantly decreased surface damage scores as well as Mankin scores, the scaffold implants provided greater protection of articular cartilage compared with the untreated total meniscectomy.Conclusion: This novel fiber-reinforced meniscus scaffold can act as a functional meniscus replacement, with mechanical properties similar to those of the native meniscus, while protecting the articular cartilage of the knee from the extensive damage after a total meniscectomy.Clinical Relevance: This meniscus replacement scaffold has the potential to improve surgical treatment and provide better long-term outcomes for those suffering from severe meniscus damage.