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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2011

Open Access 01-03-2011 | Knee

Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2011

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Abstract

Purpose

To evaluate the long-term effects of implantation of a biodegradable polymer meniscus implant on articular cartilage degeneration and compare this to articular cartilage degeneration after meniscectomy.

Methods

Porous polymer polycaprolacton-based polyurethane meniscus implants were implanted for 6 or 24 months in the lateral compartment of Beagle dog knees. Contralateral knees were meniscectomized, or left intact and served as controls. Articular cartilage degeneration was evaluated in detail using India ink staining, routine histology, immunochemistry for denatured (Col2-¾M) and cleaved (Col2-¾Cshort) type II collagen, Mankin’s grading system, and cartilage thickness measurements.

Results

Histologically, fibrillation and substantial immunohistochemical staining for both denatured and cleaved type II collagen were found in all three treatment groups. The cartilage of the three groups showed identical degradation patterns. In the 24 months implant group, degradation appeared to be more severe when compared to the 6 months implant group and meniscectomy group. Significantly more cartilage damage (India ink staining, Mankin’s grading system, and cartilage thickness measurements) was found in the 24 months implant group compared to the 6 months implant group and meniscectomy group.

Conclusion

Degradation of the cartilage matrix was the result of both mechanical overloading as well as localized cell-mediated degradation. The degeneration patterns were highly variable between animals. Clinical application of a porous polymer implant for total meniscus replacement is not supported by this study.
Literature
1.
go back to reference Aagaard H, Jorgensen U, Bojsen MF (1999) Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep. Knee Surg Sports Traumatol Arthrosc 7:184–191CrossRefPubMed Aagaard H, Jorgensen U, Bojsen MF (1999) Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep. Knee Surg Sports Traumatol Arthrosc 7:184–191CrossRefPubMed
2.
go back to reference Bae WC, Wong VW, Hwang J, Antonacci JM, Nugent-Derfus GE, Blewis ME, Temple-Wong MM, Sah RL (2008) Wear-lines and split-lines of human patellar cartilage: relation to tensile biomechanical properties. Osteoarthr Cartil 16:841–845CrossRefPubMed Bae WC, Wong VW, Hwang J, Antonacci JM, Nugent-Derfus GE, Blewis ME, Temple-Wong MM, Sah RL (2008) Wear-lines and split-lines of human patellar cartilage: relation to tensile biomechanical properties. Osteoarthr Cartil 16:841–845CrossRefPubMed
3.
go back to reference Bruns J, Kahrs J, Kampen J, Behrens P, Plitz W (1998) Autologous perichondral tissue for meniscal replacement. J Bone Joint Surg Br 80:918–923CrossRefPubMed Bruns J, Kahrs J, Kampen J, Behrens P, Plitz W (1998) Autologous perichondral tissue for meniscal replacement. J Bone Joint Surg Br 80:918–923CrossRefPubMed
4.
go back to reference Bruns J, Kampen J, Kahrs J, Plitz W (2000) Autologous meniscus replacement with rib perichondrium Experimental results. Orthopade 29:145–150CrossRefPubMed Bruns J, Kampen J, Kahrs J, Plitz W (2000) Autologous meniscus replacement with rib perichondrium Experimental results. Orthopade 29:145–150CrossRefPubMed
5.
go back to reference Crook TB, Ardolino A, Williams LA, Barlow IW (2009) Meniscal allograft transplantation: a review of the current literature. Ann R Coll Surg Engl 91:361–365CrossRefPubMed Crook TB, Ardolino A, Williams LA, Barlow IW (2009) Meniscal allograft transplantation: a review of the current literature. Ann R Coll Surg Engl 91:361–365CrossRefPubMed
6.
go back to reference Dienst M, Greis PE, Ellis BJ, Bachus KN, Burks RT (2007) Effect of lateral meniscal allograft sizing on contact mechanics of the lateral tibial plateau: an experimental study in human cadaveric knee joints. Am J Sports Med 35:34–42CrossRefPubMed Dienst M, Greis PE, Ellis BJ, Bachus KN, Burks RT (2007) Effect of lateral meniscal allograft sizing on contact mechanics of the lateral tibial plateau: an experimental study in human cadaveric knee joints. Am J Sports Med 35:34–42CrossRefPubMed
7.
go back to reference Elliott DM III, JR Setton LA, Scully SP, Vail P, Guilak F (2002) Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage. Knee Surg Sports Traumatol Arthrosc 10:109–118CrossRefPubMed Elliott DM III, JR Setton LA, Scully SP, Vail P, Guilak F (2002) Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage. Knee Surg Sports Traumatol Arthrosc 10:109–118CrossRefPubMed
8.
go back to reference Heijkants RG, van Calck RV, de Groot JH, Pennings AJ, Schouten AJ, van Tienen TG, Ramrattan N, Buma P, Veth RP (2004) Design, synthesis and properties of a degradable polyurethane scaffold for meniscus regeneration. J Mater Sci Mater Med 15:423–427CrossRefPubMed Heijkants RG, van Calck RV, de Groot JH, Pennings AJ, Schouten AJ, van Tienen TG, Ramrattan N, Buma P, Veth RP (2004) Design, synthesis and properties of a degradable polyurethane scaffold for meniscus regeneration. J Mater Sci Mater Med 15:423–427CrossRefPubMed
9.
go back to reference Heijkants RG, van Calck RV, van Tienen TG, de Groot JH, Buma P, Pennings AJ, Veth RP, Schouten AJ (2005) Uncatalyzed synthesis, thermal and mechanical properties of polyurethanes based on poly (epsilon-caprolactone) and 1,4-butane diisocyanate with uniform hard segment. Biomaterials 26:4219–4228CrossRefPubMed Heijkants RG, van Calck RV, van Tienen TG, de Groot JH, Buma P, Pennings AJ, Veth RP, Schouten AJ (2005) Uncatalyzed synthesis, thermal and mechanical properties of polyurethanes based on poly (epsilon-caprolactone) and 1,4-butane diisocyanate with uniform hard segment. Biomaterials 26:4219–4228CrossRefPubMed
10.
go back to reference Kang SW, Son SM, Lee JS, Lee ES, Lee KY, Park SG, Park JH, Kim BS (2006) Regeneration of whole meniscus using meniscal cells and polymer scaffolds in a rabbit total meniscectomy model. J Biomed Mater Res A 77:659–671PubMed Kang SW, Son SM, Lee JS, Lee ES, Lee KY, Park SG, Park JH, Kim BS (2006) Regeneration of whole meniscus using meniscal cells and polymer scaffolds in a rabbit total meniscectomy model. J Biomed Mater Res A 77:659–671PubMed
11.
go back to reference Kelly BT, Robertson W, Potter HG, Deng XH, Turner AS, Lyman S, Warren RF, Rodeo SA (2007) Hydrogel meniscal replacement in the sheep knee: preliminary evaluation of chondroprotective effects. Am J Sports Med 35:43–52CrossRefPubMed Kelly BT, Robertson W, Potter HG, Deng XH, Turner AS, Lyman S, Warren RF, Rodeo SA (2007) Hydrogel meniscal replacement in the sheep knee: preliminary evaluation of chondroprotective effects. Am J Sports Med 35:43–52CrossRefPubMed
12.
go back to reference Khetia EA, McKeon BP (2007) Meniscal allografts: biomechanics and techniques. Sports Med Arthrosc 15:114–120CrossRefPubMed Khetia EA, McKeon BP (2007) Meniscal allografts: biomechanics and techniques. Sports Med Arthrosc 15:114–120CrossRefPubMed
13.
go back to reference Klompmaker J, Veth RP, Jansen HW, Nielsen HK, de Groot JH, Pennings AJ (1996) Meniscal replacement using a porous polymer prosthesis: a preliminary study in the dog. Biomaterials 17:1169–1175CrossRefPubMed Klompmaker J, Veth RP, Jansen HW, Nielsen HK, de Groot JH, Pennings AJ (1996) Meniscal replacement using a porous polymer prosthesis: a preliminary study in the dog. Biomaterials 17:1169–1175CrossRefPubMed
14.
go back to reference Kobayashi M, Chang YS, Oka M (2005) A two year in vivo study of polyvinyl alcohol-hydrogel (PVA-H) artificial meniscus. Biomaterials 26:3243–3248CrossRefPubMed Kobayashi M, Chang YS, Oka M (2005) A two year in vivo study of polyvinyl alcohol-hydrogel (PVA-H) artificial meniscus. Biomaterials 26:3243–3248CrossRefPubMed
15.
go back to reference Kohn D, Rudert M, Wirth CJ, Plitz W, Reiss G, Maschek H (1997) Medial meniscus replacement by a fat pad autograft. An experimental study in sheep. Int Orthop 21:232–238CrossRefPubMed Kohn D, Rudert M, Wirth CJ, Plitz W, Reiss G, Maschek H (1997) Medial meniscus replacement by a fat pad autograft. An experimental study in sheep. Int Orthop 21:232–238CrossRefPubMed
16.
go back to reference Kohn D, Wirth CJ, Reiss G, Plitz W, Maschek H, Erhardt W, Wulker N (1992) Medial meniscus replacement by a tendon autograft.Experiments in sheep. J Bone Joint Surg Br 74:910–917PubMed Kohn D, Wirth CJ, Reiss G, Plitz W, Maschek H, Erhardt W, Wulker N (1992) Medial meniscus replacement by a tendon autograft.Experiments in sheep. J Bone Joint Surg Br 74:910–917PubMed
17.
go back to reference Kon E, Chiari C, Marcacci M, Delcogliano M, Salter DM, Martin I, Ambrosio L, Fini M, Tschon M, Tognana E, Plasenzotti R, Nehrer S (2008) Tissue engineering for total meniscal substitution: animal study in sheep model. Tissue Eng Part A 14:1067–1080CrossRefPubMed Kon E, Chiari C, Marcacci M, Delcogliano M, Salter DM, Martin I, Ambrosio L, Fini M, Tschon M, Tognana E, Plasenzotti R, Nehrer S (2008) Tissue engineering for total meniscal substitution: animal study in sheep model. Tissue Eng Part A 14:1067–1080CrossRefPubMed
18.
go back to reference Konttinen YT, Ma J, Ruuttilal P, Hukkanen M, Santavirta S (2005) Chondrocyte-mediated collagenolysis correlates with cartilage destruction grades in osteoarthritis. Clin Exp Rheumatol 23:19–26PubMed Konttinen YT, Ma J, Ruuttilal P, Hukkanen M, Santavirta S (2005) Chondrocyte-mediated collagenolysis correlates with cartilage destruction grades in osteoarthritis. Clin Exp Rheumatol 23:19–26PubMed
19.
go back to reference Mankin HJ, Dorfman H, Lippiello L, Zarins A (1971) Biochemical and metabolic abnormalities in articular cartilage from osteo-arthritic human hips II. Correlation of morphology with biochemical and metabolic data. J Bone Joint Surg Am 53:523–537PubMed Mankin HJ, Dorfman H, Lippiello L, Zarins A (1971) Biochemical and metabolic abnormalities in articular cartilage from osteo-arthritic human hips II. Correlation of morphology with biochemical and metabolic data. J Bone Joint Surg Am 53:523–537PubMed
20.
go back to reference McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88:1549–1556PubMed McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88:1549–1556PubMed
21.
go back to reference McDermott ID, Sharifi F, Bull AM, Gupte CM, Thomas RW, Amis AA (2004) An anatomical study of meniscal allograft sizing. Knee Surg Sports Traumatol Arthrosc 12:130–135CrossRefPubMed McDermott ID, Sharifi F, Bull AM, Gupte CM, Thomas RW, Amis AA (2004) An anatomical study of meniscal allograft sizing. Knee Surg Sports Traumatol Arthrosc 12:130–135CrossRefPubMed
22.
go back to reference Messner K (1994) Meniscal substitution with a teflon-periosteal composite graft: a rabbit experiment. Biomaterials 15:223–230CrossRefPubMed Messner K (1994) Meniscal substitution with a teflon-periosteal composite graft: a rabbit experiment. Biomaterials 15:223–230CrossRefPubMed
23.
go back to reference Messner K (1994) The concept of a permanent synthetic meniscus prosthesis: a critical discussion after 5 years of experimental investigations using dacron and teflon implants. Biomaterials 15:243–250CrossRefPubMed Messner K (1994) The concept of a permanent synthetic meniscus prosthesis: a critical discussion after 5 years of experimental investigations using dacron and teflon implants. Biomaterials 15:243–250CrossRefPubMed
24.
go back to reference Mora G, Alvarez E, Ripalda P, Forriol F (2003) Articular cartilage degeneration after frozen meniscus and Achilles tendon allograft transplantation: experimental study in sheep. Arthroscopy 19:833–841CrossRefPubMed Mora G, Alvarez E, Ripalda P, Forriol F (2003) Articular cartilage degeneration after frozen meniscus and Achilles tendon allograft transplantation: experimental study in sheep. Arthroscopy 19:833–841CrossRefPubMed
25.
go back to reference Noyes FR, Barber-Westin SD (2005) Meniscus transplantation: indications, techniques, clinical outcomes. Instr Course Lect 54:341–353PubMed Noyes FR, Barber-Westin SD (2005) Meniscus transplantation: indications, techniques, clinical outcomes. Instr Course Lect 54:341–353PubMed
26.
go back to reference Pastoureau P, Chomel A (2004) Methods for cartilage and subchondral bone histomorphometry. Methods Mol Med 101:79–91PubMed Pastoureau P, Chomel A (2004) Methods for cartilage and subchondral bone histomorphometry. Methods Mol Med 101:79–91PubMed
27.
go back to reference Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F (2001) Meniscal allograft transplantation. Two-to eight-year results. Am J Sports Med 29:410–414PubMed Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F (2001) Meniscal allograft transplantation. Two-to eight-year results. Am J Sports Med 29:410–414PubMed
28.
go back to reference Rijk PC, Tigchelaar-Gutter W, Bernoski FP, Van Noorden CJ (2004) Histologic changes in articular cartilage after medial meniscus replacement in rabbits. Arthroscopy 20:911–917PubMed Rijk PC, Tigchelaar-Gutter W, Bernoski FP, Van Noorden CJ (2004) Histologic changes in articular cartilage after medial meniscus replacement in rabbits. Arthroscopy 20:911–917PubMed
29.
go back to reference Sekaran SV, Hull ML, Howell SM (2002) Nonanatomic location of the posterior horn of a medial meniscal autograft implanted in a cadaveric knee adversely affects the pressure distribution on the tibial plateau. Am J Sports Med 30:74–82PubMed Sekaran SV, Hull ML, Howell SM (2002) Nonanatomic location of the posterior horn of a medial meniscal autograft implanted in a cadaveric knee adversely affects the pressure distribution on the tibial plateau. Am J Sports Med 30:74–82PubMed
30.
go back to reference Sohn DH, Toth AP (2008) Meniscus transplantation: current concepts. J Knee Surg 21:163–172PubMed Sohn DH, Toth AP (2008) Meniscus transplantation: current concepts. J Knee Surg 21:163–172PubMed
31.
go back to reference Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL (2000) Meniscal allograft transplantation: a 1 to 5-year follow-up of 22 patients. Arthroscopy 16:343–347CrossRefPubMed Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL (2000) Meniscal allograft transplantation: a 1 to 5-year follow-up of 22 patients. Arthroscopy 16:343–347CrossRefPubMed
32.
go back to reference Szomor ZL, Martin TE, Bonar F, Murrell GA (2000) The protective effects of meniscal transplantation on cartilage. An experimental study in sheep. J Bone Joint Surg Am 82:80–88PubMed Szomor ZL, Martin TE, Bonar F, Murrell GA (2000) The protective effects of meniscal transplantation on cartilage. An experimental study in sheep. J Bone Joint Surg Am 82:80–88PubMed
33.
go back to reference Thomas CM, Fuller CJ, Whittles CE, Sharif M (2007) Chondrocyte death by apoptosis is associated with cartilage matrix degradation. Osteoarthr Cartil 15:27–34CrossRefPubMed Thomas CM, Fuller CJ, Whittles CE, Sharif M (2007) Chondrocyte death by apoptosis is associated with cartilage matrix degradation. Osteoarthr Cartil 15:27–34CrossRefPubMed
34.
go back to reference Toyonaga T, Uezaki N, Chikama H (1983) Substitute meniscus of Teflon-net for the knee joint of dogs. Clin Orthop 291–297 Toyonaga T, Uezaki N, Chikama H (1983) Substitute meniscus of Teflon-net for the knee joint of dogs. Clin Orthop 291–297
35.
go back to reference van Arkel ER, de Boer HH (2002) Survival analysis of human meniscal transplantations. J Bone Joint Surg Br 84:227–231CrossRefPubMed van Arkel ER, de Boer HH (2002) Survival analysis of human meniscal transplantations. J Bone Joint Surg Br 84:227–231CrossRefPubMed
36.
go back to reference van Tienen TG, Hannink G, Buma P (2009) Meniscus replacement using synthetic materials. Clin Sports Med 28:143–156CrossRefPubMed van Tienen TG, Hannink G, Buma P (2009) Meniscus replacement using synthetic materials. Clin Sports Med 28:143–156CrossRefPubMed
37.
go back to reference van Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Poole AR, Veth RP, Buma P (2003) Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs. Osteoarthr Cartil 11:78–84CrossRefPubMed van Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Poole AR, Veth RP, Buma P (2003) Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs. Osteoarthr Cartil 11:78–84CrossRefPubMed
38.
go back to reference van Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Schouten AJ, Veth RP, Buma P (2006) Replacement of the knee meniscus by a porous polymer implant: a study in dogs. Am J Sports Med 34:64–71CrossRefPubMed van Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Schouten AJ, Veth RP, Buma P (2006) Replacement of the knee meniscus by a porous polymer implant: a study in dogs. Am J Sports Med 34:64–71CrossRefPubMed
39.
go back to reference van Tienen TG, Heijkants RG, de Groot JH, Schouten AJ, Pennings AJ, Veth RP, Buma P (2006) Meniscal replacement in dogs. Tissue regeneration in two different materials with similar properties. J Biomed Mater Res B Appl Biomater 76:389–396PubMed van Tienen TG, Heijkants RG, de Groot JH, Schouten AJ, Pennings AJ, Veth RP, Buma P (2006) Meniscal replacement in dogs. Tissue regeneration in two different materials with similar properties. J Biomed Mater Res B Appl Biomater 76:389–396PubMed
40.
go back to reference von Lewinski G, Kohn D, Wirth CJ, Lazovic D (2008) The influence of nonanatomical insertion and incongruence of meniscal transplants on the articular cartilage in an ovine model. Am J Sports Med 36:841–850CrossRef von Lewinski G, Kohn D, Wirth CJ, Lazovic D (2008) The influence of nonanatomical insertion and incongruence of meniscal transplants on the articular cartilage in an ovine model. Am J Sports Med 36:841–850CrossRef
41.
go back to reference Welsing RT, van Tienen TG, Ramrattan N, Heijkants R, Schouten AJ, Veth RP, Buma P (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 36:1978–1989CrossRefPubMed Welsing RT, van Tienen TG, Ramrattan N, Heijkants R, Schouten AJ, Veth RP, Buma P (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 36:1978–1989CrossRefPubMed
42.
go back to reference Wilson W, van Burken C, van Donkelaar C, Buma P, van Rietbergen B, Huiskes R (2006) Causes of mechanically induced collagen damage in articular cartilage. J Orthop Res 24:220–228CrossRefPubMed Wilson W, van Burken C, van Donkelaar C, Buma P, van Rietbergen B, Huiskes R (2006) Causes of mechanically induced collagen damage in articular cartilage. J Orthop Res 24:220–228CrossRefPubMed
43.
go back to reference Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30:174–181PubMed Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30:174–181PubMed
44.
go back to reference Wood DJ, Minns RJ, Strover A (1990) Replacement of the rabbit medial meniscus with a polyester-carbon fibre bioprosthesis. Biomaterials 11:13–16CrossRefPubMed Wood DJ, Minns RJ, Strover A (1990) Replacement of the rabbit medial meniscus with a polyester-carbon fibre bioprosthesis. Biomaterials 11:13–16CrossRefPubMed
45.
go back to reference Zaffagnini S, Giordano G, Vascellari A, Bruni D, Neri MP, Iacono F, Kon E, Presti ML, Marcacci M (2007) Arthroscopic collagen meniscus implant results at 6 to 8 years follow up. Knee Surg Sports Traumatol Arthrosc 15:175–183CrossRefPubMed Zaffagnini S, Giordano G, Vascellari A, Bruni D, Neri MP, Iacono F, Kon E, Presti ML, Marcacci M (2007) Arthroscopic collagen meniscus implant results at 6 to 8 years follow up. Knee Surg Sports Traumatol Arthrosc 15:175–183CrossRefPubMed
Metadata
Title
Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant
Publication date
01-03-2011
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1244-8

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