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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]. Yet, in general, ECM component scaffolds are more intrinsically biomimetic than synthetic and hydrogel materials. The lateral compartment is convex in a convex configuration. Healing lesions found in the inner avascular region, which functions under a highly demanding mechanical environment, is considered to be a significant challenge. Effects of multiple chondroitinase ABC applications on tissue-engineered articular cartilage. Lechner K, Hull ML, Howell SM. Daniel D, Daniels E, Aronson D. The diagnosis of meniscus pathology. Location. Effects of temporal hydrostatic pressure on tissue-engineered bovine articular cartilage constructs. Development of the menisci of the human knee joint. Springer Berlin Heidelberg. Agrawal CM, Ray RB. Do physical diagnostic tests accurately detect meniscal tears? Meniscal repair using engineered tissue. Other tissue engineers have taken advantage of various methods to create cell-seeded hydrogel scaffolds that accurately represent the complex geometry of the meniscus. Salata MJ, Gibbs AE, Sekiya JK. A meniscal cyst is a collection of joint fluid (also called synovial fluid) that forms when there is a tear within the meniscus cartilage, usually due to a knee injury. A recent investigation developed a hybrid scaffold consisting of chitosan, hyaluronan, chondroitin-6-sulfate, collagen I, and collagen II molecules [208]. Combined effects of growth factors and static mechanical compression on meniscus explant biosynthesis. 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. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Meniscal Tears: Current Understanding, Diagnosis, and Management Systematic assessment of growth factor treatment on biochemical and biomechanical properties of engineered articular cartilage constructs. In addition to this, investigation of the biomechanical properties of healed meniscus in experimental and clinical studies is essential. Finally, this acellular scaffold's primary mode of healing is thought to be through host cell migration and subsequent synthesis of meniscus matrix, yet results in sheep have indicated more developed healing if collagen meniscus implants are seeded with autologous fibrochondrocytes [101]. Lastly, as of this writing, the FDA approval granted to the collagen meniscus implant in 2008 has been rescinded, and the device has been removed from clinical use. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. You have to take care of yourself, though. Telomerase expression extends the proliferative lifespan and maintains the osteogenic potential of human bone marrow stromal cells. Improving the healing process in this type of injury is an ongoing challenge for clinicians and researchers. At the time the article was created Henry Knipe had no recorded disclosures. An experimental study in dogs. Nakata K, Shino K, Hamada M, Mae T, Miyama T, Shinjo H, et al. Veilleux N, Spector M. Effects of FGF-2 and IGF-1 on adult canine articular chondrocytes in type II collagen-glycosaminoglycan scaffolds in vitro. Deep dissection. Similar results have also been reported in a longer-term study with SIS specimens assessed after up to 12 months of implantation, although the study also reported samples with biomechanics inferior to contralateral meniscectomy [217]. Because of these methods, ECM scaffolds may possess strength comparable to synthetic scaffolds. Deep dissection. A direct compression stimulator for articular cartilage and meniscal explants. Chiari C, Koller U, Dorotka R, Eder C, Plasenzotti R, Lang S, et al. Tissue engineering has spurred recent advances in synthetic polymer scaffolds that emphasize and build upon the advantages stated above. Currently, many surgeons use this method to transplant bone marrow-derived stem cells (BMSCs) for bone healing applications due to its high value and low risk and cost [130]. Three-dimensional culture of human meniscal cells: extracellular matrix and proteoglycan production. You may be experiencing knee pain and want to know the possible causes. Cells in the superficial layer of the meniscus are small and round. Diagnosis of internal derangements of the knee. Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Meniscus Tears - OrthoInfo - AAOS Proctor CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Lee SY, Niikura T, Reddi AH. The main challenges in this field coincide with the main challenges of tissue engineering in general: development of functional tissue mirroring the composition of native tissue, which will satisfactorily integrate with the host, and which will allow long-term preservation of cell viability and meniscus function. 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). The meniscofemoral ligaments, also known as the Humphrey and Wrisberg ligaments, connect the posterior horn of the lateral meniscus to a location near the insertion site of the posterior cruciate ligament on the medial femoral condyle. 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. Become a Gold Supporter and see no third-party ads. Angel KR, Hall DJ. From a clinical perspective, ECM scaffolds have received perhaps the most attention of all scaffold categories, due to the use of collagen meniscus implants. Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Imaging modalities that need to be applied when diagnosing such injuries are X-ray and MRI [12]. Selection of cells is of paramount importance. The microvasculature of the meniscus and its response to injury. Studies of native menisci have deemed pore sizes of 100-150 microns as appropriate for meniscus cells [219], yet cell infiltration can be highly variant through the depths of both whole processed tissue (SIS, dermis, etc.) Knee and tibiofibular joint.Deep dissection. They will also consider the type, size, and location of the injury. Hashimoto J, Kurosaka M, Yoshiya S, Hirohata K. Meniscal repair using fibrin sealant and endothelial cell growth factor. Howell GED. Fink C, Fermor B, Weinberg JB, Pisetsky DS, Misukonis MA, Guilak F. The effect of dynamic mechanical compression on nitric oxide production in the meniscus. Chondrocytic differentiation of human adipose-derived adult stem cells in elastin-like polypeptide. The meniscus: review of basic principles with application to surgery and rehabilitation. A ligament is a type of, Before being recognized by the brain, sound waves enter the auditory canal, go through the eardrum, and then enter the middle ear. Noyes FR, Barber-Westin SD. Since cell-seeded polymers consistently outperform acellular scaffolds in terms of regenerative capacity [101, 147, 148], this section will primarily focus on studies examining the capabilities of scaffolds incorporating cells. LCL tears usually heal after three to 12 weeks, depending on severity. Although this scaffold has not yet been applied to meniscus tissue engineering, it may greatly aid in coupling cell-mediated matrix remodeling to scaffold degradation. Explant and engineered tissue can demonstrate varied remodeling responses to hydrostatic pressure. During everyday activity, axial tibiofemoral forces compress the menisci. Such meniscal lesions lead to joint swelling, joint line pain, and mechanical blocking [81, 82]. Hydrogels represent a versatile class of tissue engineering scaffolds, but their mechanical properties (especially in tension) and bioactivity (especially in promoting meniscus cell phenotype and ECM synthesis) need to be improved. Tennis players and weight lifters are prone to tears of the lateral meniscus. 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. In addition, once implanted, scaffold degradation and shrinkage as well as shape incongruency remain significant issues [213, 214]. Most patients report an acute onset of sharp pain following a twisting injury with the knee flexed and the foot planted on the ground [59, 60]. Aggrecan is the major large proteoglycan of the meniscus while biglycan and decorin are the main small proteoglycans [22]. Meniscal repair using an exogenous fibrin clot. The bioactive phospholipid lysophosphatidic acid is released from activated platelets. J Athl Train. However, more studies using C-ABC for meniscus tissue engineering, especially in conjunction with other stimuli, are necessary. In another study, researchers used four different types of cells: allogeneic chondrocytes, MSCs, fibroblasts, and human umbilical cord blood (hUCB) stem cells, and embedded them in PLA scaffolds to repair cartilage defects in a rabbit model [111]. Cheung HS. Upton ML, Chen J, Guilak F, Setton LA. Induction of meniscal regeneration in dogs using a novel biomaterial. The site is secure. Soppimath KS, Aminabhavi TM, Dave AM, Kumbar SG, Rudzinski WE. Elder BD, Athanasiou KA. Thie M, Schlumberger W, Rauterberg J, Robenek H. Mechanical confinement inhibits collagen synthesis in gel-cultured fibroblasts. This way, one can distinguish between different types of meniscal tearsthe most important being vertical/longitudinal (including bucket handle), flat/oblique, radial/transverse, and horizontal/complex (including degenerative) [63]. Mechanisms of cartilage growth: modulation of balance between proteoglycan and collagen in vitro using chondroitinase ABC. Suture techniques are determined based on the location and extent of peripheral tear . Future research in this direction is needed. Englund M, Niu J, Guermazi A, Roemer FW, Hunter DJ, Lynch JA, et al. Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, et al. Sweigart MA, Zhu CF, Burt DM, DeHoll PD, Agrawal CM, Clanton TO, et al. Incorporation of a matrix metalloproteinase-sensitive substrate into self-assembling peptides - a model for biofunctional scaffolds. Of these nine, b-FGF, PDGF-AB, EGF, and TGF- encouraged proliferation, with b-FGF inducing the greatest effect [241]. If a meniscal tear is suspected following clinical examination, the application of an imaging technique should be pursued. Dynamic culture enhances stem cell infiltration and modulates extracellular matrix production on aligned electrospun nanofibrous scaffolds. Apart from its potential clinical benefit, a tissue-engineered meniscus can also be of great use in the study of developmental, regenerative, and degenerative processes in the knee. 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. The current prevailing trend in repairing meniscus-related lesions is to maintain the tissue intact whenever possible [4-6]. Anterior view. small ligaments/retinaculia from LM to the capsule: inferior meniscopopliteal ligament at the body: the floor of popliteal hiatus, superior and inferior meniscopopliteal ligaments at body-posterior horn junction, superior meniscopopliteal ligament at posterior horn: the roof of popliteal hiatus. Another strategy is the local administration of autologous MSCs to replenish the population of local cells which has been diminished due to trauma, degeneration, tissue defects, or compromised vascularity. 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. In these constructs, collagen and GAG content, as well as compressive properties, were all significantly higher than control or dynamic hydrostatic pressure regimens run at 0.1 or 1 Hz [271]. Moutos FT, Freed LE, Guilak F. A biomimetic three-dimensional woven composite scaffold for functional tissue engineering of cartilage. Lee HJ, Lee JS, Chansakul T, Yu C, Elisseeff JH, Yu SM. Other techniques use vascularized synovial flaps or fibrin clots, based on the same rationale [133-138]. Chau Y, Luo Y, Cheung AC, Nagai Y, Zhang S, Kobler JB, et al. Evaluation of a porous polyurethane scaffold in a partial meniscal defect ovine model. Methods for generating mechanical anisotropy within synthetic cartilage scaffolds are one example. Additionally, biological and mechanical performance after recellularization and in vivo implantation represent areas for further exploration. Other researchers have shown that aggrecan surfaces are more effective in encouraging meniscus cell ECM deposition than collagen I surfaces [104]. 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]. More severe tears of the lateral meniscus require surgical repair or removal, which can often be done arthroscopically. Pain in the knee. Knee Pain Location Chart: What Knee Pain May Indicate - Healthline Yaeger PC, Masi TL, de Ortiz JL, Binette F, Tubo R, McPherson JM. lateral meniscus C-shape - tight and closed off more like an incomplete circle, i.e. Tears can also be treated by allowing it to heal naturally, immobilizing the knee to prevent further damage. Tears in the avascular zone of the meniscus are generally more complex and broad, and are often associated with a poor prognosis following repair. Meniscus Tear in Knee: Symptoms, Causes, and Treatments - WebMD However, monolayer expansion of meniscus cells leads to significant downregulation of ECM gene expression [104]. The medial and lateral menisci differ in size and shape as follows: C-shape -open and wide, almost semi-circular, posterior horn substantially larger than anterior horn, C-shape -tight and closed off more like an incomplete circle,i.e. These woven scaffolds may be combined with hydrogels to make composites capable of supporting seeded articular chondrocytes or adipose-derived stem cells [168, 169]. Ghosh P, Taylor TK. Horibe S, Shino K, Nakata K, Maeda A, Nakamura N, Matsumoto N. Second-look arthroscopy after meniscal repair. The medial meniscus sits on the inside of the knee and the lateral meniscus sits on the outside of the knee. Miller DB., Jr. Arthroscopic meniscus repair. Lyyra T, Arokoski JP, Oksala N, Vihko A, Hyttinen M, Jurvelin JS, et al. 2010;36 (2): 160-9. Going a step further, experimental (animal) studies and well-designed prospective, randomized, and controlled clinical trials with long-term quantitative outcome measurement are key to in vivo evaluation of research in this field. A prospective randomized trial. Fithian DC, Kelly MA, Mow VC. Lateral Meniscus Anatomy, Function & Diagram | Body Maps - Healthline Izuta Y, Ochi M, Adachi N, Deie M, Yamasaki T, Shinomiya R. Meniscal repair using bone marrow-derived mesenchymal stem cells: experimental study using green fluorescent protein transgenic rats. Anderson DG, Risbud MV, Shapiro IM, Vaccaro AR, Albert TJ. After 24 wks, the authors reported the appearance of articular cartilage neotissue, which integrated with the native tissue, and an overall lack of measurable immune response. Influence of selected growth factors administered to meniscus cells. It is about eight to ten centimeters long and stretches from, The fibular collateral ligament is one of the ligaments that make up the knee joint. Meniscus Tear Recovery Time Without Surgery: What to Know - Healthline The management of meniscal tears in the ACL-deficient knee. Assessment of a bovine co-culture, scaffold-free method for growing meniscus-shaped constructs. The meniscus is a C-shaped piece of tough, rubbery cartilage that acts as a shock absorber between the shinbone and the thighbone. There are two fibrocartilaginous menisci in the knee joint: a medial meniscus within the medial tibiofemoral compartmentand a lateral meniscus within the lateral tibiofemoral compartment. The outer one-third of the meniscus has a rich blood supply. This review will cover current knowledge regarding anatomical and biochemical characteristics of the knee meniscus, and discuss the tissue's biomechanical and functional properties. Diagnosing meniscal malfunction is greatly dependent upon both the experience and insight of a physician. Finally, fine-tuning of synthetic polymers, so as to promote joint lubrication and to prevent tissue wear and tear at bone-cartilage interfaces, also represent avenues for further research. Their main role is shock absorption, improve stability of the knee joint, and load transmission. A fibrous band of tissue, this ligament is both broad and flat in shape. The limited ability of cell isolation for large-scale constructs is a notable example. Swelling. Hellio Le Graverand MP, Ou Y, Schield-Yee T, Barclay L, Hart D, Natsume T, et al. However, the use of SDS is associated with many detrimental side effects. Interestingly, while shear is generally thought of as detrimental to the chondrocyte phenotype, oscillatory fluid flow has been shown to upregulate calcium signaling and GAG production of meniscus cells in parallel plate flow chambers [279]. These results under different loading regimens highlight the varied biosynthetic responses that may occur following mechanical stimulus, and encourage the pursuit of additional research. ECM component scaffolds are materials formed primarily from a macromolecule abundant in native matrix. Shrive NG, O'Connor JJ, Goodfellow JW. Anatomy, Bony Pelvis and Lower Limb, Knee Lateral Meniscus Isolation and characterization of small proteoglycans from different zones of the porcine knee meniscus. Hoshino A, Wallace WA. To achieve these results, there are several possible methods of stimulating meniscus tissue. Gunja NJ, Athanasiou KA. Medial and Lateral Meniscus Tears | Cedars-Sinai A systematic review of clinical outcomes in patients undergoing meniscectomy. anterior and posterior tibial roots are very close to each other. Ballyns JJ, Gleghorn JP, Niebrzydowski V, Rawlinson JJ, Potter HG, Maher SA, et al. Normal MR imaging anatomy of the knee. 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]. These multiple and complex functions require a specialized form. The lateral meniscus is grooved laterally for the tendon of the popliteus, which separates it from the fibular collateral ligament. Distribution of type I, II, III and V in the pepsin solubilized collagens in bovine menisci. The horn attachments connect the tibial plateau to the meniscus. Diagnosis Your doctor or physio will perform a full knee assessment. Steadman JR, Rodkey WG. Bethesda, MD 20894, Web Policies Rat meniscus cells passaged in monolayer underwent conventional dedifferentiation, but those subsequently cultured in these hybrid scaffolds underwent partial redifferentiation over 1 wk. Mesgarzadeh M, Moyer R, Leder DS et-al. Although the use of these three elements in combination comprises the classical approach to engineering replacement tissue, in recent years cell self-assembly has begun to gain recognition and support in generation of functional cartilage, fibrocartilage, vasculature, and retina [226-231]. Sandmann GH, Eichhorn S, Vogt S, Adamczyk C, Aryee S, Hoberg M, et al. Sutureless avascular meniscal repair with a photoactive naphthalimide compound: a preliminary animal study. Hydrogels have also been investigated for use as meniscus scaffolds. Torn meniscus - Diagnosis and treatment - Mayo Clinic In general, ECM component scaffolds display a mix of desirable traits between mechanics, bioactivity, and logistics. Despite considerable diversity amongst current strategies for tissue engineering the meniscus, several important design principles are emerging. Towards tissue engineering of meniscus substitutes: selection of cell source and culture environment.

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