Meniscal repair: The current state and recent advances in augmentation

Bansal, S. and Floyd, E. R. and M, A. Kowalski and Aikman, E. and Elrod, P. and Burkey, K. and Chahla, J. and LaPrade, R. F. and Maher, S. A. and Robinson, J. L. and Patel, J. M.

J Orthop Res (2021) 39: 1368–1382

DOI: 10.1002/jor.25021

Abstract

Meniscal injuries represent one of the most common orthopedic injuries. The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health. For this reason, the field has shifted gradually towards suture repair, with the intent of preservation of the tissue. "Save the Meniscus" is now a prolific theme in the field; however, meniscal repair can be challenging and ineffective in many scenarios. The objectives of this review are to present the current state of surgical management of meniscal injuries and to explore current approaches being developed to enhance meniscal repair. Through a systematic literature review, we identified meniscal tear classifications and prevalence, approaches being used to improve meniscal repair, and biological- and material-based systems being developed to promote meniscal healing. We found that biologic augmentation typically aims to improve cellular incorporation to the wound site, vascularization in the inner zones, matrix deposition, and inflammatory relief. Furthermore, materials can be used, both with and without contained biologics, to further support matrix deposition and tear integration, and novel tissue adhesives may provide the mechanical integrity that the meniscus requires. Altogether, evaluation of these approaches in relevant in vitro and in vivo models provides new insights into the mechanisms needed to salvage meniscal tissue, and along with regulatory considerations, may justify translation to the clinic. With the need to restore long-term function to injured menisci, biologists, engineers, and clinicians are developing novel approaches to enhance the future of robust and consistent meniscal reparative techniques.

Citation

Bansal, S., Floyd, E. R., M, A. K., Aikman, E., Elrod, P., Burkey, K., Chahla, J., LaPrade, R. F., Maher, S. A., Robinson, J. L., & Patel, J. M. (2021). Meniscal repair: The current state and recent advances in augmentation. J Orthop Res, 39(7), 1368–1382. https://doi.org/10.1002/jor.25021 Animals, Disease Models, Animal, Humans, *Tissue Scaffolds, *repair, Biological Products/*therapeutic use, *biologics, *materials, *meniscectomy, *meniscus, Arthroplasty/*methods, Business Services Inc, Stryker Corp, and Medwest Associates. Robert F. LaPrade is a, consultant for Arthrex, Ossur, Linvatec Corp, and Smith & Nephew, received royalties, Corp, and DePuy Synthes Products, and hospitality payments from Medical Devices, from Arthrex, Ossur, and Smith & Nephew, received research grants from Ossur and, Jorge Chahla received consulting fees from Smith & Nephew, Arthrex, Ossur, Linvatec, Maher is a founder of AGelity Biomechanics Corp. Jay M. Patel is a consultant for, NovoPedics Inc., Smith & Nephew, and is on the editorial board of the AJSM, JEO, KSSTA. Suzanne A., Tibial Meniscus Injuries/*surgery

Keywords

• Animals
• Disease Models
• Animal
• Humans
• *Tissue Scaffolds
• *repair
• Biological Products/*therapeutic use
• *biologics
• *materials
• *meniscectomy
• *meniscus
• Arthroplasty/*methods
• Business Services Inc
• Stryker Corp
• and Medwest Associates. Robert F. LaPrade is a
• consultant for Arthrex
• Ossur
• Linvatec Corp
• and Smith & Nephew
• received royalties
• Corp
• and DePuy Synthes Products
• and hospitality payments from Medical Devices
• from Arthrex
• Ossur
• and Smith & Nephew
• received research grants from Ossur and
• Jorge Chahla received consulting fees from Smith & Nephew
• Arthrex
• Ossur
• Linvatec
• Maher is a founder of AGelity Biomechanics Corp. Jay M. Patel is a consultant for
• NovoPedics Inc.
• Smith & Nephew
• and is on the editorial board of the AJSM
• JEO
• KSSTA. Suzanne A.
• Tibial Meniscus Injuries/*surgery