Abstract
Injuries to menisci are the most common disease among knee joint-related morbidities and cover a widespread population ranging from children and the general population to the old and athletes. Repair of the injuries in the meniscal avascular zone remains a significant challenge due to the limited intrinsic healing capacity compared to the peripheral vascularized zone. The current surgical strategies for avascular zone injuries remain insufficient to prevent the development of cartilage degeneration and the ultimate emergence of osteoarthritis (OA). Due to the drawbacks of current surgical methods, the research interest has been transferred toward facilitating meniscal avascular zone repair, where it is expected to maintain meniscal tissue integrity, prevent secondary cartilage degeneration and improve knee joint function, which is consistent with the current prevailing management idea to maintain the integrity of meniscal tissue whenever possible. Biological augmentations have emerged as an alternative to current surgical methods for meniscal avascular zone repair. However, understanding the specific biological mechanisms that affect meniscal avascular zone repair is critical for the development of novel and comprehensive biological augmentations. For this reason, this review firstly summarized the current surgical techniques, including meniscectomies and meniscal substitution. We then discuss the state-of-the-art biological mechanisms, including vascularization, inflammation, extracellular matrix degradation and cellular component that were associated with meniscal avascular zone healing and the advances in therapeutic strategies. Finally, perspectives for the future biological augmentations for meniscal avascular zone injuries will be given.
Highlights
Menisci, semilunar fibrocartilage tissue located between the femoral condyle and tibial plateau, function in load-bearing, load transmission, shock absorption, lubrication and nutrition during dynamic movements of the knee (Cameron and Macnab, 1972; Newman et al, 1989; Proctor et al, 1989; Zhu et al, 1994; Kohn and Moreno, 1995; Tissakht et al, 1996; Makris et al, 2011)
The research interest has been transferred toward facilitating meniscus avascular zone repair, where it is expected to maintain meniscal tissue integrity, prevent secondary cartilage degeneration and improve knee joint function
Current surgical strategies for meniscal avascular zone lesions remained to be insufficient to prevent the development of OA, accelerating the development of alternative biological augmentations to promote meniscal healing
Summary
Semilunar fibrocartilage tissue located between the femoral condyle and tibial plateau, function in load-bearing, load transmission, shock absorption, lubrication and nutrition during dynamic movements of the knee (Cameron and Macnab, 1972; Newman et al, 1989; Proctor et al, 1989; Zhu et al, 1994; Kohn and Moreno, 1995; Tissakht et al, 1996; Makris et al, 2011). Many clinical and basic studies have been performed to facilitate the healing of meniscus avascular zone injuries, such as the mechanical stimulation of the synovium and meniscus by rasping the parameniscal synovium and meniscal tear edges (Ritchie et al, 1998), the hoped introduction of blood supply by trephination between the red zone and white zone (Zhang et al, 1995), the addition of extrinsic fibrin clot (Henning et al, 1990) or the introduction of bone marrow cells and growth factors by bone marrow venting (Dean et al, 2017).
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