Abstract
Avascular meniscus tears show poor intrinsic regenerative potential. Thus, lesions within this area predispose the patient to developing knee osteoarthritis. Current research focuses on regenerative approaches using growth factors or mesenchymal stem cells (MSCs) to enhance healing capacity within the avascular meniscus zone. The use of MSCs especially as progenitor cells and a source of growth factors has shown promising results. However, present studies use bone-marrow-derived BMSCs in a two-step procedure, which is limiting the transfer in clinical praxis. So, the aim of this study was to evaluate a one-step procedure using bone marrow aspirate concentrate (BMAC), containing BMSCs, for inducing the regeneration of avascular meniscus lesions. Longitudinal meniscus tears of 4 mm in size of the lateral New Zealand White rabbit meniscus were treated with clotted autologous PRP (platelet-rich plasma) or BMAC and a meniscus suture or a meniscus suture alone. Menisci were harvested at 6 and 12 weeks after initial surgery. Macroscopical and histological evaluation was performed according to an established Meniscus Scoring System. BMAC significantly enhanced regeneration of the meniscus lesions in a time-dependent manner and in comparison to the PRP and control groups, where no healing could be observed. Treatment of avascular meniscus lesions with BMAC and meniscus suturing seems to be a promising approach to promote meniscus regeneration in the avascular zone using a one-step procedure.
Highlights
An intact meniscus is essential to a healthy knee joint [1,2]
Longitudinal meniscus tears of 4 mm in size of the lateral New Zealand White rabbit meniscus were treated with clotted autologous PRP or bone marrow aspirate concentrate (BMAC) and a meniscus suture or a meniscus suture alone
During BMAC and PRP preparation, the surgical procedure to create avascular meniscus tears began with the control on the left side and, subsequently, the index surgery on the right side
Summary
An intact meniscus is essential to a healthy knee joint [1,2]. Any loss of meniscus integrity is associated with a loss of function, such as load bearing, shock absorption, stabilization, or proprioception of the knee joint, and subsequent biomechanical derangement [3,4,5,6,7,8]. The increased load to the articular cartilage predisposes patients to the development of osteoarthritic changes [9,10,11,12,13] Based on this knowledge, previously developed regenerative-medicine-based meniscus therapy options have focused on successful repair strategies, such as meniscus suturing that has been established in the clinical routine for peripheral meniscus lesions in the vascular area [14,15]. The repair tissue of five menisci was infiltrated by cells of a meniscus-like type and with a clear staining for proteoglycan. Regarding intralesional PRP application and meniscus suture of meniscus tears after a study period of 12 weeks, all evaluated menisci (n = 6) macroscopically showed no meniscus healing with an obviously remaining meniscus tear. B) + e): Microscopic view (4× enlargement), DMMB staining of the lateral meniscus 12 weeks after surgery.
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