Abstract
PurposeMeniscus allograft transplantation (MAT) is a possible treatment for patients suffering with pain after meniscectomy. Here, peracetic acid (PAA) sterilised meniscus transplants were investigated on whether they would provide an adequate alternative to fresh-frozen transplants in their viscoelastic and mechanical properties.MethodsIn this analysis, 31 menisci donors (26 male and 5 female) were included. The average donor age was 49.87 years, ranging from 32 to 65 years. Menisci of matched pairs of knees underwent chemical sterilisation while counterparts were left fresh-frozen. Stiffness and load to failure were determined via suture retention. Further menisci were analysed while attached to the tibial bone block using a novel test device to mimic physiological load distribution. Meniscus relaxation, stiffness and failure loads were determined. Histology and biphasic properties of the menisci were examined and results were analysed using paired t-tests.ResultsA novel custom built test device allowed the application of physiological loads for suture retention testing and revealed no significant differences between PAA sterilised (14.85 ± 4.46 N/mm, 50.49 ± 17.01 N) and fresh-frozen (18.26 ± 4.46 N/mm, 59.49 ± 21.07 N) regarding stiffness and failure load, respectively. Furthermore, initial 200 N loading showed significantly higher strain in sterilised menisci (18.87 ± 1.56) compared to fresh frozen (13.81 ± 1.04). Load relaxation experiments demonstrated significantly lower relaxation for sterilised menisci (77.71 ± 1.62) compared to fresh-frozen (89.11 ± 1.00, p-value < 0.0001).ConclusionPeracetic acid sterilised human menisci performed equally to fresh-frozen counterparts in a suture retention test and in physiological failure testing providing an adequate alternative. However, meniscus relaxation, biphasic properties and strain were shown to be significantly different between the groups. A common problem of MAT is graft extrusion or shrinkage, therefore the parameters measured here should be considered and may influence meniscus extrusion after transplantation.Level of evidencen/a (experimental study)
Highlights
The meniscus is an essential part of the complex knee mechanics as it acts as a shock absorber by resisting tibiofemoral pressure [19, 27]
Suture retention analysis Pairwise comparison of 13 meniscus pairs revealed no significant difference between peracetic acid (PAA) sterilised (14.85 ± 4.46 N/mm, 50.49 ± 17.01 N) and fresh-frozen (18.26 ± 4.46 N/mm, 59.49 ± 21.07 N) menisci regarding stiffness and load to failure, respectively (Fig. 2)
Menisci showed a significant size reduction after treatment with peracetic acid (18.30 ± 0.66 for PAA compared to FF 19.39 ± 0.65, p-value 0.0126) (Fig. 3a)
Summary
The meniscus is an essential part of the complex knee mechanics as it acts as a shock absorber by resisting tibiofemoral pressure [19, 27]. It stabilizes the knee, improves congruency and further provides lubrication [17, 34, 52]. A meniscectomy is associated with early cartilage damage and in many cases leaving no other option than knee arthroplasty [13, 45]. For young and active patients, Eras et al Journal of Experimental Orthopaedics (2021) 8:18 who, with todays life expectancy, will undergo several cycles of revision arthroplasty, meniscus transplantation provides a valuable alternative [33, 36, 37, 48]
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