Role of mesenchymal stem cells in meniscal repair.

Peter Angele,Richard Kujat,Matthias Koch,Johannes Zellner

doi:10.1186/s40634-014-0012-y

Peter Angele, Richard Kujat + Show 2 more

Open Access

https://doi.org/10.1186/s40634-014-0012-y

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Abstract

Meniscus integrity is the key for joint health of the knee. Therefore, the main goal of every meniscus treatment should be the maintenance of as much meniscus tissue as possible.Repair of meniscus tears can be achieved by meniscus suture. However, in a recently published meta-analysis, the long-term outcome of meniscus repair showed a mean failure rate of 24%.In a preclinical trial, locally applied mesenchymal stem cells produced differentiated meniscus-like tissue in meniscus tears indicating that mesenchymal-based cells, harvested from the bone marrow, enhance meniscus healing in critical-size meniscus tears.Symptomatic meniscus defects offer the option for meniscus transplantation with porous cell free biomaterials, when a complete meniscus rim is available. Cell-free biomaterials, which are actually in clinical application, reveal variable outcome in mid-term results from complete failure to regeneration with meniscus-like tissue.In several preclinical studies with different critical-size defects in the meniscus, the application of mesenchymal stem cells could significantly enhance meniscus regeneration compared to empty defects or to cell-free biomaterials.Regenerative treatment of meniscus with mesenchymal stem cells seems to be a promising approach to treat meniscal tears and defects. However it is still not clear, whether the stem cell effect is a direct action of the mesenchymal-based cells or is rather mediated by secretion of certain stimulating factors. The missing knowledge of the underlying mechanism is one of the reasons for regulatory burdens to permit these stem cell-based strategies in clinical practice. Other limitations are the necessity to expand cells prior to transplantation resulting in high treatment costs. Alternative treatment modalities, which use growth factors concentrated from peripheral blood aspirates or mononucleated cells concentrated from bone marrow aspirates, are currently in development in order to allow an attractive one-step procedure without the need for cell expansion in cultures and thus lower efforts and costs.In summary, Tissue Engineering of meniscus with mesenchymal based cells seems to be a promising approach to treat meniscal tears and defects in order to restore native meniscus tissue. However, advances of the technology are necessary to allow clinical application of this modern regenerative therapy.

Highlights

Meniscal lesions represent the most common intraarticular knee injury, and are the most frequent cause of surgical procedures performed by orthopaedic surgeons (Makris et al 2011)
The mean annual incidence of meniscal lesions has been reported to be 66 per 100.000 inhabitants, 61 of which result in meniscectomy (Makris et al 2011)
In the long-term, meniscus tears can result in the onset of joint degeneration and, knee osteoarthritis with all its consequences including pain, immobility and knee arthroplasty (Lohmander et al 2007; Stein et al 2010; Borchers et al 2011; Jeong et al 2012; Badlani et al 2013)

Summary

Introduction

Meniscal lesions represent the most common intraarticular knee injury, and are the most frequent cause of surgical procedures performed by orthopaedic surgeons (Makris et al 2011). Mesenchymal stem cells from the bone marrow in combination with hyaluronan collagen carriers resulted in meniscal repair with differentiated meniscus-like tissue detected by histology, immunohistochemistry and biomechanical analysis (Figure 2) (Zellner et al 2013).

Results

Conclusion