Abstract
PurposeSince the treatment options for symptomatic total meniscectomy patients are still limited, an anatomically shaped, polycarbonate urethane (PCU), total meniscus replacement was developed. This study evaluates the in vivo performance of the implant in a goat model, with a specific focus on the implant location in the joint, geometrical integrity of the implant and the effect of the implant on synovial membrane and articular cartilage histopathological condition.MethodsThe right medial meniscus of seven Saanen goats was replaced by the implant. Sham surgery (transection of the MCL, arthrotomy and MCL suturing) was performed in six animals. The contralateral knee joints of both groups served as control groups. After three months follow-up the following aspects of implant performance were evaluated: implant position, implant deformation and the histopathological condition of the synovium and cartilage.ResultsImplant geometry was well maintained during the three month implantation period. No signs of PCU wear were found and the implant did not induce an inflammatory response in the knee joint. In all animals, implant fixation was compromised due to suture breakage, wear or elongation, likely causing the increase in extrusion observed in the implant group. Both the femoral cartilage and tibial cartilage in direct contact with the implant showed increased damage compared to the sham and sham-control groups.ConclusionThis study demonstrates that the novel, anatomically shaped PCU total meniscal replacement is biocompatible and resistant to three months of physiological loading. Failure of the fixation sutures may have increased implant mobility, which probably induced implant extrusion and potentially stimulated cartilage degeneration. Evidently, redesigning the fixation method is necessary. Future animal studies should evaluate the improved fixation method and compare implant performance to current treatment standards, such as allografts.
Highlights
After meniscectomy the loads on the tibiofemoral cartilage surfaces substantially increase [1, 2]
No signs of polycarbonate urethane (PCU) wear were found and the implant did not induce an inflammatory response in the knee joint
This study demonstrates that the novel, anatomically shaped PCU total meniscal replacement is biocompatible and resistant to three months of physiological loading
Summary
After (partial or total) meniscectomy the loads on the tibiofemoral cartilage surfaces substantially increase [1, 2]. 94% of the meniscal injuries still requires (partial) meniscectomy [3]. Meniscal allograft transplantation has been shown to be successful in reducing pain and functional limitations in symptomatic total meniscectomy patients [5, 6]. The integrity of the allograft tissue may be compromised by post-implantation shrinkage and retearing [8,9,10]. These limitations illustrate the need for an alternative treatment for total meniscectomy patients
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