Replacement of the Irreparably Injured Meniscus

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Abstract
Irreparable damage or loss of the meniscal cartilage causes knee joint instability; increases stress on the articular surfaces of the femorotibial joint; and invariably leads to osteoarthrosis, osteoarthritis, and degenerative changes that produce irreversible damage to the articular surfaces. Significant advances have been made in surgical techniques to repair injured menisci; however, little success has been achieved in efforts to replace irreparably damaged menisci with artificial materials or prostheses. Much of the ineffectiveness of prosthetic replacements appears to be a direct result of the inability to match perfectly the size, shape, and physical and biomechanical properties of the normal meniscus. Because of the inabilities of the artificial materials to function as a meniscus, our research team has turned to tissue engineering. Our efforts have been directed at development of a bioresorbable scaffold of reconstituted collagen, which would support tissue ingrowth and permit the host to regrow or regenerate its own meniscus cartilage. We have developed a collagen-based implant that will support ingrowth and maturation of meniscal fibrochondrocytes in vitro and in vivo. This material has been used in numerous laboratory studies with encouraging results and is under continued development for eventual clinical application. This article reviews the efforts of other investigators and summarizes our own laboratory findings in this challenging area.

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