Meniscal scaffold for the treatment of partial meniscal defect—clinical and radiological outcomes in a two-year follow-up

Author(s):  
Umer Butt ◽  
Filip Vuletić ◽  
Gregor Stenhouse ◽  
Damir Hudetz ◽  
Neil Bradbury
Keyword(s):  
Joints ◽  
2013 ◽  
Vol 01 (04) ◽  
pp. 161-166 ◽  
Author(s):  
Paolo Bulgheroni ◽  
Erica Bulgheroni ◽  
Gianmarco Regazzola ◽  
Claudio Mazzola

Purpose: to evaluate the safety and effectiveness of the polyurethane meniscal scaffold through clinical examination, MRI and arthroscopic second look, over a minimum two-year follow-up. Methods: between 2009 and 2011, 19 patients underwent meniscal scaffold implantation in our department (medial meniscus in 16 cases lateral meniscus in two cases, and bilateral in one case). All the patients were clinically evaluated preoperatively, and at 6, 12, and 24 months after surgery using Lysholm score, Tegner score, and VAS. Ten patients were studied with MRI, and nine patients were evaluated arthroscopically. Results: no adverse reactions to the implant were observed. The clinical scores showed a significant improvement at 6 months and increased progressively over time. On MRI studies, the implants showed a clear hyperintense signal, sometimes irregular, and the chondral surface was preserved in all cases. At arthroscopic second look in the first months after surgery, the scaffold size was unchanged and the scaffold appeared light yellowish in color and well integrated into the surrounding tissues. At arthroscopic second look at 12 and 24 months the scaffold was found to have an irregular morphology and to be slightly reduced in size. Conclusions: polyurethane meniscal scaffold is a good alternative to a collagen scaffold, but a longer follow-up is needed to evaluate the scaffold degradation and chondral coverage. Level of Evidence: level IV, therapeutic case series.


The Knee ◽  
2015 ◽  
Vol 22 (5) ◽  
pp. 389-394 ◽  
Author(s):  
Pablo Eduardo Gelber ◽  
Alexandru Mihai Petrica ◽  
Anna Isart ◽  
Raquel Mari-Molina ◽  
Juan Carlos Monllau

2018 ◽  
Vol 34 (5) ◽  
pp. 1621-1627 ◽  
Author(s):  
Joan C. Monllau ◽  
Francesco Poggioli ◽  
Juan Erquicia ◽  
Eduardo Ramírez ◽  
Xavier Pelfort ◽  
...  

2017 ◽  
Vol 103 (4) ◽  
pp. 609-614 ◽  
Author(s):  
A. Leroy ◽  
P. Beaufils ◽  
B. Faivre ◽  
C. Steltzlen ◽  
P. Boisrenoult ◽  
...  

2015 ◽  
Vol 24 (5) ◽  
pp. 1478-1484 ◽  
Author(s):  
Karl F. Schüttler ◽  
Felix Haberhauer ◽  
Markus Gesslein ◽  
Thomas J. Heyse ◽  
Jens Figiel ◽  
...  

Author(s):  
Pablo E. Gelber ◽  
Raúl Torres-Claramunt ◽  
Francesco Poggioli ◽  
Daniel Pérez-Prieto ◽  
Joan C. Monllau

AbstractMeniscal extrusion (ME) has been identified as a risk factor in the development of knee osteoarthritis. The relevance of this finding when a meniscal scaffold is used has not been extensively studied. The objective of this study was to determine whether preoperative meniscal remnant extrusion (MRE) was correlated with postoperative scaffold extrusion (SE) or with functional outcomes at the 2-year follow-up. Retrospective study included all polyurethane scaffolds implanted with a minimum 2-year follow-up. A magnetic resonance imaging (MRI) was performed preoperatively and postoperatively at 2 years. Extrusion was measured in millimeters in a coronal view. Patients were assigned to either group 1 or 2 depending on the preoperative MRE being either <3 mm (minor extrusion) or 3 mm (major extrusion). Functional outcomes were analyzed by means of the Western Ontario Meniscal Evaluation Tool (WOMET), International Knee Documentation Committee, Kujala and Tegner scores, as well as visual analog scale. Satisfaction was also documented. Sixty-two out of 98 patients were available to undergo an MRI at final follow-up. The mean age was 41.3 years (range, 17–58) and the mean follow-up was 45 months (range, 25–69). The mean preoperative MRE was 2.8 mm (standard deviation [SD] 1.2) and the mean postoperative SE was 3.8 mm (SD 1.8) (p < 0.01). All functional scores improved during the study period. When the correlation (Spearman's rho) between the difference in extrusion between the pre 26 and postoperative periods and their correlation with the different scores was assessed, correlation was only observed in the WOMET (rho 0.61, p = 0.02). The preoperative MRE in Group 1 was 1.85 mm (SD 0.83) and 3.7 mm (SD 2.2) in Group 2 (p < 0.01). At final follow-up, SE was 3.86 mm (SD 0.7) in Group 1, whereas it was 3.98 mm (SD 1) in Group 2 (p = 0.81). No differences were observed in the scores used for these two groups. The SE observed at the 2-year follow-up after the implantation of a polyurethane scaffold did not depend on preoperative MRE (major or minor extrusion). The WOMET score, which was the only meniscal-specific functional scored used, showed some inferior results in the most extruded meniscal scaffolds. This is a retrospective case series. Level of evidence is 4.


2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.


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