NİHAT DEMİRHAN DEMİRKIRAN, HASAN HAVITÇIOĞLU, AYLİN ZİYLAN, ÜLKER CANKURT, Reşi̇t Buğra HÜSEMOĞLU

Novel multilayer meniscal scaffold provides biomechanical and histological results comparable to polyurethane scaffolds: An 8 week rabbit study

Objective: The aim of this study was to evaluate the meniscal regeneration and arthritic changes after partial meniscectomy and application of either polyurethane scaffold or novel multilayer meniscal scaffold in a rabbit model. Methods: Sixteen NewZealand rabbits were randomly divided into three groups. A reproducible 1.5-mm cylindrical defect was created in the avascular zone of the anterior horn of the medial meniscus bilaterally. Defects were filled with the polyurethane scaffold in Group 1 (n:6) and with novel multilayer scaffold in Group 2 (n:6). Rabbits in Group 3 (n:4) did not receive any treatment and defects were left empty. All animals were sacrificed after 8 weeks and bilateral knee joints were taken for macroscopic, biomechanical, and histological analysis. After excision of menisci, inked condylar surfaces and tibial plateaus were evaluated for arthritic changes. Digital photographs of excised menisci were also obtained and surface areas were measured by a computer software. Indentation testing of the tibial condyles and compression tests for the relevant meniscal areas was also performed in all groups. Histological analysis was made and all specimens were scored according to Rodeo scoring system. Results: No signs of inflammation or infection were observed in any animals. A significant difference was observed between meniscus surface areas of the multilayer scaffold group (20.13 ± 1.91 mm2 ) and the group with empty meniscus defects (15.62 ± 2.04 mm2 ) (p ¼ 0.047). The results of biomechanical compression tests revealed a significant difference between the Hayes scores of the second group (1.728) and the empty defect group (0,467) (p ¼ 0.029). Intact meniscal tissue showed higher mechanical properties than all the defected samples. Multilayer scaffold group demonstrated the closest results compared to healthy meniscus tissue. Tibia indentation tests and histological evaluation showed no significant differences between groups (p ¼ 0.401 and p ¼ 0.186 respectively). Conclusions: In this study, the initial evaluation of novel multilayer meniscal scaffold prevented the shrinkage that may occur in the meniscus area and demonstrated superior biomechanical results compared to empty defects. No adverse events related to scaffold material was observed. Besides, promising biomechanical and histological results, comparable to polyurethane scaffold, were obtained.

___

Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull. 2011 Jan;99(1): 89e106.

Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med. 1995 Mar 1;23(2): 240e244.

McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br Vol. 2006 Dec 1;88(12):1549e1556.

Kelly BT, Potter HG, Deng XH, et al. Meniscal allograft transplantation in the sheep knee evaluation of chondroprotective effects. Am J Sports Med. 2006 Sep 1;34(9):1464e1477.

Rijk PC. Meniscal allograft transplantationdpart I: background, results, graft selection and preservation, and surgical considerations. Arthroscopy. 2004 Sep 30;20(7):728e743.

Rijk PC, Tigchelaar-Gutter W, Bernoski FP, Van Noorden CJ. Functional changes in articular cartilage after meniscal allograft transplantation: a quantitative histochemical evaluation in rabbits. Arthroscopy. 2006 Feb 28;22(2):152e158.

Rongen JJ, van Tienen TG, van Bochove B, Grijpma DW, Buma P. Biomaterials in search of a meniscus substitute. Biomaterials. 2014 Apr 30;35(11):3527e3540.

Mandal BB, Park SH, Gil ES, Kaplan DL. Multilayered silk scaffolds for meniscus tissue engineering. Biomaterials. 2011;32(2):639e651.

Bodin A, Concaro S, Brittberg M, Gatenholm P. Bacterial cellulose as a potential meniscus implant. J Tissue Eng Regen Med. 2007 Sep 1;1(5):406e408.

Barber F Alan. Editorial commentary: polyurethane meniscal scaffold: a perfect fit or flop? Arthroscopy. 2018, (May);34(No 5):1628e1630.

Buma P, Ramrattan NN, van Tienen TG, Veth RP. Tissue engineering of the meniscus. Biomaterials. 2004 Apr 30;25(9):1523e1532.

de Groot JH. Polyurethane scaffolds for meniscal tissue regeneration. Med Device Technol. 2005 Sep;16(7):18e20.

Van Minnen B, Van Leeuwen MB, Kors G, Zuidema J, Van Kooten TG, Bos RR. In vivo resorption of a biodegradable polyurethane foam, based on 1, 4-butanediisocyanate: a three-year subcutaneous implantation study. J Biomed Mater Res A. 2008 Jun 15;85(4):972e982.

Welsing RT, van Tienen TG, Ramrattan N, et al. Effect on tissue differentiation and articular cartilage degradation of a polymer meniscus implant a 2-year follow-up study in dogs. Am J Sports Med. 2008 Oct 1;36(10):1978e1989.

Driscoll MD, Robin BN, Horie M, et al. Marrow stimulation improves meniscal healing at early endpoints in a rabbit meniscal injury model. Arthroscopy. 2013;29(1):113e121.

Oda S, Otsuki S, Kurokawa Y, Hoshiyama Y, Nakajima M, Neo M. A new method for meniscus repair using type I collagen scaffold and infrapatellar fat pad. J Biomater Appl. 2015 May 1;29(10):1439e1448.

Horie M, Driscoll MD, Sampson HW, et al. Implantation of allogenic synovial stem cells promotes meniscal regeneration in a rabbit meniscal defect model. J Bone Joint Surg Am. 2012 Apr 18;94(8):701e712.

Rodeo SA, Seneviratne A, Suzuki K, Felker K, Wickiewicz TL, Warren RF. Histological analysis of human meniscal allografts. J Bone Joint Surg Am. 2000 Aug 1;82(8):1071e1082.

Hayes WC, Keer LM, Herrmann G, Mockros LF. A mathematical analysis for indentation tests of articular cartilage. J Biomech. 1972 Sep 30;5(5):541e551.

Patel JM, Ghodbane SA, Brzezinski A, Gatt Jr CJ, Dunn MG. Tissue-engineered total meniscus replacement with a fiber-reinforced scaffold in a 2-year ovine model. Am J Sports Med. 2018;46(8):1844e1856.

Gao S, Chen M, Wang P, et al. An electrospun fiber reinforced scaffold promotes total meniscus regeneration in rabbit meniscectomy model. Acta Biomater. 2018;73:127e140.

Ying XZ, Qian JJ, Ping L, et al. Model research on repairing meniscus injury in rabbits using bone marrow mesenchymal stem cells and silk fibroin meniscus porous scaffold. Eur Rev Med Pharmacol Sci. 2018;22(12):3689e3693.

Koch M, Achatz FP, Lang S, et al. Tissue engineering of large full-size meniscus defects by a polyurethane scaffold: accelerated regeneration by mesenchymal stromal cells. Stem Cell Int. 2018;2018, 8207071.

Lee KI, Olmer M, Baek J, D'Lima DD, Lotz MK. Platelet-derived growth factorcoated decellularized meniscus scaffold for integrative healing of meniscus tears. Acta Biomater. 2018;76:126e134.

Kose GT, Korkusuz F, Korkusuz P, Hasirci V. In vivo tissue engineering of bone € using poly (3-hydroxybutyric acid-co-3-hydroxyvaleric acid) and collagen scaffolds. Tissue Eng. 2004 Jul 1;10(7e8):1234e1250.

Zhou M, Yu D. Cartilage tissue engineering using PHBV and PHBV/Bioglass scaffolds. Mol Med Rep. 2014 Jul 1;10(1):508e514.

Gu Z, Zhang X, Li L, Wang Q, Yu X, Feng T. Acceleration of segmental bone regeneration in a rabbit model by strontium-doped calcium polyphosphate scaffold through stimulating VEGF and bFGF secretion from osteoblasts. Mater Sci Eng C. 2013 Jan 1;33(1):274e281.

Gu Z, Xie H, Li L, Zhang X, Liu F, Yu X. Application of strontium-doped calcium polyphosphate scaffold on angiogenesis for bone tissue engineering. J Mater Sci Mater Med. 2013 May 1;24(5):1251e1260.

Chevrier A, Nelea M, Hurtig MB, Hoemann CD, Buschmann MD. Meniscus structure in human, sheep, and rabbit for animal models of meniscus repair. J Orthop Res. 2009 Sep 1;27(9):1197e1203.

Ishida K, Kuroda R, Miwa M, et al. The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng. 2007;13(5):1103e1112.