Menisküs Cerrahisinin Geleceği; Menisküs Doku Mühendisliği

Son yıllarda yapılan bilimsel çalışmalarla diz eklemi için menisküslerin anatomik, biyomekanik ve fonksiyonel önemi ortaya konmuştur. Menisküs, eklemin hayati bir parçası olarak eklem kıkırdağının bozulmasını ve osteoartit gelişimini engellemektedir. Günümüz onarım teknikleri menisküsün periferal vaskülarize bölgesindeki sınırlı lezyonlarda etkili olmaktadır. Fonksiyonu, eklem fonksiyonuyla direk ilişkili merkezi avasküler bölge lezyonunun tedavisi ise ciddi bir sorun olarak bulunmaktadır. Tüm yaş grupları özellikle çocuklar artan şekilde daha zorlu, yarışmalı ve hatta profesyonel sporlarla uğraşmaktadır. Bunun sonucu olarak menisküs cerrahisi daha genç yaşlarda uygulanmakta ve uzun yaşam süreci içerisinde daha az sağlam menisküs dokusu korunabilmektedir. Genç ve aktif hastalarda parsiyel mediyal menisektomi sadece mekanik aksı hafifçe varusa kaydırsa da diz dengesinin bozulmasında başlangıç noktası olacaktır. Bozulan diz dengesi ve artan yüklenmenin ardından kaçınılmaz bir şekilde osteoartit gelişimine neden olmaktadır. Bu yüzden genç ve orta yaş hastalar için yeni rejeneratif stratejilere ihtiyaç olduğu açıktır. Bugüne kadar belli ölçüde menisküs lezyonlarının restorasyonuyla anatomik ve fonksiyonel bütünlüğünün sağlanması için invitro menisküs yapısı elde etmeye yönelik farklı yaklaşım ve stratejiler denenmiştir. Uygun hücre kaynaklarının seleksiyonu (otolog, allogenik, ksenogenik ve kök hücreler) menisküs onarım mühendisliğinde anahtar noktalardan biridir. Ayrıca çeşitli skafoldlar geliştirilmiştir. Bunlar deneysel ve klinik çalışmalarla üretilmekte ancak bazı problemlerde beraberinde gelişmektedir (stresi perdeleme, degradasyon sonucu meydana gelen yan ürünler vb). Bu problemler yeni stratejilerin geliştirilme ihtiyacını doğurmuştur. Skafoldsuz yaklaşımlar, kendi kendine toplanarak (self – assembly) çoğalma, birçok kimyasal/biyokimyasal ve mekanik uyaranın, ayrıca gen terapisinin de fonksiyonel yeni doku formasyonu oluşumundaki yeri araştırılmıştır. Bu yazı yeni menisküs rejenerasyon stratejilerine olan ihtiyacı ortaya koyacak şekilde günümüzdeki son duruma bir bakış sağlarken geleceğe yönelik yapılması gerekli çalışmalar hakkında klinisyene fikir vermektedir. Anahtar Kelimeler:

Anahtar Kelimeler:

Menisküs, Cerrahi, Doku

Future of Meniscus Surgery; Meniscus Tissue Engineering

In recent years scientific researches have established the anatomical, biomechanical, and functional importance that the meniscus holds within the knee joint. As a vital part of the joint, meniscus acts to prevent the degeneration of articular cartilage, and the development of osteoarthritis. Current repair techniques are only effective in treating lesions located in the peripheral vascularized region of the meniscus. Healing lesions found in the iner avascular region, which functions direct related to joint function, is considered to be a significant challenge. All age groups and in particular children increasingly participate in more extreme, competitive or even professional sports. The consequence of this fact is that meniscal surgery is performed at a younger age, and less meniscus tissue is preserved for a lifetime period. In young, active patients a partial medial meniscectomy will be the starting point for a disturbed homeostasis of the knee, even if the mechanical axis is only slightly varus aligned. This altered knee homeostasis and increased loading the inevitably leads to the development of osteoarthritis. Therefore there is a clear need for regenerative strategies in these young and middle aged patients. So far, different approaches and strategies have contributed to the in vitro generation of meniscus constructs, which are capable of restoring meniscal lesions to some extent, both functionally as well as anatomically. The selection of the appropriate cell source (autologous, allogeneic, or xenogeneic cells, or stemcells) is regarded as one of key points for meniscal tissue engineering. Furthermore, a large variation of scaffolds for tissue engineering have been proposed and produced in experimental and clinical studies although a few problems with these (byproducts of degradation, stressshielding). Problems have shifted research interest toward new strategies (scaffoldless approaches, selfassembly). A large number of different chemical/biochemical and mechanical stimuli and also gene therapy have been investigated, in terms of encouraging functional tissue formation. In this review, we will give an overview on the need of research for meniscus regeneration, and provide a perspective, from the clinician’s standpoint, for designing future regenerative strategies. Key words:

Keywords:

Meniscus, Surgery,

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