Cem Yalın KILINÇ, Uğur TİFTİKÇİ, Sancar SERBEST, Mustafa TÜRK, Siyami KARAHAN

Tavşanlarda Horizontal Menisküs Yırtık Modellerinde Primer ve Kollajen Skafold ile İyileşme

Bu çalışmanın amacı, tavşan modelinde horizontal menisküs yırtıklarının onarımında kollajen skafold kullanımı sonrası menisküsün iyileşme potansiyelini araştırmak ve skafold ile tamirin primer tamirden daha üstün olup olmadığını göstermektir. Ağırlıkları 2.5-3 kg arasında değişen olgun 21 adet New Zealand White cinsi erkek tavşanlar her grupta 7 hayvan olacak şekilde 3 eşit gruba ayrıldı. Medial menisküs anterior boynuzdan orta kısmına kadar horizontal yırtık modeli yapıldı. Çalışma protokolüne uygun olarak, Grup 1 (n=7); kontrol grubu sadece horizontal menisküs yırtığı olan tavşanlardan oluşturuldu. Grup 2 (n=7); horizontal menisküs yırtığa primer tamir yapılırken, Grup 3; horizontal menisküs yırtığa kollajen skafold ile tamir yapılanlar idi. Tüm deney hayvanları 12. haftanın sonunda sakrifiye edildi. Medial menisküsün 1/3 anterior alanı ölçüldü. Dokuların histolojik analizi, üç bileşenden oluşan Ishida skoru ile gerçekleştirildi. Grup I'deki menisküsün yüzey alanı grup II’den (p<0.008) ve grup III'ten (p<0.002) anlamlı olarak daha düşüktü. Grup III’deki dokunun kalitesi İshida puanına göre değerlendirildiğinde diğer gruplardan anlamlı olarak daha yüksekti (p<0.001). Horizontal menisküs yırtıkları gibi avasküler bölgelerindeki yırtıklarda skafold ve benzeri materyaller ile daha iyi iyileşme ve normal anatomik dokuya yakın işlev ve fonksiyonda menisküs elde edilebilir.

Anahtar Kelimeler:

Horizontal Yırtık, Kollajen Skafold, Menisküs Tamiri, Primer Tamir, Tavşan

Primary and Collagen Supported Scaffold Healing in Rabbit Horizontal Meniscus Ripped Models

The aim of this study is to investigate the potential for improvement of the collagen scaffold in the repair of horizontal meniscus tears in the rabbit model. Mature 21 New Zealand white male rabbits weighing 2.5-3 kg were divided into 3 equal groups, with 7 animals in each group. The medial meniscus was anteriorly horizontal torn from the horn to the middle. In accordance with the study protocol, Group 1 (n=7); only the horizontal meniscus was tilted in the control group. Group 2 (n=7); horizontal meniscus rupture primer repair. Group 3; horizontal meniscus were repaired with a colloidal scaffold. All experimental animals were sacrificed at the end of the 12th week. 1/3 anterior area of medial meniscus was measured. Histological analysis of the tissues was performed with Ishida score consisting of three components. Surface area of meniscus in group I was significantly lower than group II (p<0.008) and group III (p<0.002). The quality of the group III was significantly higher than the other groups (p<0.001). In the tears of the avascular region, such as the horizontal meniscus tears, scaffolds and similar materials can provide better healing and meniscal function and function close to normal anatomic tissue.

Keywords:

Collagen Scaffold, Horizontal Rupture, Menuscus Repair, Primary Repair, Rabbit,

PDF

___

1. Christoforakis J, Pradhan R, Sanchez-Ballester J, Hunt N, Strachan RK. Is there an association between articular cartilage changes and degenerative meniscus tears? Arthroscopy. 2005;21(11):1366-9.
2. Maak TG, Fabricant PD, Wickiewicz TL. Indications for  meniscus repair. Clin Sports Med. 2012; 31:1-14.
3. Starke C, Kopf S, Petersen W, Becker R. Meniscal repair. Arthroscopy. 2009; 25:1033-44.
4. Noyes FR, Barber-Westin SD. Meniscus tears: Diagnosis, repair techniques, and clinical outcomes. In: Noyes’ knee disorders: Surgery, rehabilitation, clinical outcomes. Philadelphia, PA: Saunders, 2010;733-71.
5. Kim JM, Bin SI, Kim E. Inframeniscal portal for horizontal tears of the meniscus. Arthroscopy. 2009; 25(3):269–73.
6. Seil R, Pape D. Meniscal repair: Biomechanics. In: Beaufils P, Verdonk R, eds. The meniscus. New York: Springer, 2010;107-17.
7. Fukubayashi T and Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand. 1980; 51: 871–9.
8. Abrams GD, Frank RM, Gupta AK, et al. Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med. 2013; 41: 2333–39.
9. Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982; 10:90–5.
10. Gunja NJ and Athanasiou KA. Effects of hydrostatic pressure on leporine meniscus cell-seeded PLLA scaffolds. J Biomed Mater Res. 2009; 92: 896–905.
11. Freymann U, Endres M, Neumann K, et al. Expanded human meniscus-derived cells in 3-D polymer–hyaluronan scaffolds for meniscus repair. Acta Biomaterialia. 2012; 8: 677–85.
12. Ishida K, Kuroda R, Miwa M, et al. The regenerative effects of platelet-rich plasma on meniscal cells in vitro and it’s in vivo application with biodegradable gelatin hydrogel. Tissue Eng. 2007;13:1103–12.
13. Maitra RS, Miller MD, Johnson DL. Meniscal reconstruction: Part I: indications, techniques, and graft considerations. Am J Orthop. 1999; 28:213–8.
14. Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee: the contributions of the supporting structures: a quantitative in vitro study. J Bone Joint Surg Am. 1976; 58:583–94.
15. Stone KR. Meniscus replacement. Clin Sports Med. 1996;15: 557–71.
16. Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986; 14:271-5.
17. McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br. 2006; 88:1549-56.
18. Hede A, Larsen E, Sandberg H. The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. Int Orthop. 1992; 16:122-5.
19. Kamimura T, Kimura M. Repair of horizontal meniscal cleavage tears with exogenous fibrin clots. Knee Surg Sports Traumatol Arthrosc. 2011; 19:1154-7.
20. Pujol N, Bohu Y, Boisrenoult P, Macdes A, Beaufils P. Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients. Knee Surg Sports Traumatol Arthrosc. 2013; 21:1530-3.
21. Ahn JH, Kwon OJ, Nam TS. Arthroscopic repair of horizontal meniscal cleavage tears with marrow-stimulating technique. Arthroscopy. 2015; 31(1):92-8.
22. Saliman, Justin D. The circumferential compression stitch for meniscus repair. Arthrosc Tech. 2013; 2(3): 257-64.
23. Ti̇fti̇kçi̇ U, Serbest S. Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up. J Orthop Surg Res. 2016; 11(1):131.
24. Kamimura T, Kimura M. Repair of horizontal meniscal cleavage tears with ex- ogenous fibrin clots. Knee Surg Sports Traumatol Arthrosc. 2011; 19(7):1154-7.
25. He W, Liu YJ, Wang ZG, Guo ZK, Wang MX, Wang N. Enhancement of meniscal repair in the avascular zone using connective tissue growth factor in a rabbit model. Chin Med J. 2011;124:3968–75.
26. Kopf S, Birkenfeld F, Becker R, et al. Local treatment of meniscal lesions with vascular endothelial growth factor. J Bone Joint Surg Am. 2010; 92:2682–91.
27. 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; 13:1103–12.
28. Jang SH, Ha JK, Lee DW, Kim JG. Fibrin clot delivery system for meniscal repair. Knee Surg Relat Res 2011; 23:180-3.
29. Narita A, Takahara M, Sato D, et al. Biodegradable gelatin hydrogels incorporating fibroblast growth factor 2 promote healing of horizontal tears in rabbit meniscus. Arthroscopy. 2012; 28(2):255–63
30. Narita, A, Takahara, M, Sato, D, et al. Biodegradable gelatin hydrogels incorporating fibroblast growth factor 2 promote healing of horizontal tears in rabbit meniscus.Arthroscopy. 2012; 28(2): 255-63.
31. Anz AW, Rodkey WG. Biological enhancement of meniscus repair and replacement. Sports Med Arthrosc. 2012; 20:115-20.
32. Schüttler KF, Haberhauer F, Gesslein M. et al. Midterm follow-up after implantation of a polyurethane meniscal scaffold for segmental medial meniscus loss: maintenance of good clinical and MRI outcome. Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1478–84.
33. Harston A, Nyland J, Caborn DN, et al. Collagen meniscus implantation: a systematic review including rehabilitation and return to sports activity. Knee Surg Sports Traumatol Arthrosc. 2012; 20: 135–46.
34. Grassi A, Zaffagnini S, Marcheggiani Muccioli GM, et al. Clinical outcomes and complications of a collagen meniscus implant: a systematic review. Int Orthop. 2014; 38: 1945–53.
35. Reguzzoni M, Manelli A, Ronga M, Raspanti M, Grassi FA. Histology and ultrastructure of a tissue-engineered collagen meniscus before and after implantation. J Biomed Mater Res B Appl Biomater. 2005; 74(2):808-16.
36. Verdonk R, Verdonk P, Huysse W, et al. Tissue ingrowth after implantation of a novel, biodegradable polyurethane scaffold for treatment of partial meniscal lesions. Am J Sports Med. 2011; 39: 774–82.
37. Henning CE, Yearout KM, Vequist SW, Stallbaumer RJ, Decker KA. Use of the fascia sheath coverage and exogenous fibrin clot in the treatment of complex meniscal tears. Am J Sports Med. 1991; 19(6):626-31.