Abstract
INTRODUCTION
The menisci play a fundamental biomechanical role in the knee and also help in the maintaining of the articular homeostasis; thus, either a lesion or the complete absence of the menisci can invalidate the physiological function of the knee causing important damages, even at long term. Unfortunately, meniscal tears are often found during the ordinary orthopaedic practice while the regenerative potential of this kind of tissue is very low and limited to its peripheral-vascularized part; this is why the majority of these common arthroscopic findings are not reparable and often the surgeon is almost forced to perform a partial, subtotal or even total meniscectomy, regardless of the well-known consequences of this kind of surgery.
MATERIALS AND METHODS
Recently a porous, biodegradable scaffold made of an aliphatic polyurethane (Actifit(tm),Orteq Ltd) has been developed for the arthroscopic treatment of partial and irreparable meniscal tears; thanks to its particular structure, this scaffold facilitates the regeneration of the removed meniscal part, preventing the potential cartilage damage due to its complete or partial lack.
We performed a prospective clinical study on 17 patients affected by a massive loss of meniscal substance either medial or lateral associated with intraarticular or global knee pain and/or swelling.
We analyzed the patient both clinically and by using the International Knee Document Committee's (IKDC) Subjective and Objective Knee Evaluation Form. We also assessed the sport activity resumption by comparing the Tegner score at the time of the very first visit with the presurgery and prelesional ones. Finally, we also organized a control MRI at 6 and 12 months after surgery.
DISCUSSION
Our preliminary results are encouraging and they confirm the clinical experiences of other study groups. Apparently, the properties of this scaffold help in vessels formation and tissue regeneration potentially allowing the restoration of the surgically removed portion and preventing, or delaying at least, both chondral and articular degeneration.
We also performed some biopsy associated arthroscopic “second-looks” that reinforced the already good clinical results; the biopsies also confirmed the new tissue ingrowth into the biomaterial, potentially leading to the replacement of the previously removed damaged tissue.
CONCLUSIONS
Preliminary results suggest that this surgical procedure can be considered a really promising method for the treatment of both inveterate and symptomatic meniscal tears; however, other randomized studies with a longer follow-up should be done to confirm its reliability and potentialities.
