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A Comparison Between Polyurethane and Collagen Meniscal Scaffold for Partial Meniscal Defects: Similar Positive Clinical Results at a Mean of 10 Years of Follow-Up

Published:September 24, 2021DOI:https://doi.org/10.1016/j.arthro.2021.09.011

      Purpose

      To compare, at long-term follow-up, the clinical outcomes and failures of collagen and polyurethane meniscal scaffolds for the treatment of partial meniscal defects.

      Methods

      Patients affected by partial meniscal defect with intact anterior and posterior meniscal attachments and an intact rim at the circumference of the missing meniscus were included, treated with a collagen meniscal implant or with polyurethane scaffold, and clinically evaluated by analysis of the subjective International Knee Documentation Committee score, the visual analog scale score for the evaluation of knee function and symptoms, and the Tegner score to assess the activity level.

      Results

      After 3 patients dropped out, a total of 47 patients, comprising 31 men and 16 women, with a mean age of 43 ± 14.1 years and mean body mass index of 25 ± 1.4, were clinically evaluated up to a mean of 10 years’ follow-up. The International Knee Documentation Committee score improved from 42.9 ± 15.9 to 67.4 ± 12.4 (P < .0005) in the polyurethane implant group and from 46.8 ± 16.7 to 62.1 ± 22.6 (P < .0005) in the collagen meniscal implant group. The visual analog scale score decreased significantly from baseline values of 5.4 ± 2.3 and 4.4 ± 1.7, to 3.4 ± 2.5 and 2.7 ± 2.4, respectively, at final follow-up in the polyurethane implant (P = .002) and collagen meniscal implant (P < .0005) groups. The Tegner score improved in both groups without reaching the preinjury activity level. No significant differences in the scores were found between the polyurethane and collagen scaffold groups. A total of 10 implants failed, 5 per group, for a cumulative failure rate of 21.3%, with no differences between the 2 scaffolds.

      Conclusions

      The long-term comparison showed positive and similar results for both polyurethane- and collagen-based meniscal scaffolds, with an implant survival rate of about 80% at 10 years of follow-up and no differences in terms of pain, function, and activity level.

      Level of evidence

      Level IV, case-control comparative study.
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      References

        • Verdonk P.
        • Beaufils P.
        • Bellemans J.
        • et al.
        Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: Two-year safety and clinical outcomes.
        Am J Sports Med. 2012; 40: 844-853
        • Baratz M.E.
        • Fu F.H.
        • 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: 270-275
        • Lee S.J.
        • Aadalen K.J.
        • Malaviya P.
        • et al.
        Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee.
        Am J Sports Med. 2006; 34: 1334-1344
        • Ode G.E.
        • Van Thiel G.S.
        • McArthur S.A.
        • et al.
        Effects of serial sectioning and repair of radial tears in the lateral meniscus.
        Am J Sports Med. 2012; 40: 1863-1870
        • Kon E.
        • Filardo G.
        • Tschon M.
        • et al.
        Tissue engineering for total meniscal substitution: Animal study in sheep model—Results at 12 months.
        Tissue Eng Part A. 2012; 18: 1573-1582
        • Testa Pezzin A.P.
        • Cardoso T.P.
        • do Carmo Alberto Rincon M.
        • de Carvalho Zavaglia C.A.
        • de Rezende Duek E.A.
        Bioreabsorbable polymer scaffold as temporary meniscal prosthesis.
        Artif Organs. 2003; 27: 428-431
        • Verdonk R.
        • Volpi P.
        • Verdonk P.
        • et al.
        Indications and limits of meniscal allografts.
        Injury. 2013; 44: S21-S27
        • Gomoll A.H.
        • Filardo G.
        • Almqvist F.K.
        • et al.
        Surgical treatment for early osteoarthritis. Part II: Allografts and concurrent procedures.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 468-486
        • Rodkey W.G.
        • Steadman J.R.
        • Li S.T.
        A clinical study of collagen meniscus implants to restore the injured meniscus.
        Clin Orthop Relat Res. 1999; 367: S281-S292
        • Stone K.R.
        • Rodkey W.G.
        • Webber R.
        • McKinney L.
        • Steadman J.R.
        Meniscal regeneration with copolymeric collagen scaffolds. In vitro and in vivo studies evaluated clinically, histologically, and biochemically.
        Am J Sports Med. 1992; 20: 104-111
        • Bulgheroni P.
        • Murena L.
        • Ratti C.
        • Bulgheroni E.
        • Ronga M.
        • Cherubino P.
        Follow-up of collagen meniscus implant patients: Clinical, radiological, and magnetic resonance imaging results at 5 years.
        Knee. 2010; 17: 224-229
        • Monllau J.C.
        • Poggioli F.
        • Erquicia J.
        • et al.
        Magnetic resonance imaging and functional outcomes after a polyurethane meniscal scaffold implantation: Minimum 5-year follow-up.
        Arthroscopy. 2018; 34: 1621-1627
        • Steadman J.R.
        • Rodkey W.G.
        Tissue-engineered collagen meniscus implants: 5- to 6-year feasibility study results.
        Arthroscopy. 2005; 21: 515-525
        • Zaffagnini S.
        • Giordano G.
        • Vascellari A.
        • et al.
        Arthroscopic collagen meniscus implant results at 6 to 8 years follow up.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 175-183
        • Zaffagnini S.
        • Marcheggiani Muccioli G.M.
        • Lopomo N.
        • et al.
        Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: A minimum 10-year follow-up study.
        Am J Sports Med. 2011; 39: 977-985
      1. Reale D, Previtali D, Andriolo L, et al. No differences in clinical outcome between CMI and Actifit meniscal scaffolds: A systematic review and meta-analysis [published online April 16, 2021]. Knee Surg Sports Traumatol Arthrosc.

        • Monllau J.C.
        • Gelber P.E.
        • Abat F.
        • et al.
        Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years' follow-up.
        Arthroscopy. 2011; 27: 933-943
        • Bulgheroni E.
        • Grassi A.
        • Bulgheroni P.
        • Marcheggiani Muccioli G.M.
        • Zaffagnini S.
        • Marcacci M.
        Long-term outcomes of medial CMI implant versus partial medial meniscectomy in patients with concomitant ACL reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3221-3227
        • Bloch B.
        • Getgood A.
        • Parkinson B.
        • Spalding T.
        Concepts in managing the patient with post-meniscectomy knee pain.
        in: Hulet C.P.H. Peretti G. Denti M. Surgery of the meniscus. Springer, Heidelberg2016: 437-446
        • Efe T.
        • Getgood A.
        • Schofer M.D.
        • et al.
        The safety and short-term efficacy of a novel polyurethane meniscal scaffold for the treatment of segmental medial meniscus deficiency.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1822-1830
        • Dhollander A.
        • Verdonk P.
        • Verdonk R.
        Treatment of painful, irreparable partial meniscal defects with a polyurethane scaffold: Midterm clinical outcomes and survival analysis.
        Am J Sports Med. 2016; 44: 2615-2621
        • Filardo G.
        • Kon E.
        • Perdisa F.
        • et al.
        Polyurethane-based cell-free scaffold for the treatment of painful partial meniscus loss.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 459-467
        • Toanen C.
        • Dhollander A.
        • Bulgheroni P.
        • et al.
        Polyurethane meniscal scaffold for the treatment of partial meniscal deficiency: 5-Year follow-up outcomes: A European multicentric study.
        Am J Sports Med. 2020; 48: 1347-1355
        • Schuttler K.F.
        • 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: 1478-1484
        • Bulgheroni E.
        • Grassi A.
        • Campagnolo M.
        • Bulgheroni P.
        • Mudhigere A.
        • Gobbi A.
        Comparative study of collagen versus synthetic-based meniscal scaffolds in treating meniscal deficiency in young active population.
        Cartilage. 2016; 7: 29-38
        • Spencer S.J.
        • Saithna A.
        • Carmont M.R.
        • Dhillon M.S.
        • Thompson P.
        • Spalding T.
        Meniscal scaffolds: Early experience and review of the literature.
        Knee. 2012; 19: 760-765
        • Liu J.N.
        • Gowd A.K.
        • Redondo M.L.
        • et al.
        Establishing clinically significant outcomes after meniscal allograft transplantation.
        Orthop J Sports Med. 2019; 7 (2325967118818462)
        • Hirschmann M.T.
        • Keller L.
        • Hirschmann A.
        • et al.
        One-year clinical and MR imaging outcome after partial meniscal replacement in stabilized knees using a collagen meniscus implant.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 740-747
        • Gelber P.E.
        • Isart A.
        • Erquicia J.I.
        • Pelfort X.
        • Tey-Pons M.
        • Monllau J.C.
        Partial meniscus substitution with a polyurethane scaffold does not improve outcome after an open-wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 334-339
        • Houck D.A.
        • Kraeutler M.J.
        • Belk J.W.
        • McCarty E.C.
        • Bravman J.T.
        Similar clinical outcomes following collagen or polyurethane meniscal scaffold implantation: A systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2259-2269
        • Rodkey W.G.
        • DeHaven K.E.
        • Montgomery III, W.H.
        • et al.
        Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial.
        J Bone Joint Surg Am. 2008; 90: 1413-1426
        • Condello V.
        • Dei Giudici L.
        • Perdisa F.
        • et al.
        Polyurethane scaffold implants for partial meniscus lesions: Delayed intervention leads to an inferior outcome.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 109-116