Clinical Results Of Polyurethane Scaffold In Lateral Meniscus Segmental Defects

2013 ISAKOS ABSTRACTS

complete bonding of the graft to the adjacent host cartilage. Three cases showed minimal fissuring and scanty fibrous tissues between graft and host tissue. One symptomatic knee with a lesion of 900 mm2 showed extensive fibrous tissue between graft and host cartilage despite of the viable graft. It appears that a cartilage lesion larger than 500 mm2 is prone to complication and poor outcome. Fresh frozen osteochondral allograft may be a better choice for massive chondral and osteochondral defect. Conclusion: Autologous osteochondral graft provides good or excellent results in 85% of patients with focal contained chondral and osteochondral defects of the knee. There was no correlation of the clinical results with the nature of the disease and the size of the lesion smaller than 500 mm2. Any lesion larger than 500 mm2 is prone to poor clinical outcome. Autologous osteochondral graft is suitable for treatment of knee with moderate size full thickness contained articular cartilage defect of the knee. Paper #30: The Effect of Platelet-Rich Plasma on Autologous Osteochondral Transplants in a Rabbit Model NIALL A. SMYTH, MD, USA PRESENTING AUTHOR AMGAD M. HALEEM, MD, USA CHRISTOPHER D. MURAWSKI, BS, USA HUONG DO, MA, USA JONATHAN T. DELAND, MD, USA JOHN G. KENNEDY, MD, FRCS, USA $ Hospital for Special Surgery, New York, New York, USA

SUMMARY Autologous osteochondral transplants (AOT) have been shown in in-vivo studies to exhibit poor integration at the chondral interface as well as degeneration of the cartilage. We investigated the effect of platelet-rich plasma as a biological adjunct in a rabbit AOT model, and we report improved gross and histological results. ABSTRACT DATA Objectives: Autologous osteochondral transplantation restores a full-thickness cartilage defect with a cylindrical unit of bone and viable articular cartilage. Despite this, previous in-vivo studies have described poor graft integration at the chondral interface as well as degeneration of the cartilage, potentially compromising long-term viability. This has prompted the investigation into biological adjuncts to address these concerns. One such biological adjunct is platelet-rich plasma (PRP), which has the potential to improve integration of the bone and cartilage at the grafthost interface. The Purpose of this study was to evaluate the effect of PRP on soft tissue healing of osteochondral grafts in a rabbit model. Methods: Bilateral osteochondral defects (2.7 mm in diameter, 5 mm in depth) were created on the weight-bearing surface of the femoral condyles of 12 New Zealand white rabbits. Blood was drawn from the aural artery and centrifuged to produce PRP using a standard, commercially available centrifugation system. Osteochondral grafts were harvested from the ipsilateral femoral condyle and, after randomization, treated with either PRP or saline before implantation into the defect site. The rabbits were euthanized at 3, 6, and 12 weeks post-operatively. Cytological analysis was performed on

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whole blood prior to centrifugation and on PRP. Repair cartilage was assessed using the ICRS macroscopic and modified ICRS histological scoring systems. Additionally, proteoglycan staining was assessed as well as immunohistochemistry performed for type-II collagen content. Results: The PRP contained a significantly increased platelet count (5.1 fold; 819.2 +/- 169.6 X 103 / ul; mean and standard deviation) compared to whole blood (161.8 +/- 56.1 X 103 / ul; mean and standard deviation; p ¼ 0.001). Additionally, the white blood cell count was significantly increased in the PRP (1.9 fold; 9.9 +/- 4.4 X 103 / ul; mean and standard deviation) compared to whole blood (5.1 +/- 1.1 X 103 / ul; mean and standard deviation; p ¼ 0.03). The red blood cell count was significantly decreased in the PRP group (0.28 fold; 10.14 +/- 2.3 X 103 / ul; mean and standard deviation) compared to whole blood (35.9 +/- 2.2 X 103 / ul; mean and standard deviation; p ¼ 0.000005). Macroscopic assessment revealed an improved mean ICRS macroscopic score in the PRP treated group (mean 11.2 +/- 0.9) compared to the control group (mean 10.4 +/- 0.9), although this was not statistically significant (p ¼ 0.09). PRP treated grafts resulted in improved integration of the osteochondral graft with blurring of the demarcation between the graft and surrounding native tissue. Additionally, the surface of the PRP treated grafts showed less evidence of fibrillation and fissuring compared to the control group. The mean modified ICRS histological score at all time points for the PRP treated osteochondral transplants was significantly better (mean 19.2 +/- 4.3) compared to the control group (13.5 +/- 3.3; p ¼ 0.002). Assessing graft integration specifically, the mean score for the PRP treated group was significantly better (mean 2.5 +/- 0.9) compared to the control group (1.6 +/- 0.7; p ¼ 0.004). There was greater alcian blue staining at the borders of the osteochondral graft as well as at the interface when compared to the control group, indicating increased proteoglycan content. The PRP group also demonstrated greater type II collagen immunoreaction versus the control group. No adverse events occurred as a result of the surgical procedure or PRP. Conclusion: Platelet-rich plasma may improve healing of an osteochondral graft, and has the potential to be used clinically as a biological adjunct in cartilage repair. Further work must be done to characterize the contents of PRP and their effect on soft tissue healing. Paper #31: Clinical Results Of Polyurethane Scaffold In Lateral Meniscus Segmental Defects HOUSSAM BOUYARMANE, MD, FRANCE PRESENTING AUTHOR PHILIPPE BEAUFILS, MD, FRANCE JOHAN BELLEMANS, MD, PHD, BELGIUM NICOLAS PUJOL, MD, FRANCE SIMON ROBERTS, MA FRCS (ORTH) FFSEM (UK), UNITED KINGDOM TIM SPALDING, FRCS ORTH, UNITED KINGDOM STEFANO ZAFFAGNINI, MD, ITALY MAURILIO MARCACCI, MD, ITALY PETER VERDONK, MD, PHD, BELGIUM RENÉ E. VERDONK, MD, PHD, BELGIUM $ Centre Hospitalier de Versailles, Versailles, France

SUMMARY Repair of lateral meniscal defects using a novel biodegradable polyurethane scaffold

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2013 ISAKOS ABSTRACTS

ABSTRACT DATA Introduction: Segmental tissue loss in lateral meniscus is associated with pain and increased risk of osteoarthritis. Hypothesis: Repairing the defect using a novel biodegradable scaffold is able to restore the knee function. Materials and Methods: A total of 54 patients (37 males/ 17 females; mean age 28 years (16 - 50),) were enrolled in a prospective multicenter study. All patients presented with post meniscectomy syndrome and segmental lateral meniscal loss, and were treated with a polyurethane biodegradable porous scaffold (ActifitÒ Orteq) implanted arthroscopically. Clinical outcomes were assessed at 6, 12, and 24 months using Visual analog scale (VAS), International knee documentation committee score (IKDC), Knee injury and osteoarthritis outcome score (KOOS). Results: A total of 7 relook arthroscopies were performed (7/54 [13%]): 2 for torn scaffolds after 15 and 36 months, one separation of scaffold from native lateral meniscus at 15 months, 3 reinterventions for lateral meniscal tears after 6, 7 and 14 months and 1 for undiagnosed post op pain. VAS decreased from 5.5 at baseline to 3.3 at 6 months , 2.8 at 12m and 1.9 at 24 months (n ¼ 34) respectively. IKDC improved from 41 at baseline to 63, 58 and 70 at 6, 12 and 24 months (n ¼ 26) respectively. All KOOS subscores improved between baseline and 24 months. KOOS pain (71/6 months, 86/12 months, 80/24 months (n ¼ 21) vs 57 at baseline) , KOOS symptoms (75/6 months, 83/12 months and 79/24 months (n ¼ 21) vs 58 at baseline ) KOOS activities of daily living ( 81/6 months, 89/12 months, 85/24 months ( n ¼ 21) vs 66 at baseline), KOOS sports (42/6 months, 57/12 months. 56/24 months (n ¼ 21) vs 26 at baseline ), KOOS quality of life (47/6 months, 55/12 months, 57/24 months (n ¼ 20) vs 29 at baseline). Discussion: All patient outcome scores demonstrated a significant improvement in pain and function during the two years following implantation of the lateral polyurethane scaffold. Conclusion: Clinical outcome data 24 months after index surgery demonstrates the lateral polyurethane scaffold is an effective treatment for patients presenting with post meniscectomy syndrome. Paper #32: A 24-Month Follow-Up Study On Clinical And Radiological Outcomes Of Polyurethane Meniscal Scaffolds PETER VERDONK, MD, PHD, BELGIUM PRESENTING AUTHOR TINEKE DE CONINCK, BELGIUM LAURENT WILLEMOT, MD, BELGIUM WOUTER HUYSSE, MD, BELGIUM KOENRAAD VERSTRAETE, MD, PHD, BELGIUM RENÉ E. VERDONK, MD, PHD, BELGIUM $ Ghent University, Ghent, Belgium

SUMMARY Radial displacement after poly-urethane meniscus scaffold for treatment of partial defects does not correlate with significant clinical improvement

ABSTRACT DATA Background: Little is known about radial displacement (RD) of polyurethane (PU) scaffolds, intended for partial meniscus defect substitution; no data are available on whether rim thickness has an effect on RD, and if RD correlates with clinical outcome scores. Hypothesis: The meniscus is not extruded preoperatively, but RD occurs after scaffold implantation. It is also hypothesized that a thicker meniscal rim will limit RD, and that there is no correlation between RD and clinical outcome. Study Design: Case series. Methods: Twenty-six patients were implanted with a PU scaffold (8 lateral, 18 medial) and were followed up for 2 years. RD (mm) was evaluated on magnetic resonance images preoperatively and at 3, 12 and 24 months postoperatively. At each of these time points it was determined whether a correlation existed between the rim and RD. Clinical outcome scores were determined pre- and postoperative using a visual analog scale (VAS) for pain and with the Lysholm, Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores. Results: RD of lateral scaffolds was not significantly different (p¼0.178), neither preoperatively (3.420.99 mm), nor at 3 months (4.820.59 mm), 1 year (4.550.87 mm) and 2 years postoperatively (4.100.93 mm). No correlation was observed between the rim and lateral RD at all time points. RD of medial scaffolds increased significantly (p<0.001) from the preoperative values (2.170.84 mm) to those at 3 months (4.250.89 mm), 1 year (4.431.01 mm) and 2 years postoperatively (4.410.96 mm). A strong negative correlation between medial RD and the rim was observed at all postoperative time points. There was no significant correlation between clinical outcome scores and RD, both pre- and postoperative. Conclusion: This study demonstrated that limited medial meniscal RD was present preoperatively, but increased by 2 mm after scaffold implantation. Lateral RD was also present preoperatively, but did not increase after scaffold implantation. Importantly, a strong negative correlation was found between the rim and postoperative medial RD ; a thicker rim limited RD. However, in the lateral compartment, rim thickness did not correlate with RD because RD was already strongly present preoperatively. Finally, no correlations were observed between scaffold RD and clinical outcome scores, both pre-and postoperative. Paper #33: Meniscus Allograft Transplantation Allows Return To Sporting Activities KEVIN R. STONE, MD, USA PRESENTING AUTHOR JONATHAN PELSIS, MHS, USA SCOTT SURRETTE, MENG, USA AMANDA STAVELY, BS, USA ANN W. WALGENBACH, RN, NP, MSN, USA $ Stone Research Foundation, San Francisco, California, USA

SUMMARY This study shows promising long-term clinical results and estimated survival of meniscus allograft transplantation