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Collagen meniscus implant in humans
MINI-PAPERS
383
Mini-Papers Collagen Meniscus Implant in Humans. Kevin R. Stone, J. Richard Steadman, Shu-Tung Li, and William Rodkey. San Francisco, California, Vail, Colorado, and Franklin Lakes, New Jersey, U.S.A. The purpose of this FDA-approved study was to evaluate the safety, implantability, and ability of a collagen meniscus implant to support tissue ingrowth humans. Ten patients underwent implantation of the collagen implant for irreparable meniscal tears or significant segmental meniscal defects. Three patients underwent second-look arthroscopy with biopsy at 3 months, and 6 patients at 6 months. One patient had an additional 12-month arthroscopy and biopsy. One patient refused follow-up arthroscopy. All patients had varying portions of the previous defect filled with regenerated tissue. Remnants of implant were still present at 6 months, and loose bodies representing portions of the implant were noted in 2 patients. Fibrochondrocyte ingrowth and new tissue regeneration were consistently noted with a chondroid appearance. There appeared to be no adverse tissue reaction to the implant, although 7 patients had at least one episode of transient swelling. The etiology of the swelling was not specifically determined. Screening of patients' sera and joint fluid for antibodies revealed no humoral immunological response. MRI evaluation revealed progressive increase in signal intensity within the implant new tissue complex. The clinical evaluations have revealed marked improvement from the preoperative assessment with minimal pain and return to athletic activities. We conclude that the collagen meniscus implant can support meniscal fibrocartilage regeneration. We believe that further refinements in the implant to speed ingrowth and enhance durability will continue to improve our ability to induce regrowth of the meniscus cartilage.
Arthroscopic Ankle Synovectomy for Recurrent Hemarthroses in Severe Hemophilia. James E. Patti and W. E. Barry Mayo. Royal Oak, Michigan, U.S.A. Introduction: The ankle is among the most fre-
quently affected joints in patients with hemophilia. Several studies have documented the beneficial effects of open ankle synovectomy, reporting increased range of motion, decreased pain, and decreased frequency of hemarthrosis. To date, no study has documented the effectiveness of arthroscopic ankle synovectomy in the setting of severe hemophilia. The purpose of this study, therefore, was to evaluate the outcome of arthroscopic ankle synovectomies for recurrent ankle hemarthrosis in patients with severe hemophilia. Methods: Nine patients with severe hemophilia and recurrent bleeding episodes into the index ankle were evaluated following arthroscopic ankle synovectomy. Preoperative clinical charts were reviewed retrospectively for range of motion, frequency of bleeds, duration of symptoms, and age at the time of surgery. Postoperative anteroposterior and lateral ankle radiographs were reviewed for evidence of arthrosis. These were compared to preoperative radiographs. Postoperative physical examinations were performed on all available patients. Postoperatively, all patients were questioned in person or via telephone regarding a functional level as modifed from Mazur. Results: Follow-up averaged 33 months (range, 967 months). The average age at the time of surgery was 12.3 years (range, 6.1-21.9 years). The functional score averaged 36.1 points (range, 17-68 points) preoperatively, and 77.9 points (range, 32-100 points) postoperatively. This difference was significant with a P value < .001 by the paired-t test. No postoperative complications were noted. Discussion and Conclusion: The functional score of all nine patients improved relative to their preoperative levels. The frequency of bleeds was similarly reduced. The availability of preoperative data was not sufficient to draw meaningful conclusions regarding range of motion or progression of arthrosis; however, both parameters appeared stable over the timecourse of this study. We feel that arthroscopic ankle synovectomy is a safe and effective method for improving ankle function and decreasing the frequency of ankle hemarthrosis in hemophiliacs. Arthroscopy, Vol 12, No 3, 1996
383
Mini-Papers Collagen Meniscus Implant in Humans. Kevin R. Stone, J. Richard Steadman, Shu-Tung Li, and William Rodkey. San Francisco, California, Vail, Colorado, and Franklin Lakes, New Jersey, U.S.A. The purpose of this FDA-approved study was to evaluate the safety, implantability, and ability of a collagen meniscus implant to support tissue ingrowth humans. Ten patients underwent implantation of the collagen implant for irreparable meniscal tears or significant segmental meniscal defects. Three patients underwent second-look arthroscopy with biopsy at 3 months, and 6 patients at 6 months. One patient had an additional 12-month arthroscopy and biopsy. One patient refused follow-up arthroscopy. All patients had varying portions of the previous defect filled with regenerated tissue. Remnants of implant were still present at 6 months, and loose bodies representing portions of the implant were noted in 2 patients. Fibrochondrocyte ingrowth and new tissue regeneration were consistently noted with a chondroid appearance. There appeared to be no adverse tissue reaction to the implant, although 7 patients had at least one episode of transient swelling. The etiology of the swelling was not specifically determined. Screening of patients' sera and joint fluid for antibodies revealed no humoral immunological response. MRI evaluation revealed progressive increase in signal intensity within the implant new tissue complex. The clinical evaluations have revealed marked improvement from the preoperative assessment with minimal pain and return to athletic activities. We conclude that the collagen meniscus implant can support meniscal fibrocartilage regeneration. We believe that further refinements in the implant to speed ingrowth and enhance durability will continue to improve our ability to induce regrowth of the meniscus cartilage.
Arthroscopic Ankle Synovectomy for Recurrent Hemarthroses in Severe Hemophilia. James E. Patti and W. E. Barry Mayo. Royal Oak, Michigan, U.S.A. Introduction: The ankle is among the most fre-
quently affected joints in patients with hemophilia. Several studies have documented the beneficial effects of open ankle synovectomy, reporting increased range of motion, decreased pain, and decreased frequency of hemarthrosis. To date, no study has documented the effectiveness of arthroscopic ankle synovectomy in the setting of severe hemophilia. The purpose of this study, therefore, was to evaluate the outcome of arthroscopic ankle synovectomies for recurrent ankle hemarthrosis in patients with severe hemophilia. Methods: Nine patients with severe hemophilia and recurrent bleeding episodes into the index ankle were evaluated following arthroscopic ankle synovectomy. Preoperative clinical charts were reviewed retrospectively for range of motion, frequency of bleeds, duration of symptoms, and age at the time of surgery. Postoperative anteroposterior and lateral ankle radiographs were reviewed for evidence of arthrosis. These were compared to preoperative radiographs. Postoperative physical examinations were performed on all available patients. Postoperatively, all patients were questioned in person or via telephone regarding a functional level as modifed from Mazur. Results: Follow-up averaged 33 months (range, 967 months). The average age at the time of surgery was 12.3 years (range, 6.1-21.9 years). The functional score averaged 36.1 points (range, 17-68 points) preoperatively, and 77.9 points (range, 32-100 points) postoperatively. This difference was significant with a P value < .001 by the paired-t test. No postoperative complications were noted. Discussion and Conclusion: The functional score of all nine patients improved relative to their preoperative levels. The frequency of bleeds was similarly reduced. The availability of preoperative data was not sufficient to draw meaningful conclusions regarding range of motion or progression of arthrosis; however, both parameters appeared stable over the timecourse of this study. We feel that arthroscopic ankle synovectomy is a safe and effective method for improving ankle function and decreasing the frequency of ankle hemarthrosis in hemophiliacs. Arthroscopy, Vol 12, No 3, 1996