Paper 236: Long Term Clinical Outcome of Meniscal Allograft Transplantation
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sequentially (two to three times) so as to obtain an adequate number of MSC; in the last culture the cells were incubated in a solution containing deoxibromouri- dine (DBU) so as to mark their DNA. The medial me- niscus of both knees was approached, and a 0,5 cm longitudinal tear in the avascular area of the anterior horn was performed. In twelve rabbits the lesions were re- paired immediately and in another twelve rabbits the lesions were repaired three weeks later. All the tears were sutured with one simple vertical stitch of nonab- sorbable suture. A Matrigel® solution with 100,000- 1,000,000 MSC was placed prior to suture tightening inside the sutured area of one of the knees; in the contralateral knee the Matrigel® solution was placed without cells to be used as controls. The rabbits were sacrificed after 12 weeks, menisci were evaluated macro-microscopically and an inmunohistochemical analysis with antibodies for DBU was performed to evaluate the presence of siblings of the stem cells. Results: In the group repaired acutely three total and three partial healings were observed in the MSC group and none in the control group. In the group repaired after three weeks one total and one partial healing were ob- served in the MSC group and none in the control group The inmunohistochemical evaluation showed positive results in menisci with partial or complete healing. Conclusions: MSC have a strong positive effect in the healing of meniscal lesions in the avascular zone in rabbits repaired acutely. This effect is lees marked if at all present when the lesion is repaired in a delayed fashion. Paper 236: Long Term Clinical Outcome of Meniscal Allograft Transplantation ROBERT VAN DER WAL, MD, NETHERLANDS,PRESENTING AUTHOR EWOUD VAN ARKEL, MD, PHD, NETHERLANDS ABSTRACT Purpose: Meniscal allograft transplantation for the symp- tomatic post-meniscectomized knee in younger patients has become an accepted treatment. However, long-term data on the clinical outcome of this procedure are scarce. We de- scribe the results of cryopreserved meniscal allograft trans- plantations with a follow-up of nine to eighteen years. Methods: From 1989 to 1999, 63 meniscal allografts were transplantated in 57 patients. The clinical outcome and failure rate of 40 lateral and 23 medial meniscal allografts were evaluated at a mean follow-up of 165 months (SD 105-221) using KOOS, Lysholm and the IKDC scoring systems. Results: Combined failure rate was 29%, 35% of medial allografts and 25% of lateral allografts failed. A signif- icant difference between preoperative and long-term Lysholm scores were found for almost all types of allograft transplantation, except medial transplanted allografts, fe- male patiens and left treated knees. Lysholm scores were poor (65) for both medial and lateral allografts. No sig- nificant differences in pain, symptoms and function scores were seen between these groups. In addition, there was no significant difference in clinical outcome between post- transplanted survivors and post-transplanted non-survivors who received a total knee arthroplasty. Conclusions: The results of pain and function scores of the knee after meniscal allograft transplantation at the long-term are poor. However, earlier results from this population confirmed an improvement in clinical func- tion and pain relief at the short- and intermediate-term, leaving meniscal allograft transplantation as a good op- tion for the treatment of degenerative arthritis of the symptomatic, post-meniscectomized knee. Meniscal al- lograft transplantation is a good postponement till total knee arthroplasty. Paper 237: An Allograft Based Tissue Engineered Meniscus Scaffold KATHRYNE J. STABILE, MD, MS, USA, PRESENTING AUTHOR DEVIN ODOM, BS, USA JULIE STEEN, BS, USA JOEL STITZEL,PHD, USA THOMAS L. SMITH,PH.D., USA MARK E. VANDYKE,PHD, USA CRISTIN MARTHA FERGUSON, MD, USA ABSTRACT Intro: Treatment options for irreparable meniscus inju- ries in the USA remain limited to partial or total menis- cectomy and meniscus transplant. Current allograft me- niscus transplants have been shown to lack complete cellular ingrowth. This may contribute to impaired long term incorporation and function. Increased porosity and interconnected pores may be able to improve the poten- tial for cellular ingrowth. The objective of this study was to develop an allograft based 3-dimensional scaffold for use as a meniscus transplant. Methods: Twelve ovine medial menisci were harvested and frozen in isotonic saline. Six menisci were left intact while n6 menisci were decellularized and oxidatively etched using a series of hypotonic washes, tritonX100, and peracetic acid washes. The menisci (now scaffolds) were normalized in phosphate buffered saline. To look for remaining nuclei, menisci (intact and scaffold) were an- alyzed histologically using H&E, Masson’s Trichrome, and nuclear fluorescent staining. DNA content was quan- tified for both the intact and scaffold menisci. To eval- uate changes in porosity, 2-dimensional SEM analysis e476 ABSTRACTS
Transcript of Paper 236: Long Term Clinical Outcome of Meniscal Allograft Transplantation
sequentially (two to three times) so as to obtain anadequate number of MSC; in the last culture the cellswere incubated in a solution containing deoxibromouri-dine (DBU) so as to mark their DNA. The medial me-niscus of both knees was approached, and a 0,5 cmlongitudinal tear in the avascular area of the anterior hornwas performed. In twelve rabbits the lesions were re-paired immediately and in another twelve rabbits thelesions were repaired three weeks later. All the tearswere sutured with one simple vertical stitch of nonab-sorbable suture. A Matrigel® solution with 100,000-1,000,000 MSC was placed prior to suture tightening insidethe sutured area of one of the knees; in the contralateralknee the Matrigel® solution was placed without cells to beused as controls. The rabbits were sacrificed after 12weeks, menisci were evaluated macro-microscopicallyand an inmunohistochemical analysis with antibodies forDBU was performed to evaluate the presence of siblingsof the stem cells.Results: In the group repaired acutely three total andthree partial healings were observed in the MSC groupand none in the control group. In the group repaired afterthree weeks one total and one partial healing were ob-served in the MSC group and none in the control groupThe inmunohistochemical evaluation showed positiveresults in menisci with partial or complete healing.Conclusions: MSC have a strong positive effect in thehealing of meniscal lesions in the avascular zone in rabbitsrepaired acutely. This effect is lees marked if at all presentwhen the lesion is repaired in a delayed fashion.
Paper 236: Long Term Clinical Outcome of MeniscalAllograft Transplantation ROBERT VAN DER WAL, MD,NETHERLANDS, PRESENTING AUTHOR
EWOUD VAN ARKEL, MD, PHD, NETHERLANDS
ABSTRACTPurpose: Meniscal allograft transplantation for the symp-tomatic post-meniscectomized knee in younger patients hasbecome an accepted treatment. However, long-term data onthe clinical outcome of this procedure are scarce. We de-scribe the results of cryopreserved meniscal allograft trans-plantations with a follow-up of nine to eighteen years.Methods: From 1989 to 1999, 63 meniscal allograftswere transplantated in 57 patients. The clinical outcomeand failure rate of 40 lateral and 23 medial meniscalallografts were evaluated at a mean follow-up of 165months (SD 105-221) using KOOS, Lysholm and theIKDC scoring systems.Results: Combined failure rate was 29%, 35% of medialallografts and 25% of lateral allografts failed. A signif-icant difference between preoperative and long-term
Lysholm scores were found for almost all types of allografttransplantation, except medial transplanted allografts, fe-male patiens and left treated knees. Lysholm scores werepoor (�65) for both medial and lateral allografts. No sig-nificant differences in pain, symptoms and function scoreswere seen between these groups. In addition, there was nosignificant difference in clinical outcome between post-transplanted survivors and post-transplanted non-survivorswho received a total knee arthroplasty.Conclusions: The results of pain and function scores ofthe knee after meniscal allograft transplantation at thelong-term are poor. However, earlier results from thispopulation confirmed an improvement in clinical func-tion and pain relief at the short- and intermediate-term,leaving meniscal allograft transplantation as a good op-tion for the treatment of degenerative arthritis of thesymptomatic, post-meniscectomized knee. Meniscal al-lograft transplantation is a good postponement till totalknee arthroplasty.
Paper 237: An Allograft Based Tissue EngineeredMeniscus Scaffold KATHRYNE J. STABILE, MD, MS, USA,PRESENTING AUTHOR
DEVIN ODOM, BS, USAJULIE STEEN, BS, USAJOEL STITZEL, PHD, USATHOMAS L. SMITH, PH.D., USAMARK E. VANDYKE, PHD, USACRISTIN MARTHA FERGUSON, MD, USA
ABSTRACTIntro: Treatment options for irreparable meniscus inju-ries in the USA remain limited to partial or total menis-cectomy and meniscus transplant. Current allograft me-niscus transplants have been shown to lack completecellular ingrowth. This may contribute to impaired longterm incorporation and function. Increased porosity andinterconnected pores may be able to improve the poten-tial for cellular ingrowth. The objective of this study wasto develop an allograft based 3-dimensional scaffold foruse as a meniscus transplant.Methods: Twelve ovine medial menisci were harvestedand frozen in isotonic saline. Six menisci were left intactwhile n�6 menisci were decellularized and oxidativelyetched using a series of hypotonic washes, tritonX100, andperacetic acid washes. The menisci (now scaffolds) werenormalized in phosphate buffered saline. To look forremaining nuclei, menisci (intact and scaffold) were an-alyzed histologically using H&E, Masson’s Trichrome,and nuclear fluorescent staining. DNA content was quan-tified for both the intact and scaffold menisci. To eval-uate changes in porosity, 2-dimensional SEM analysis
e476 ABSTRACTS
