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5. Polyurethane Meniscal Scaffold for the Treatment of Partial Meniscal Deficiency: 5-Year Follow-up Outcomes: A European Multicentric Study

Author

Toanen, Cecile, primary, Dhollander, Aad, additional, Bulgheroni, Paolo, additional, Filardo, Giuseppe, additional, Zaffagnini, Stefano, additional, Spalding, Tim, additional, Monllau, Joan Carles, additional, Gelber, Pablo, additional, Verdonk, Rene, additional, Beaufils, Philippe, additional, Pujol, Nicolas, additional, Bulgheroni, Erica, additional, Asplin, Laura, additional, and Verdonk, Peter, additional

Published
2020
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6. Substituts méniscaux en polyuréthane Actifit® : résultats à 5 ans minimum d’une étude multicentrique européenne

Author

Toanen, Cécile, primary, Dhollander, Aad, additional, Bulgheroni, Erica, additional, Bulgheroni, Paolo, additional, Filardo, Giuseppe, additional, Zaffagnini, Stefano, additional, Asplin, Laura, additional, Spalding, Tim, additional, Monllau, Juan Carlos, additional, Gelber, Pablo, additional, Verdonk, René, additional, Beaufils, Philippe, additional, Verdonk, Peter, additional, and Pujol, Nicolas, additional

Published
2019
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14. Comparative Study of Collagen versus Synthetic-Based Meniscal Scaffolds in Treating Meniscal Deficiency in Young Active Population

Author

Bulgheroni, Erica, Grassi, Alberto, Campagnolo, Monica, Bulgheroni, Paolo, Mudhigere, Abhishek, and Gobbi, Alberto

Abstract

Purpose: The aim of this study was to compare the effectiveness of 2 different meniscal scaffolds in treating patients with irreparable partial medial meniscal tear and patients complaining of pain in the medial compartment of the knee due to a previous partial medial meniscectomy. Based on previous studies, we hypothesized that both the scaffolds are effective in improving clinical outcomes in these patient populations.Material and Methods: Twenty-eight patients underwent collagen-based medial meniscus implantation (CMI-Menaflex) and 25 with a second-generation scaffold (Actifit). All patients were assessed with Lysholm, Tegner scale, and MRI evaluation—preoperatively, at 6 months, at 12 moths, and followed-up for a minimum of 2 years. Second look arthroscopy and concomitant biopsy were performed in 7 and 12 patients of CMI and Actifit groups, respectively.Results: The CMI group at final follow-up showed improvement in Lysholm score from 58.4 ± 17.3 to 94.5 ± 6.0, while the Actifit group showed improvement from 67.0 ± 15.7 to 90.3 ± 13.1; the improvement was statistically significant in both the groups but intergroup difference was not statistically significant (P= 0.1061). Tegner Activity Scale score improved in both the groups, but intergroup difference was not statistically significant (P= 0.5918). MRI evaluation showed in situscaffold and no progression of degenerative arthritis in both the groups at final follow-up. Histological evaluation showed more fibrous tissue with blood vessels in the CMI group and the Actift group showed avascular cartilaginous features.Conclusion: Both the scaffolds are effective in improving patients’ symptoms and joint function at short-term follow-up.

Published
2016
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15. Long-term outcomes of medial CMI implant versus partial medial meniscectomy in patients with concomitant ACL reconstruction

Author

Stefano Zaffagnini, Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Maurilio Marcacci, Erica Bulgheroni, Paolo Bulgheroni, Bulgheroni, Erica, Grassi, Alberto, Bulgheroni, Paolo, Marcheggiani Muccioli, Giulio Maria, Zaffagnini, Stefano, and Marcacci, Maurilio

Subjects
Adult, Joint Instability, Male, medicine.medical_specialty, Knee Joint, Anterior cruciate ligament reconstruction, Meniscu, Anterior cruciate ligament, medicine.medical_treatment, Meniscus (anatomy), Menisci, Tibial, CMI, medicine, Humans, Orthopedics and Sports Medicine, Retrospective Studies, Pain, Postoperative, Lysholm Knee Score, Anterior Cruciate Ligament Reconstruction, Tissue Scaffolds, business.industry, ACL, Prostheses and Implants, Middle Aged, musculoskeletal system, Tibial Meniscus Injuries, Surgery, surgical procedures, operative, medicine.anatomical_structure, Italy, Orthopedic surgery, Female, Osteoarthriti, Collagen, Implant, business, human activities, Medial meniscus, Follow-Up Studies
Abstract

PURPOSE: To compare the clinical, objective and radiographic long-term results of patients with anterior cruciate ligament (ACL) lesion and partial medial meniscus defects, treated with ACL reconstruction and partial medial meniscectomy or medial CMI implant. METHODS: Seventeen patients treated with combined ACL reconstruction and medial CMI and 17 patients treated with ACL reconstruction and partial medial meniscectomy were evaluated with mean follow-up 9.6 years with Lysholm, Tegner, objective and subjective International Knee Documentation Committee scores, and VAS for pain. Arthrometric evaluation was performed with KT 2000. Weigh-bearing radiographs, antero-posterior and Rosenberg view, were also performed and evaluated with Kellgren-Lawrence score, Ahlback score and joint space narrowing. RESULTS: Pre-operative demographic parameters and clinical scores between patients treated with CMI and partial medial meniscectomy revealed no significant differences. A significant improvement of all the clinical scores was detected in both groups from pre-operative status to final follow-up. No significant difference between groups were found for clinical and radiographic scores; however, the chronic subgroup of patients treated with CMI showed a significantly lower level of post-operative knee pain compared to patients treated with partial medial meniscectomy and the acute subgroup of medial CMI showed better arthrometric scores. CONCLUSION: Good long-term clinical results in terms of stability, subjective outcomes and objective evaluation were reported both for medial CMI implant and partial medial meniscectomy, combined with ACL reconstruction for the treatment of partial medial meniscus tears combined with ACL lesions. Chronic meniscal tears treated with medial CMI reported lower levels of post-operative pain compared to meniscectomy, while acute lesions treated with medial CMI showed less knee laxity. Therefore, the use of the collagen meniscus implant in the case of anterior knee instability with a meniscal defect appears justified and able to improve clinical outcomes in the long term. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Published
2015

16. Polyurethane scaffold for the treatment of partial meniscal tears. Clinical results with a minimum two-year follow-up.

Author

Bulgheroni P, Bulgheroni E, Regazzola G, and Mazzola C

Abstract

Purpose: to evaluate the safety and effectiveness of the polyurethane meniscal scaffold through clinical examination, MRI and arthroscopic second look, over a minimum two-year follow-up., Methods: between 2009 and 2011, 19 patients underwent meniscal scaffold implantation in our department (medial meniscus in 16 cases lateral meniscus in two cases, and bilateral in one case). All the patients were clinically evaluated preoperatively, and at 6, 12, and 24 months after surgery using Lysholm score, Tegner score, and VAS. Ten patients were studied with MRI, and nine patients were evaluated arthroscopically., Results: no adverse reactions to the implant were observed. The clinical scores showed a significant improvement at 6 months and increased progressively over time. On MRI studies, the implants showed a clear hyperintense signal, sometimes irregular, and the chondral surface was preserved in all cases. At arthroscopic second look in the first months after surgery, the scaffold size was unchanged and the scaffold appeared light yellowish in color and well integrated into the surrounding tissues. At arthroscopic second look at 12 and 24 months the scaffold was found to have an irregular morphology and to be slightly reduced in size., Conclusions: polyurethane meniscal scaffold is a good alternative to a collagen scaffold, but a longer follow-up is needed to evaluate the scaffold degradation and chondral coverage., Level of Evidence: level IV, therapeutic case series.

Published
2014
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