Purposes of the study. To assess the performance of an acellular synthetic scaffold in the treatment of painful partial meniscal tissue loss. Methods. Subjects recruited (n=52) had irreparable medial or lateral meniscus partial meniscus loss, intact rim, presence of both horns and a stable well aligned knee. Diagnostic imaging was used to assess tissue ingrowth at 3 months post-implantation by evidence of vascularisation in the scaffold using DCE-MRI with intravenous gadolinium contrast material (n=42). All DCE-MRI scans were assessed centrally for neovascularisation in the peripheral half of the scaffold meniscus and integration of the implanted device. Stability of tissue ingrowth and cartilage scores in the index compartment were assessed at 12 and 24 months post-implantation using anatomic MRI scans. Results. The 52 patients recruited (75% males) had a mean age of 30.8 ± 9.4 years and mean longitudinally measured lesions of 47.1 ± 10.0 mm, involving 34 medial and 18 lateral indications. At 3 months post-implantation tissue ingrowth was demonstrated in the peripheral half of the scaffold, in 36/42 (85.7%) subjects. To date stable or improved cartilage scores were seen in the index compartment at 12 months (n= 47) and 24 months (n=9). No signs of an inflammatory reaction to the scaffold or its degradation products were observed. The tissue observed on MRI at 12 months (n=47) remained stable at 24 months (n=9). No safety issues related to the scaffold were reported. Conclusions. These preliminary results indicate that this novel scaffold induces ingrowth of stable tissue

The anatomy and microstructure of the menisci allow the effective distribution of load across the knee. Meniscectomy alters the biomechanical environment and is a potent risk factor for osteoarthritis. Despite a trend towards meniscus-preserving surgery, many tears are irreparable, and many repairs fail. . Meniscal allograft transplantation has principally been carried out for pain in patients who have had a meniscectomy. Numerous case series have reported a significant improvement in patient-reported outcomes after surgery, but randomised controlled trials have not been undertaken. It is scientifically plausible that meniscal allograft transplantation is protective of cartilage, but this has not been established clinically to date. Cite this article: Bone Joint J 2015; 97-B:590–4

Purpose. To assess performance of a polyurethane scaffold designed to facilitate regrowth of tissue after irreparable partial meniscus tissue loss. Methods. Fifty-two subjects with irreparable medial or lateral meniscus tissue lesions with intact rim, presence of both horns and stable, well aligned knees, were treated with the scaffold. Tissue ingrowth was assessed using dynamic contrast enhanced MRI (DCE-MRI) at 3 months (n=43), and by histological examination of biopsies (n=44) at 12 months relook arthroscopy. Cartilage status on MRI at 1week, 3, 12 and 24 months, and clinical outcomes were assessed from baseline to 24 months using Visual Analogue Scale (VAS), Knee and Osteoarthritis Outcome Score (KOOS), Lysholm and International Knee Documentation Committee (IKDC). Results. Clinically and statistically significant improvements on all outcome scores were observed at 6, 12 and 24 months. On MRI, stable or improved ICRS scores in all but 3 subjects (n=40) at 24 months were observed, with no signs of scaffold related cartilage damage. All biopsies contained vital material, with no signs of necrosis, cell death (presence of cell pods, ghost cells, cells with defragmented nuclei), or adverse reaction to the scaffold or its degradation products. A fibrous capsule and three distinct layers were observed, each with its own unique histological characteristics, including presence or absence of vessel structures, and the composition of extracellular matrix. In one case with unknown causality, the scaffold did not integrated with the native tissue. No safety issues related to the scaffold were reported. Conclusions. These data demonstrate the safety and performance of the polyurethane scaffold and illustrate new tissue generation resulting in significant pain reduction and functional improvement

Knee arthrodesis is a potential salvage procedure for limb preservation after failure of total knee arthroplasty (TKA) due to infection. In this study, we evaluated the outcome of single-stage knee arthrodesis using an intramedullary cemented coupled nail without bone-on-bone fusion after failed and infected TKA with extensor mechanism deficiency. Between 2002 and 2012, 27 patients (ten female, 17 male; mean age 68.8 years; 52 to 87) were treated with septic single-stage exchange. Mean follow-up duration was 67.1months (24 to 143, n = 27) (minimum follow-up 24 months) and for patients with a minimum follow-up of five years 104.9 (65 to 143,; n = 13). A subjective patient evaluation (Short Form (SF)-36) was obtained, in addition to the Visual Analogue Scale (VAS). The mean VAS score was 1.44 (SD 1.48). At final follow-up, four patients had recurrent infections after arthrodesis (14.8%). Of these, three patients were treated with a one-stage arthrodesis nail exchange; one of the three patients had an aseptic loosening with a third single-stage exchange, and one patient underwent knee amputation for uncontrolled sepsis at 108 months. All patients, including the amputee, indicated that they would choose arthrodesis again. Data indicate that a single-stage knee arthrodesis offers an acceptable salvage procedure after failed and infected TKA.

Cite this article: Bone Joint J 2015;97-B:649–53.

We describe 119 meniscal allograft transplantations performed concurrently with articular cartilage repair in 115 patients with severe articular cartilage damage. In all, 53 (46.1%) of the patients were over the age of 50 at the time of surgery. The mean follow-up was for 5.8 years (2 months to 12.3 years), with 25 procedures (20.1%) failing at a mean of 4.6 years (2 months to 10.4 years). Of these, 18 progressed to knee replacement at a mean of 5.1 years (1.3 to 10.4). The Kaplan-Meier estimated mean survival time for the whole series was 9.9 years (sd 0.4). Cox’s proportional hazards model was used to assess the effect of covariates on survival, with age at the time of surgery (p = 0.026) and number of previous operations (p = 0.006) found to be significant.

The survival of the transplant was not affected by gender, the severity of cartilage damage, axial alignment, the degree of narrowing of the joint space or medial versus lateral allograft transplantation. Patients experienced significant improvements at all periods of follow-up in subjective outcome measures of pain, activity and function (all p-values < 0.05), with the exception of the seven-year Tegner index score (p = 0.076).