Dataset Information

Repair of a Chronic Large Meniscal Defect With Implantation of Autogenous Meniscal Fragments Using a Tubular-Shaped Fibrin Clot.

ABSTRACT: We present a technique to implant autogenous meniscal fragments using a fibrin clot to repair a large degenerative meniscal defect. A total of 25 mL of the patient's blood is agitated for 10 minutes using a stainless steel swizzle stick in a sterile glass syringe. The elastic fibrin clot subsequently adheres to the stick in a tubular manner. Using arthroscopic debridement, native meniscal tissue is resected. The meniscal fragments are packaged into the tubular-shaped fibrin clot, and the tube is tied at both ends using 4-0 absorbable sutures. A repair suture is prepared using the inside-out meniscal repair device and woven into the margins of the tubular-shaped fibrin clot. The packaged graft with the tubular-shaped fibrin clot is placed with a horizontal suture across both edges of the meniscal defect and secured with a supplemental vertical suture using an all-inside meniscal repair device. Follow-up arthroscopy performed 6 months postoperatively reveals regeneration of meniscus-like tissue. It is ideal to treat large degenerative defects with meniscal preservation, and the present procedure has the advantage of tissue regeneration with native meniscal tissue and growth factors obtained from the fibrin clot using a simple technique. This method could prove helpful in patients with degenerative meniscal defects.

SUBMITTER: Kamimura T

PROVIDER: S-EPMC5989823 | biostudies-other | 2018 Mar

REPOSITORIES: biostudies-other

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Repair of a Chronic Large Meniscal Defect With Implantation of Autogenous Meniscal Fragments Using a Tubular-Shaped Fibrin Clot.

Kamimura Tamiko T Kimura Masashi M

Arthroscopy techniques 20180219 3

We present a technique to implant autogenous meniscal fragments using a fibrin clot to repair a large degenerative meniscal defect. A total of 25 mL of the patient's blood is agitated for 10 minutes using a stainless steel swizzle stick in a sterile glass syringe. The elastic fibrin clot subsequently adheres to the stick in a tubular manner. Using arthroscopic debridement, native meniscal tissue is resected. The meniscal fragments are packaged into the tubular-shaped fibrin clot, and the tube is ...[more]

PMID: 29881698

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Project description:BackgroundIndications for surgical meniscal repair are limited, and failure rates remain high. Thus, new ways to augment repair and stimulate meniscal regeneration are needed. Mesenchymal stem cells are multipotent cells present in mature individuals and accessible from peripheral connective tissue sites, including synovium. The purpose of this study was to quantitatively evaluate the effect of implantation of synovial tissue-derived mesenchymal stem cells on meniscal regeneration in a rabbit model of partial meniscectomy.MethodsSynovial mesenchymal stem cells were harvested from the knee of one New Zealand White rabbit, expanded in culture, and labeled with a fluorescent marker. A reproducible 1.5-mm cylindrical defect was created in the avascular portion of the anterior horn of the medial meniscus bilaterally in fifteen additional rabbits. Allogenic synovial mesenchymal stem cells suspended in phosphate-buffered saline solution were implanted into the right knees, and phosphate-buffered saline solution alone was placed in the left knees. Meniscal regeneration was evaluated histologically at four, twelve, and twenty-four weeks for (1) quantity and (2) quality (with use of an established three-component scoring system). A similar procedure was performed in four additional rabbits with use of green fluorescent protein-positive synovial mesenchymal stem cells for the purpose of tracking progeny following implantation.ResultsThe quantity of regenerated tissue in the group that had implantation of synovial mesenchymal stem cells was greater at all end points, reaching significance at four and twelve weeks (p < 0.05). Tissue quality scores were also superior in knees treated with mesenchymal stem cells compared with controls at all end points, achieving significance at twelve and twenty-four weeks (3.8 versus 2.8 at four weeks [p = 0.29], 5.7 versus 1.7 at twelve weeks [p = 0.008], and 6.0 versus 3.9 at twenty-four weeks [p = 0.021]). Implanted cells adhered to meniscal defects and were observed in the regenerated tissue, where they differentiated into type-I and II collagen-expressing cells, at up to twenty-four weeks.ConclusionsSynovial mesenchymal stem cells adhere to sites of meniscal injury, differentiate into cells resembling meniscal fibrochondrocytes, and enhance both quality and quantity of meniscal regeneration.

Dataset Information

Repair of a Chronic Large Meniscal Defect With Implantation of Autogenous Meniscal Fragments Using a Tubular-Shaped Fibrin Clot.

Publications

Repair of a Chronic Large Meniscal Defect With Implantation of Autogenous Meniscal Fragments Using a Tubular-Shaped Fibrin Clot.

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