Meiscus= The menisci of the knee are two pads of fibrocartilaginous tissue which serve to disperse friction in the knee joint between the lower leg (tibia) and the thigh (femur)
harvesting = Gathering cells from sources such as bone marring, there are other sources, to produce MSCs
MSCs = Mesenchymal stem cells; literally just think “Stem Cells”
vascular = containing cells or vessels that carry or circulate fluids; such as blood
scaffolding = 3D-printed poly(e-caprolactone) (PCL) scaffold or simular
white zone = Inner most section of meiscus, no blood
red zone = Outter most sectiuon of meiscus, blood flow
white/red zone = Middle section of meiscus, some blood
meniscus zones(6)
The knee joint is a multi-functional structure responsible for tasks such as shock absorption and energy transfer. In this article, we will delve into the realm of injured meniscus and explore both current and experimental treatment options. Our aim is to provide a straightforward explanation of the role played by the meniscus, the impact of injuries on daily life, and the available treatments for such injuries.
Of note: Every attempt should be made by the surgeon, if surgery is needed, to preserve the meniscus instead of removing it, as studies indicate that its removal can contribute to the early onset of osteoporosis. Additionally, in basic terms, it alters the dynamics of how the body functions collectively in force transfer.
However, with the current understanding of the function and roles of the meniscus, meniscectomy has been identified to accelerate joint degradation significantly and is no longer a preferred treatment option in meniscal tears.(2)
In recent years, several studies have demonstrated the potential of stem cell therapy in meniscus repair. These studies have shown that stem cells can differentiate into meniscal cells and contribute to the formation of new, functional meniscal tissue. This regenerative approach holds great promise for patients with meniscus injuries, particularly those with extensive damage or in cases where the traditional repair methods may not be sufficient.
Moreover, advances in tissue engineering and 3D printing have opened up new possibilities for meniscus repair. Researchers are exploring the development of bioengineered meniscus scaffolds, basically 3D printed, that mimic the natural structure and properties of the meniscus. These scaffolds, made from biocompatible materials and seeded with stem cells, have the potential to facilitate meniscal tissue regeneration and integration with the existing knee joint. This personalized approach to meniscus repair holds immense potential in restoring knee functionality and preventing the onset of degenerative conditions.
After 24 weeks, the gross appearance of all meniscal tissues from the cell-seeded or the cell-free groups was normal with a shiny white color and a smooth surface. No obvious synovial hypertrophy or implant tears were found in either group.(5)
While the field of meniscus repair is evolving rapidly, it is important to note that these innovative approaches are still in the experimental stage or limited to specialized medical centers. Further research is needed to optimize the techniques, ensure their safety and long-term efficacy, and establish guidelines for their widespread implementation. Additionally, factors such as tear location, tear type, patient age, and overall knee condition should be carefully considered when determining the most appropriate treatment approach.
(A) Anatomic reconstruction model of rabbit menisci in left knee. (B) A typical model of 3D medial meniscal scaffold. (C) 3D-printed poly(ε-caprolactone) (PCL) scaffold seeded with mesenchymal stem cells (scale bar represents 10 mm). (D) PCL scaffold (black arrow) implanted between femur and tibia, with medial collateral ligament (green arrow) reserved.(1)
Closing:
The bottom line is that the knee plays a crucial role in how you interact with the world, and any injury to it can significantly alter that interaction. The purpose of these new procedures is to minimize the chances of such changes occurring. They aim to provide the best possible opportunity for the injury to heal to a state where any previous damage or debilitation's are only known via medical history and memory of injury. It's important to acknowledge that we still have a long way to go in fully understanding how to repair these components without any negative impact on the body.
VAS is visual analog scale and error bars indicate standard deviations.(3)
Also, by consistently training and maintaining proper form in all your activities, you can reduce the risk of injury and keep your knee in good health. There are numerous exercises that can help strengthen the knee, regardless of your age. In Part 2, we will delve into these exercises, discuss effective routines, and provide some important considerations to bear in mind.
TL;DR:
Currently, the standard procedure for meniscus repair involves suturing the tear and providing a blood supply to aid in the healing process. However, experimental studies are exploring the potential benefits of utilizing stem cells. These studies suggest that stem cell injections or the use of scaffold-like structures to introduce stem cells and donor cell components could offer promising alternatives for repairing meniscus tears. These emerging approaches hold the potential to revolutionize the field of meniscus repair and improve outcomes for patients.
In cases where the tear occurs in the red or red/white zone of the meniscus, a stem cell injection is usually sufficient to promote effective repair. If the meniscus is worn down, studies have shown that a combination of stem cells and with "scaffolding" can facilitate meniscus regrowth. The primary objective behind these advancements is to prevent osteoporosis, as it gives rise to a host of additional problems that can significantly impact one's well-being.
If your hospital or doctor is unable to perform these procedures you can seek outside help. However, this will most certainly cost more and you will have to cover the cost. That aside, if cost is not a concern and you are able to receive this treatment, you should explore this option.
In part 1.5 we will go over the knee ligaments, ACL, PCL, etc..
This is not medical advice, but rather plain English information derived from the following articles. It is not intended to replace the advice of a licensed medical doctor, but rather to provide a basic layman's understanding of certain concepts and procedures.
If you have questions or concerns about the article fell free to reach out: thorn@hey.com
Jacob, G., Shimomura, K., Krych, A. J., & Nakamura, N. (2020). The meniscus tear: A review of stem cell therapies. Cells, 9(1), 92. https://doi.org/10.3390/cells9010092
Pak, J., Lee, J. H., & Lee, S. H. (2014). Regenerative repair of damaged meniscus with autologous adipose tissue-derived stem cells. BioMed Research International, 2014, Article ID 436029, 10 pages. https://doi.org/10.1155/2014/436029
Shimomura, K., Rothrauff, B. B., & Tuan, R. S. (2017). Region-Specific Effect of the Decellularized Meniscus Extracellular Matrix on Mesenchymal Stem Cell–Based Meniscus Tissue Engineering. The American Journal of Sports Medicine, 45(3), 604-611. https://doi.org/10.1177/0363546516674184
Zhang Z-Z, Wang S-J, Zhang J-Y, et al. 3D-Printed Poly(ε-caprolactone) Scaffold Augmented With Mesenchymal Stem Cells for Total Meniscal Substitution: A 12- and 24-Week Animal Study in a Rabbit Model. The American Journal of Sports Medicine. 2017;45(7):1497-1511. doi:10.1177/0363546517691513
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