Meniscal scaffolds: Options post meniscectomy

Abstract

Surgery for repair or replacement of the menisci is one of the most common procedures in orthopedic surgery, with estimates of more than one million operations each year. In cases involving complex tears or degeneration, the injured portion of the meniscus is usually removed (meniscectomy) or, less commonly, the entire meniscus is replaced using a meniscal allograft. However, meniscectomy does not restore the proper mechanics of the native tissue and can lead to early osteoarthritis (OA). Similarly, allograft replacement has not demonstrated clear evidence of chondral protection, and issues with cost, viral transmission, and technical challenges remain. Thus, researchers have developed a variety of scaffolds aimed at replacement of the meniscus. Several of these have undergone clinical trials and have been implemented in clinical practice. In this chapter, we will discuss the available and developing scaffolds in detail. Following a discussion of the types of materials and fabrication techniques available to create scaffolds, we will examine the results of acellular scaffolds intended to be semipermanent replacements of the meniscus. We will then assess scaffolds intended to promote the regeneration of meniscus-like tissue. Finally, we will elaborate on recent efforts combining cells and scaffolds to create tissue-engineered constructs and will conclude with a discussion of the challenges and future directions for meniscal replacement.