DOCSLIB.ORG

The Knee Meniscus: Structure-Function, Pathophysiology, Current Repair Techniques, and Prospects for Regeneration

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Knee Meniscus: Structure-Function, Pathophysiology, Current Repair Techniques, and Prospects for Regeneration INVESTIGATION OF MOLECULAR PARAMETERS ON CARTILAGE REGENERATION IN EXPERIMENTAL MODELS OF CARTILAGE DEFECTS AND OSTEOARTHRITIS By ELEFTHERIOS A. MAKRIS M.D. (Aristotle University, Thessaloniki, Greece) 2009 DISSERTATION Submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in Biomedical Engineering Research in the OFFICES OF GRADUATE STUDIES of the UNIVERSITY OF THESSALY, GREECE UNIVERSITY OF CALIFORNIA DAVIS, USA i Institutional Repository - Library & Information Centre - University of Thessaly 09/12/2017 09:28:15 EET - 137.108.70.7 Fall 08 Eleftherios Makris March 2014 Biomedical Engineering INVESTIGATION OF MOLECULAR PARAMETERS ON CARTILAGE REGENERATION IN EXPERIMENTAL MODELS OF CARTILAGE DEFECTS AND OSTEOARTHRITIS ABSTRACT Articular cartilage and fibrocartilage have limited abilities to self-repair following disease- or injury-induced degradation. With such cartilages providing the critical roles of protecting the osseous features of the knee joint and ensuring smooth, stable joint articulation, it is therefore critical that treatment modalities are created to promote the repair and/or regeneration of these tissues. A promising novel treatment modality comes from the potential of tissue engineered cartilage. While much progress has been recently made toward achieving engineered articular cartilage and fibrocartilage with compressive properties on par with native tissue values, their tensile properties still remain far behind. It is, therefore, critical that novel treatments be established to generate robust neotissue to address the approximately 46.4 million individuals affected by arthritis in the United States alone. Motivated by the potential of tissue engineering, this thesis had three global objectives: 1) to investigate novel molecular pathways toward regenerating articular cartilage in in vitro and in vivo experimental models of cartilage defects and osteoarthritis, 2) to develop and optimize treatment modalities toward engineering neocartilage of clinical applicability, and 3) to promote neotissue maturation and foster integration between self-assembled neocartilage and native tissue. Toward achieving these goals, this thesis sought to tailor the use of exogenous agents to ii Institutional Repository - Library & Information Centre - University of Thessaly 09/12/2017 09:28:15 EET - 137.108.70.7 promote native articular cartilage and fibrocartilage organization in engineered tissues. To begin, a treatment regimen consisting of copper and hydroxylysine was utilized to enhance the collagen crosslink content of self-assembled neocartilage constructs. A hypoxia treatment regimen was also investigated with the similar goal of enhancing the crosslink content and, therefore, the functional properties of engineered cartilage. Given the promising correlation between increased collagen crosslink content and neotissue tensile properties, a more direct approach to increase these crosslinks was established via application of the exogenous agent lysyl oxidase (LOX) to further enhance neotissue functional properties. Other studies in this thesis focused on developing approaches for enhancing the collagen content and organization of the engineered tissues that, when combined with the novel collagen crosslinking approaches, would potentially result in mature engineered tissues capable of repairing cartilage defects in experimental (animal) models. Specifically, two agents known to modulate intracellular Ca2+ signaling (digoxin and adenosine triphosphate) were investigated as an alternative means to improve matrix content and biomechanical properties of neocartilage through promoting both collagen enhancement and collagen crosslinking. In addition, similar studies were focused on optimizing a treatment regimen consisting of the biophysical agent chondroitinase-ABC (C-ABC) and the biochemical agent transforming growth factor-β1 (TGF- β1) to enhance the functional properties of self-assembled neofibrocartilage constructs. Biomechanical stimulation in the form of passive axial compressive loading was also examined to aid in further driving in vitro development of self-assembled neofibrocartilage in an organized, shape-specific manner. An additional study investigated the possibility of alternative primary cell sources from the ankle joint as a superior cell source for generating tissue-specific self- assembled neocartilage for ankle joint cartilage defects. iii Institutional Repository - Library & Information Centre - University of Thessaly 09/12/2017 09:28:15 EET - 137.108.70.7 Finally, this thesis investigated the potential of the exogenously applied LOX molecular mechanism to promote integration between neocartilage and native tissue. An initial study investigated the ability of LOX to promote integration between neocartilage and native articular cartilage. Promising results lead to combining LOX with C-ABC and TGF-β1 with the goal of inducing simultaneous neofibrocartilage maturation and integration. Specifically, this novel combination of stimuli was first applied to an in vitro model of integration, and then on an experimental animal model of integration to investigate the ability of the in vivo environment to further promote such integration. Overall, the series of studies presented in this thesis represent various novel and potentially clinically significant molecular strategies to enhance the functional properties of a spectrum of collagen-rich tissues. Specifically, copper, endogenous LOX enhancement though hypoxia, and exogenous LOX application were all found to improve the mechanical properties of engineered cartilage, demonstrating the ability of enhancing collagen crosslinks to promote the development of mechanically robust, biomimetic neotissues. Further, agents such as digoxin, adenosine triphosphate, C-ABC, TGF-β1, and static weight application were all found to exhibit significant abilities toward promoting collagen enhancement and collagen crosslinking in neotissues. Finally, exogenous LOX applied alone and in combination with C-ABC and TGF-β1 was found to foster in vitro and in vivo tissue maturation and integration, illustrating the promise of this novel combination of agents to promote in vivo tissue regeneration. Taken together, these studies provide an overview of several exciting and promising technologies to 1) increase the functional properties of both native and engineered tissues, and 2) to enhance their in vivo integration potential, highlighting the tremendous potential of such agents toward developing clinically robust neotissues to repair and/or replace those damaged by injury or disease. iv Institutional Repository - Library & Information Centre - University of Thessaly 09/12/2017 09:28:15 EET - 137.108.70.7 ACKNOWLEDGEMENTS I would first like to thank my dissertation committee members, including Prof. Konstantinos Malizos, Prof. Kyriacos A. Athanasiou, Prof. Aspasia Tsezou, and Prof. Grigoris Haidemenopoulos, for their collective mentoring and great support. I would also like to thank my fellow Athanasiou lab members; my work would not have been possible with out the tremendous foundation and contributions of my predecessors, or the advice and support of those presently in the lab. I would especially like to thank Dr. Regina F. MacBarb, whose continued collaboration has been instrumental to my graduate work and has resulted in numerous high impact publications. In addition, I would also like to thank Dr. Donald Responte and Dr. Nikolaos Paschos for their collaboration, time, and advice. Beyond the Athanasiou lab, I am very grateful to Dr. Jerry Hu, whose enthusiasm and mentoring has been a tremendous help to me. I would also like to extend remarkable thanks to the entire Orthopedic Department of University Hospital of Larisa and UC Davis Biomedical Engineering Department staff for all of their guidance and support. I am also very grateful for the financial support of NIH grants supported me all these years. Last but not least, I would like to thank my family and friends, who have provided me with immeasurable encouragement and support. To my dad (Athanasios Makris) mom (Archontia Makri), and my brother (Stergios Makris), who have always believed in me and continually provide me with the love, strength, and courage necessary to always push forward toward achieving my goals. I would not have done any big step without them and I am blessed to have such a wonderful family. I am also grateful for all my friends, but I would like to specially thank my dear friend Tasos (Anastasios Mantikas). v Institutional Repository - Library & Information Centre - University of Thessaly 09/12/2017 09:28:15 EET - 137.108.70.7 Finally and most importantly, I would like to sincerely thank my PhD advisors Professors Kyriacos A. Athanasiou and Konstantinos N. Malizos, both leaders in their fields, whose excellence in research and science was always for me a great example to mimic and a continues challenge to reach. Their guidance, mentorship, and unswerving belief and support to me over the past four years are unparalleled. vi Institutional Repository - Library & Information Centre - University of Thessaly 09/12/2017 09:28:15 EET - 137.108.70.7 TABLE OF CONTENTS ABSTRACT ....................................................................................................................................... ii ACKNOWLEDGEMENTS ................................................................................................................... v TABLE OF CONTENTS ..................................................................................................................
Load more

Recommended publications
  • Cervical Spine Injuries
    Essential Sports Medicine Essential Sports Medicine Joseph E. Herrera Editor Department of Rehabilitation Medicine, Interventional Spine and Sports, Mount Sinai Medical Center New York, NY Grant Cooper Editor New York Presbyterian Hospital New York, NY Editors Joseph E. Herrera Grant Cooper Department of Rehabilitation Medicine New York Presbyterian Hospital Interventional Spine & Sports New York, NY Mount Sinai Medical Center New York, NY Series Editors Grant Cooper Joseph E. Herrera New York Presbyterian Hospital Department of Rehabilitation Medicine New York, NY Interventional Spine and Sports Mount Sinai Medical Center New York, NY ISBN: 978-1-58829-985-7 e-ISBN: 978-1-59745-414-8 DOI: 10.1007/978-1-59745-414-8 Library of Congress Control Number © 2008 Humana Press, a part of Springer Science + Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, 999 Riverview Drive, Suite 208, Totowa, NJ 07512 USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
    [Show full text]
  • Knee Examination (ACL Tear) (Please Tick)
    Year 4 Formative OSCE (September) 2018 Station 3 Year 4 Formative OSCE (September) 2018 Reading for Station 3 Candidate Instructions Clinical Scenario You are an ED intern at the Gold Coast University Hospital. Alex Jones, 20-years-old, was brought into the hospital by ambulance. Alex presents with knee pain following an injury playing soccer a few hours ago. Alex has already been sent for an X-ray. The registrar has asked you to examine Alex. Task In the first six (6) minutes: • Perform an appropriate physical examination of Alex and explain what you are doing to the registrar as you go. In the last two (2) minutes, you will be given Alex’s X-ray and will be prompted to: • Interpret the radiograph • Provide a provisional diagnosis to the registrar • Provide a management plan to the registrar You do not need to take a history. The examiner will assume the role of the registrar. Year 4 Formative OSCE (September) 2018 Station 3 Simulated Patient Information The candidate has the following scenario and task Clinical Scenario You are an ED intern at the Gold Coast University Hospital. Alex Jones, 20-years-old, was brought into the hospital by ambulance. Alex presents with knee pain following an injury playing soccer a few hours ago. Alex has already been sent for an X-ray. The registrar has asked you to examine Alex. Task In the first six (6) minutes: • Perform an appropriate physical examination of Alex and explain what you are doing to the registrar as you go. In the last two (2) minutes, you will be given Alex’s X-ray and will be prompted to: • Interpret the radiograph • Provide a provisional diagnosis to the registrar • Provide a management plan to the registrar You do not need to take a history.
    [Show full text]
  • Physical Examination of the Knee: Meniscus, Cartilage, and Patellofemoral Conditions
    Review Article Physical Examination of the Knee: Meniscus, Cartilage, and Patellofemoral Conditions Abstract Robert D. Bronstein, MD The knee is one of the most commonly injured joints in the body. Its Joseph C. Schaffer, MD superficial anatomy enables diagnosis of the injury through a thorough history and physical examination. Examination techniques for the knee described decades ago are still useful, as are more recently developed tests. Proper use of these techniques requires understanding of the anatomy and biomechanical principles of the knee as well as the pathophysiology of the injuries, including tears to the menisci and extensor mechanism, patellofemoral conditions, and osteochondritis dissecans. Nevertheless, the clinical validity and accuracy of the diagnostic tests vary. Advanced imaging studies may be useful adjuncts. ecause of its location and func- We have previously described the Btion, the knee is one of the most ligamentous examination.1 frequently injured joints in the body. Diagnosis of an injury General Examination requires a thorough knowledge of the anatomy and biomechanics of When a patient reports a knee injury, the joint. Many of the tests cur- the clinician should first obtain a rently used to help diagnose the good history. The location of the pain injured structures of the knee and any mechanical symptoms were developed before the avail- should be elicited, along with the ability of advanced imaging. How- mechanism of injury. From these From the Division of Sports Medicine, ever, several of these examinations descriptions, the structures that may Department of Orthopaedics, are as accurate or, in some cases, University of Rochester School of have been stressed or compressed can Medicine and Dentistry, Rochester, more accurate than state-of-the-art be determined and a differential NY.
    [Show full text]
  • Evaluation of Knee Joint Injury by MRI
    ISSN: 2455-944X Int. J. Curr. Res. Biol. Med. (2018). 3(1): 10-21 INTERNATIONAL JOURNAL OF CURRENT RESEARCH IN BIOLOGY AND MEDICINE ISSN: 2455-944X www.darshanpublishers.com DOI:10.22192/ijcrbm Volume 3, Issue 1 - 2018 Original Research Article DOI: http://dx.doi.org/10.22192/ijcrbm.2018.03.01.002 Evaluation of knee joint injury by MRI *Harshdeep Kashyap, **Ramesh Chander, ***Sohan Singh, ****Neelam Gauba, ***** N.S. Neki *Junior Resident **Professor & Head, ***Ex Prof & Head, ****Ex Professor, Dept. of Radiodiagnosis, Govt. Medical College, Amritsar, India. *****Professor &Head, Dept. of Medicine, Govt. Medical College, Amritsar, India Corresponding Author: Dr. Harshdeep Kashyap, Junior Resident, Dept. of Radiodiagnosis, Govt. Medical College, Amritsar, 143001, India E- mail: [email protected] Abstract Background: Injury is a common cause of internal derangement of the knee (IDK) in the young adults and athletes leading to joint pain and morbidity. Although arthroscopy is considered as the gold standard but is invasive and associated with complications. MRI being non invasive and radiation free is widely used in evaluation of internal derangement of the knee joint. The following study was conducted to correlate the clinical, MRI and arthroscopic findings in diagnosing ligament and meniscal tears in knee joint injuries. Material and Methods: A prospective study was done during a period of 2015-2017 in Guru Nanak Dev Hospital, Amritsar on patients who presented to orthopedics department with chief complaints of trauma and suspicion of internal derangement of knee and were referred to the Radiodiagnosis Department for evaluation. Patients: A total of 50 patients were randomly selected who were referred with a clinical suspicion of internal derangement of knee.
    [Show full text]
  • Meniscal Pathology in the Knee
    Musculoskeletal Trauma 1 Meniscal Pathology in the Knee Tim Coughlin e knee contains two menisci. ese are crescent shaped is increased by a number of factors including previous injury structures which lie on the tibia increasing congruity of the or surgery, joint laxity, weak muscle control (especially tibiofemoral joint. ey add to the stability, lubrication and quadriceps function) and associated ligamentous injuries. All nutrition within the knee. ey can be injured leading to tears these factors contribute to abnormal movement of the knee and can also be congenitally deformed, leading to symptoms. joint. Medial meniscal injuries are particularly associated with Injuries to the menisci are the most frequent injury sustained ACL tears. in the knee. Degenerative tears can also occur secondary to e medial meniscus is less mobile than the lateral with osteoarthritis. excursion of around 5mm. It can become trapped between the condyles during movement leading to injury. e lateral Anatomy meniscus is more mobile with excursion of around 10mm moving with the rotation of the femur on the tibia during ere are two menisci within the knee; medial and lateral. e flexion. medial meniscus is large and C shaped and increases the depth of the concavity on the medial tibial plateau which in turn ere are four main types of meniscal tear which you should increases the contact area load is spread over. It is significantly know about: wider posteriorly than anteriorly. At its lateral aspect it is 1. Longitudinal tears (including the ‘bucket handle’ tear when continuous with the joint capsule and is attached to the deep displaced).
    [Show full text]
  • CARDIOLOGY Antithrombotic Therapies
    CARDIOLOGY Antithrombotic Therapies Anticoagulants: for Vitamin K antagonists Warfarin (Coumadin) -Impairs hepatic synthesis of thrombin, 7, 9, and 10 treatment of venous -Interferes with both clotting and anticoagulation = need to use another med for first 5 days of therapy clots or risk of such -Must consume consistent vit K as factor V Leiden -Pregnancy X disorder, other -Monitor with INR and PT twice weekly until stable, then every 4-6 weeks clotting disorders, Jantoven -Rarely used, usually only if there is a warfarin allergy post PE, post DVT Marvan Waran Anisindione (Miradon) Heparin -IV or injection -Short half-life of 1 hour -Monitored with aPTT, platelets for HIT -Protamine antidote LMWH Ardeparin (Normiflo) -Inhibit factors 10a and thrombin Dalteparin (Fragmin) -Injections can be done at home Danaparoid (Orgarin) -Useful as bridge therapy from warfarin prior to surgery Enoxaparin (Lovenox) -Monitor aPTT and watch platelets initially for HIT, then no monitoring needed once goal is reached? Tinzaparin (Innohep) -Safe in pregnancy Heparinoids Fondaparinux (Arixtra) -Direct 10a inhibitor Rivaroxaban (Xarelto) -Only anticoagulant that does not affect thrombin Direct thrombin Dabigatran (Pradaxa) -Monitor aPTT inhibitors Lepirudin (Refludan) Bivalirudin (Angiomax) Antiplatelets: used COX inhibitors Aspirin -Blocks thromboxane A-2 = only 1 platelet pathway blocked = weak antiplatelet for arterial clots or -Only NSAID where antiplatelet activity lasts for days rather than hours risk of such as ADP receptor inhibitors Ticlopidine (Ticlid)
    [Show full text]
  • To Preview the 5Th Edition
    An Introduction to Orthopaedic Nursing 5th Edition Production Credits Project Director: Tandy Gabbert, MSN, RN, ONC Copy Editor: Donna Polydoros, BA Creative Designer: Genevieve Gardner Editorial Coordinators: Jessica M. Scott, MFA and Jordan Winn, BSBA Legal Disclaimer An Introduction to Orthopaedic Nursing, 5th Edition, is intended to support and enhance knowledge of nurses new to and/or interested in care of orthopaedic patients. Information in this publication has been authored and peer-reviewed by experts in the field and reflects current evidence and research. The rapid pace of innovation and constant change in health care is evident across the care continuum and are closely scrutinized. Changes in best practices are inevitable as current strategies are replaced by those with better results. Individual providers, teams, and facilities are accountable for using their own knowledge and expertise when determining the course of action in a patient care situation. The National Association of Orthopaedic Nurses (NAON) as the publisher, the authors, the contributors, and the editors assume no liability for any injury or damage to persons or property from the use of instructions, products, methods, or other ideas in this book. Copyright ©2018 National Association of Orthopaedic Nurses 330 N Wabash, Suite 2000 Chicago, IL 60611 www.orthonurse.org All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage-and-retrieval
    [Show full text]
  • Posterior Knee Pain
    Curr Rev Musculoskelet Med (2010) 3:3–10 DOI 10.1007/s12178-010-9057-4 Posterior knee pain S. English • D. Perret Published online: 12 June 2010 Ó The Author(s) 2010. This article is published with open access at Springerlink.com Abstract Posterior knee pain is a common patient com- musculotendinous structures, ligaments, nerves, vascular plaint. There are broad differential diagnoses of posterior components, and/or to the bursas. In order to understand knee pain ranging from common causes such as injury to the causes of posterior knee pain, the clinician needs to the musculotendinous structures to less common causes understand the anatomy and the important aspects of the such as osteochondroma. A precise understanding of knee history and physical examination when evaluating poster- anatomy, the physical examination, and of the differential ior knee pain. This review describes those aspects and diagnosis is needed to accurately evaluate and treat pos- concludes by discussing the causes and management of terior knee pain. This article provides a review of the posterior knee pain. anatomy and important aspects of the history and physical examination when evaluating posterior knee pain. It con- cludes by discussing the causes and management of pos- Anatomy and biomechanics terior knee pain. The knee functions as a modified hinge joint consisting of Keywords Posterior Á Knee Á Pain Á Popliteal the tibia, femur, and patella. The primary plane of motion is extension and flexion; however, when pathology is present abduction, adduction, internal and external rota- Introduction tions, and anterior and posterior translations may occur [1]. The distal femur and proximal tibia form the two largest The purpose of this review is to aid the clinician in eval- points of contact in the joint.
    [Show full text]
  • 2021 Magellan Clinical Guidelines for Medical Necessity Review
    National Imaging Associates, Inc.* 2021 Magellan Clinical Guidelines For Medical Necessity Review MUSCULOSKELETAL AND SURGERY GUIDELINES - HMSA Effective March 1, 2021 – December 31, 2021 *National Imaging Associates, Inc. (NIA) is a subsidiary of Magellan Healthcare, Inc. Copyright © 2019-2020 National Imaging Associates, Inc., All Rights Reserved Guidelines for Clinical Review Determination Preamble Magellan is committed to the philosophy of supporting safe and effective treatment for patients. The medical necessity criteria that follow are guidelines for the provision of diagnostic imaging. These criteria are designed to guide both providers and reviewers to the most appropriate diagnostic tests based on a patient’s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice will be used when applying the guidelines. Determinations are made based on both the guideline and clinical information provided at the time of the request. It is expected that medical necessity decisions may change as new evidence-based information is provided or based on unique aspects of the patient’s condition. The treating clinician has final authority and responsibility for treatment decisions regarding the care of the patient. 2021 Magellan Clinical Guidelines-Musculoskeletal and Surgery 2 Guideline Development Process These medical necessity criteria were developed by Magellan Healthcare for the purpose of making clinical review determinations for requests for therapies and diagnostic procedures. The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, cardiology, and other specialty groups. Magellan’s guidelines are reviewed yearly and modified when necessary following a literature search of pertinent and established clinical guidelines and accepted diagnostic imaging practices.
    [Show full text]
  • Swesems Utbildningsutskott Rubrik Knästatus 2016-08-31
    SWESEMs utbildningsutskott Rubrik Knästatus 2016-08-31 Introduktion Skador mot, smärta och svullnad i knäet är vanliga sökorsaker på akutmottagning [1]. Syftet med detta dokument är att presentera en allmän knäundersökning som kan kombineras med anamnestisk information för att generera diagnostiska hypoteser. Ytterligare, hypotesdrivna undersökningar kan därefter genomföras. Knästatus som föreslås är riktad mot tillstånd som föranleder besök på akutmottagning (dvs inte kronisk knäsmärta). I dokumentet förkortas sensitivitet med SN, specificitet SP, positivt sannolikhetskvot LR+ och negativt sannolikhetskvot LR-. I specialisttentamen Vid specialisttentamen får läkaren begränsad anamnes gällande en patient med skada mot eller smärta i knäet. Läkaren förväntas därefter genomföra den allmänna knäundersökningen följd av relevanta hypotesdrivna undersökningar och formulera en plan för vidare handläggning. ALLMÄNT KNÄSTATUS 1-Inspektion och palpation1 Inflammation?2 Knäledsutgjutning: patellardans / bulge sign3 Patellarsena, patella, quadricepssena4 Ledspringor5 Fossa poplitea6 2-Rörelseomfång7 Flexion8 Extension8 Gångförmåga 9 HYPOTESDRIVNA KNÄUNDERSÖKNINGAR Dislokation10 Distalstatus11 Ankel-brakialindex12 Fraktur Distalstatus11 Ställningstagande till röntgen: Ottawa knee rule13 Ligamentskada Främre korsband: Lachman test14 Bakre korsband: bakre draglåda15 och tibial sag test16 Medial kollateralligament: valgus stress17, 19 Lateral kollateralligament: varus stress18, 19 Meniskskada20 McMurray test21 Apley grind test22 Utgjutning
    [Show full text]
  • Meniscal Repair 4
    Chris O’Grady, M.D Update on Treatment of Meniscal Injuries Basic Clinical Future Science • Presentation • Biologics • Anatomy • Diagnosis • PRP • Biomechanics • Treatment • Stem Cells • Rehabilitation 2 Function --joint filler (incongruous condyles) -2.5 greater contact area when mensicus present -prevent capsular/ synovial impingement -joint lubrication/ synovial distribution -load (40-60% of standing load -stability (esp. rotatory) 3 Function Medial Meniscus Lateral Meniscus Secondary stabilizer to AP 200-300% increase in translation in ACL deficient lateral compartment knee contact stresses when (more capsular attachment) removed (convex lateral Follows tibia- more likely to plateau) be torn with rotatory force 4 Radin et al., CORR, 1984 - Load transmission increases in flexion vs ext 5 Fukubayashi et al. 1980 Anatomy Histo: Fibrocartilage Composition Water 65%-75% Organic matter 25%-35% 75% Collagen Type I – 90% Types II, III,IV, V, VI, XVIII 25% Other Proteoglycans, DNA, Elastin 7 Anatomy Triangular cross section Provide structural integrity “concavity” of the articulation Dissipates forces/friction across medial/lateral compartments Axial Compression Horizontal hoop stress Creates shear forces 8 Anatomy Structure Mesh network: Arranged obliquely, radially, and vertically Prevents shear Bundles: Radial Located at surface and midsubtance Prevent longitudinal tears Circumferential Disperses compressive loads (hoops around wooden barrel) Anatomy Medial Meniscus C-Shaped structure Less mobile Firmly
    [Show full text]
  • The Knee Meniscus: Structureefunction, Pathophysiology, Current Repair Techniques, and Prospects for Regeneration
    Biomaterials 32 (2011) 7411e7431 Contents lists available at ScienceDirect Biomaterials journal homepage: www.elsevier.com/locate/biomaterials Review The knee meniscus: Structureefunction, pathophysiology, current repair techniques, and prospects for regeneration Eleftherios A. Makris, Pasha Hadidi, Kyriacos A. Athanasiou* Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA article info abstract Article history: Extensive scientific investigations in recent decades have established the anatomical, biomechanical, and Received 27 May 2011 functional importance that the meniscus holds within the knee joint. As a vital part of the joint, it acts to Accepted 17 June 2011 prevent the deterioration and degeneration of articular cartilage, and the onset and development of Available online 18 July 2011 osteoarthritis. For this reason, research into meniscus repair has been the recipient of particular interest from the orthopedic and bioengineering communities. Current repair techniques are only effective in Keywords: treating lesions located in the peripheral vascularized region of the meniscus. Healing lesions found in Knee meniscus the inner avascular region, which functions under a highly demanding mechanical environment, is Meniscus pathology fi Meniscal repair considered to be a signi cant challenge. An adequate treatment approach has yet to be established, Tissue engineering though many attempts have been undertaken. The current primary method for treatment is partial Scaffolds meniscectomy, which commonly results in the progressive development of osteoarthritis. This drawback has shifted research interest toward the fields of biomaterials and bioengineering, where it is hoped that meniscal deterioration can be tackled with the help of tissue engineering. So far, different approaches and strategies have contributed to the in vitro generation of meniscus constructs, which are capable of restoring meniscal lesions to some extent, both functionally as well as anatomically.
    [Show full text]