#treatment - Knee
- Meniscal tears are very common
- Meniscal cartilages are important shock absorbers in the knee and loss of meniscal tissue increases the risk of future arthritis in the knee
- In some cases, it may be possible to replace missing meniscal tissue with an artificial scaffold
- The patient’s own cells grow into the meniscal scaffold, and new cartilage tissue grows back
- Research has shown that with the Menaflex Collagen Meniscal Implant, about 75% of the missing tissue grows back, pain levels are improved, function is improved and the number of future operations required on the knee reduces
- Where there is too much loss of meniscal cartilage tissue, it may be necessary to insert a complete new meniscus by meniscal transplantation
The menisci (meniscal cartilages) of the knee are two important crescent shaped wedges of elastic cartilage found within each knee, sitting between the main bones of the thigh (femur) and shin (tibia).
They help bear weight across the knee joint and act as shock absorbers. Without them, the layer of articular cartilage (the smooth, white, shiny layer of tissue covering the surface of the ends of the bones) becomes subjected to increased forces, leading to excessive wear and damage.
Complete loss of a meniscus increases the risk of arthritis of the knee in later years by 15 times (ie, a 1500% risk !).
Meniscal tears are one of the most common injuries of the knee. In younger patients meniscal tears tend to happen in association with sports injuries, such as bad tackles, falls or twisting of the knee. In older individuals the meniscal cartilages become more delicate and can even tear spontaneously (a degenerate meniscal tear).
Traditionally tears of the meniscus were treated by removal of the torn cartilage (total meniscectomy). Increasingly, where possible, surgeons try to preserve meniscal tissue rather than just surgically remove it. However, the meniscal cartilages have a very poor blood supply and the potential for healing is therefore limited. Only a minority of meniscal tears are actually appropriate for surgical repair. In the rest of the cases, the only option is to surgically trim the torn cartilage, thus removing tissue.
For patients who have completely lost a meniscal cartilage, the procedure of ‘Meniscal Transplantation’ is an option. This involves surgically implanting a new meniscus into the knee using a donor graft. However, this can be a fairly major operation.
For those patients who have lost some, but not all, of a meniscus, there were until now no real surgical options. However, a new surgical implant has now been developed that stands to revolutionise the treatment of patients with problems after partial removal of a cartilage.
The Menaflex Collagen Meniscal Implant was developed in the USA by a team including Dr Richard Steadman, from Vail. The Menaflex is a biological, resorbable implant made from highly purified collagen. It is arthroscopically (through keyhole surgery) stitched into place to fill a defect in a meniscus to replace missing tissue. The body’s own cells then migrate into the implant, which is highly porous and which therefore acts as a scaffold, utilising the body’s own repairing processes to progressively regenerate new meniscal tissue.
Histological studies have shown that the implant is entirely biocompatible and that after about one year, it is largely absorbed and replaced by native new tissue.
Results from clinical trials in the US and Europe have demonstrated that patients have reduced pain post-operatively, after implantation of the Menaflex implant, and that they tend to regain activity levels comparable to those from before the original injury. Furthermore, use of the Menaflex implant has been correlated with patients being shown to subsequently end up need fewer additional surgical procedures in the future.
To-date, more than 2000 Menaflex implants have been surgically implanted worldwide. The outcome studies have shown that about 90% of patients have regrowth of meniscal tissue, regaining over 70% of their original meniscus tissue volume.
The Menaflex collagen meniscal implant has only very recently been introduced to the UK and is now available only in a restricted number of specialist centres, from surgeons who have undergone appropriate training on the technique.
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