Meniscus substitutes FOR PARTIAL MENISCECTOMISED PATIENTS I Dr.RAJAT JANGIR JAIPUR #aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur #allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon To Know more about ACL Injury, Click the links below: 1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all" https://youtu.be/oWkIr8IXvr8 2. Everything about ACL Injury tear surgery in Hindi I https://youtu.be/bqpjkAkwZ14 3. Best Screw for ACL tear surgery in Hindi https://youtu.be/1LGpU1NHiIs 4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir https://youtu.be/SIAPWiMbOqs 5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ? https://youtu.be/NEJRPKskJTI 6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ? https://youtu.be/EXpgy19Jxzw 7. PRP injection therapy in Partial ACL TEARs https://youtu.be/qyG1EYgS87E Dr.RAJAT JANGIR(Asso Prof.) Senior Consultant Arthroscopy and Joint Replacement (Specialist in Shoulder Knee Hip Surgery) Ligament and Joints Clinic 67/34 Mansarovar Jaipur Whatsapp: shorturl.at/gnAEP Appointment: +91 8104855900 Email: ligamentsurgeon@gmail.com Google Page: https://g.page/KNEE-Shoulder-SURGERY?... Facebook: https://www.facebook.com/Ligamentandj... * Vast experience and specialisation in the field of Arthroscopy and sports surgery. * M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad * Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea * Diploma in Sports Medicine from InternationaI Olympic Committee * Invited as Athlete Medical Doctor at Rio Olympic 2016 * Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'

1. MENISCAL RECONSTRUCTION –
SUBSTITUTES
DR.RAJAT JANGIR
Ligament and Joints Clinic
JAIPUR

2. • Human meniscus is a highly complex tissue
with very specific biological and
biomechanical properties, most of which are
still not well understood

3. REPLACE
• Natural tissues as meniscus allografts,
quadriceps tendon, Hoffa fat pad
• Tissue engineering scaffolds, cells, growth
factors, or combination
• Prosthetic devices

4. Substitution
• By a meniscus allograft has been accepted as a
viable therapeutic option for (sub)total
meniscectomized knee
• For partial defects is an ongoing field of
research and has attracted greater interest in
recent years.

5. APPROACHES
• Acellular scaffolds- scaffolds allow the human
body to regrow tissue
• Accelerate healing, cells and/or growth factors
or a combination of these could be added to
the acellular scaffold (biomimetic properties)

6. • Possible primary cell sources are bone
marrow-derived mesenchymal stem cells
(BMSC), local progenitor cells or differentiated
meniscus and cartilage cells.
• Autologous growth factors in the form of a
platelet-rich plasma

7. • Isolated recombinant growth factors is still
highly controversial and faced with regulatory
constraints
• TGF-b1, PDGF bb, IGF-I, FGF2, BMP-6

8. PROSTHETIC MENISCUS DEVICE
• Advantage it bypasses the intrinsic variability and
time consumption of the biological approach, i.e.,
the patient does not need to heal but receives a
prosthetic implant with specific biomechanical
properties
• Difficulties in designing and manufacturing
such implants is the biomechanical behaviour of
the meniscus and its fixation to the capsule and
bone.
• Fixation mode that ensures the stability of the
meniscus.

9. Menaflex (TM) Collagen Meniscus
Implant
• Tissue engineering techniques and collagen
matrix technology
• Supports ingrowth of new tissue and eventual
regeneration of the lost meniscus

10. Hypothesis
• Meniscus has the intrinsic ability to regenerate,
provided that the biological environment is
suitable for regeneration
• Tissue-engineered extracellular matrix scaffold
can be used to support and guide meniscus
regeneration

12. 7 Months-solid structure due
to the new tissue formation
18 Months: new collagen fibrils are
smaller and more uniform than those
in the original implant

13. 5 years: Compact and Dense

14. EVIDANCE
• Animal-Human Studies
• Reconstruct irreparable or lost meniscus tissue
in patients with a meniscus injury and improve
the functional outcomes of its recipients
• Rodkey WG, et al (2008)-Comparison of the collagen meniscus implant to
partial meniscectomy: a prospective RCT. JBJS Am 90:1413–1426
LEVEL 1
• Steadman JR, Rodkey WG (2005) Tissue-engineered colla- gen meniscus
implants: 5- to 6-year feasibility study results. Arthroscopy 21:515–525
• Zaffagnini S, Giordano G, Vascellari A et al (2007) Arthroscopic collagen
meniscus implant results at 6 to 8 years follow up. Knee Surg Sports
Traumatol Arthrosc 15:175–183

15. Technique

18. Fixation

19. CMI
• Newly formed meniscus was observed in over
two thirds of cases.
• Selecting the suitable candidate
stable and well-aligned
Technically, a secure intraarticular attachment
is probably the most critical factor
(FIXATION)

20. Actifit
Polyurethane Meniscus Implant
• Highly interconnected porous synthetic
material enabling tissue ingrowth
• Aliphatic polyurethane,
• transformation into meniscus-like tissue takes
place as the implant slowly degrades

21. two configurations, medial and lateral

22. • Two components, polyester (soft) and
polyurethane (stiff)
• Soft segment 80% is a biodegradable polyester
• Semidegradable, stiff segments 20% are of
uniform size and provide mechanical strength.
• Degradation of SOFT segments is expected to
take 4–6 years.

23. PREREQUISITES
• Intact meniscal rim and sufficient tissue
present both in the anterior and the posterior
horns to allow for secure fixation.
• Well-aligned stable knee,
• BMI) below 35
• Free from systemic disease or infection
• Cartilage damage (ICRS)<Grade 3

25. • Importantly, no safety issues related to the
scaffold, including cartilage damage or
inflammatory reactions
• Performance data showed successful tissue
ingrowth.
• In conclusion, the 12-month clinical results are
comparable to those reported following partial
meniscectomy; however, the ActifitTM scaffold
has the added benefit of promoting meniscal
tissue regeneration.

26. EVIDANCE
• Welsing RT, (2008) Effect on tissue dif- ferentiation and
articular cartilage degradation of a polymer meniscus implant:
a 2-year follow-up study in dogs. AJSM 36:1978–1989
• Tienen TG, Heijkants RG, de Groot JH et al (2006)
Replacement of the knee meniscus by a porous polymer
implant: a study in dogs. AJSM 34:64–71

27. CONCLUSION,
• Different approaches currently under
investigation.
• The potential patient- specific variability and
time consumption are a major challenge for
the biological tissue engineer,
• While for the prosthetic approach the perfect
material still has to be developed.
• Maybe a combination of a prosthetic core
with a bioactive surface would be the ideal
implant