In the first issue of ACCART's video enceplopaedia, Dr. Olaf Beck presents a groundbreaking method for meniscus implantation and cartilage induction, after detailed examination by several renowned professors.
This innovative technique, which has been available in Germany since November 2022, uses a biological substitute for meniscal injuries and aims to improve joint function and delay or avoid the need for prosthetic treatments.
For a detailed presentation of the method, patient selection criteria and initial results, visit the original article in Spanish here. Alternatively, you can read the article in Englisch here.
Key insights
- New biological implantation technique for meniscus replacement
- Improving joint function and delaying the need for prostheses
- Available in Germany by a limited number of specialists
All scientific sources and further information can be found in the original article.
Here is the article from the Spanish site, translated into German:
Introduction
In most cases, a partial meniscectomy is performed following a meniscus injury. In subsequent years, postmeniscectomy syndrome develops with secondary osteoarthritis. This situation then leads to appropriate prosthetic treatment.
Various techniques for cartilage regeneration are described in the literature. These include autologous cartilage transplantation and cartilage induction with a cell-free matrix, type 1 collagen, as well as various meniscus replacement techniques.
In the past, the MIS implant made from bovine Achilles tendons was the market leader. However, its production was discontinued in 2021. From then on, only the Actifit implant was available as a partial replacement.
In contrast to MIS, however, this was not a biological implant but a polyurethane implant. Several studies have shown that the result was inferior to that of MIS.
Since November 2022, a new biological implant has been available in Germany, which can currently be inserted by 4 doctors in Germany.
It is a DNA-free, demineralized spongiasis block made from cadaver bones. The implant is delivered sterile and dry. There are currently no studies on a combination of cartilage regeneration combined with meniscus implantation.
Description of the technique
The patient must have a maximum varus and valgus deformity of 5°. Other contraindications include joint stiffness, chronic joint inflammation such as rheumatism, psoriatic arthritis and urinary tract arthritis. Allergies to beef proteins are also a contraindication.
It is also important that the patient follows the rules, because the success of the operation depends largely on compliance with postoperative therapy.
So far, I have treated patients up to 65 years of age with this procedure. However, special attention must be paid to concomitant diseases. I rejected patients who regularly have to take cortisone or anti-inflammatory drugs.
It is also important to make the correct diagnosis using imaging, which is only possible with the help of an MRI examination.
If there are bone disorders in the sense of bone edema, appropriate relief must be provided with an orthosis and targeted shockwave therapy.
The frequency of treatments depends on the size of the area. On average, I perform 4 applications at intervals of 1 week. 6 weeks after the last shockwave treatment, a follow-up examination is carried out using MRI.
The size of the cartilage defect and the meniscus margin must also be determined. The geometry of the cartilage defect is important. Cartilage induction is possible when the defect is up to 1.5 cm wide.
In this case, length no longer matters. According to our postoperative scheme, the treatment of kissing lesions is also possible. The residual meniscus should have a 3 mm wide margin and an intact front and back horn.
If this information cannot be obtained using MRI, I perform a nanoscopy under local anesthesia to plan. During arthroscopy, the cartilage is first prepared with a ring curette. The aberat is removed using a shaver.
The meniscus implant (Spongioflex) is placed in saline solution for about 15 minutes until soft. The implant is inserted into the joint through a mini open incision with meniscus forceps and secured with internal sutures.
The procedure then transitions from water arthroscopy to gas arthroscopy. In this case, CO2 is used. The suppressor is connected via a gas hose, which can be connected to the arthroscopy trocar. As soon as the cartilage defect areas are dry, they are covered with a collagen gel.
My own results
So far, no follow-up results have been published for this combined technique. However, as the Spongioflex implant is also a biological implant, it can be assumed that the results are similar to those of the MIS implant.
This is also confirmed by the short interviews I conducted and a histological examination. Since November 2022, I have inserted a total of 21 Spongioflex implants.
There were 2 complications caused by the patients themselves (withdrawal due to a fall or incorrect load). An implant could be replanted.
The second implant was removed and examined histologically. Cell migration of cartilage cells could be observed after just 4 weeks, which supports my previous assumption.
The histological section shows the integration of cartilage cells into the bone support tissue. The immunohistological examination is still pending. There were no other complications.
Histological examination of a chondrofiller fluid sample, also after 4 weeks, revealed chondrocyte migration and the presence of collagen during immunohistological examination.
From 12.2018 to 05.2023, a total of 23 men and 8 women were treated with this combined technique of cartilage induction and partial mensicus implantation. These 31 patients were treated with MIS in 17 cases and Actifit in 15 cases. One patient was treated with MIS on both sides at intervals of 7 months.
All patients had damage to the medial or lateral meniscus. Concomitant treatment of medial and lateral meniscus injuries was not performed.
Follow-up examinations were carried out on 11 men and 5 women with an average age of 58 years (42-69 years) using the IKDC questionnaire after an average of 24 months (3-39.5 months).
It was found that one patient treated with MIS received a full or sled prosthesis after 8 months and two patients treated with Actifit after 8 and 10 months, respectively.
In the MIS group, there was an average improvement of 35.1 (25.3-37.9) to 82.3 (55.8-93.1) according to IKDC and with Actifit from 30.4 (21.8-54) to 73.4 (56.3-83.5).
There were no complications during the procedures (dislocation of meniscus, allergic reactions, dislocation of meniscus anchors). All patients underwent a standardized post-operative treatment regimen.
These results show that a combination of both biological methods can prevent or - due to lack of long-term studies - delay prosthesis implantation if the indications are correct.
If you are experiencing issues with your joints, you can contact Dr. Olaf Beck here for a consultation.
author
