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Integration of polyurethane meniscus scaffold during ACL revision is not reliable at 5 years despite favourable clinical outcome

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to evaluate the clinical outcome at 5-year follow-up of a one-step procedure combining anterior cruciate ligament (ACL) reconstruction and partial meniscus replacement using a polyurethane scaffold for the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy. Moreover, the implanted scaffolds have been evaluated by MRI protocol in terms of morphology, volume, and signal intensity.

Methods

Twenty patients with symptomatic knee laxity after failed ACL reconstruction and partial medial meniscectomy underwent ACL revision combined with polyurethane-based meniscal scaffold implant. Clinical assessment at 2- and 5-year follow-ups included VAS, Tegner Activity Score, International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lysholm Score. MRI evaluation of the scaffold was performed according to the Genovese scale with quantification of the scaffold’s volume at 1- and 5-year follow-ups.

Results

All scores revealed clinical improvement as compared with the preoperative values at the 2- and 5-year follow-ups. However, a slight, but significant reduction of scores was observed between 2 and 5 years. Concerning the MRI assessment, a significant reduction of the scaffold’s volume was observed between 1 and 5 years. Genovese Morphology classification at 5 years included two complete resorptions (Type 3) and all the remaining patients had irregular morphology (Type 2). With regard to the Genovese Signal at the 5-year follow-up, three were classified as markedly hyperintense (Type 1), 15 as slightly hyperintense (Type 2), and two as isointense (Type 1).

Conclusion

Simultaneous ACL reconstruction and partial meniscus replacement using a polyurethane scaffold provides favourable clinical outcomes in the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy at 5 years. However, MRI evaluation suggests that integration of the scaffold is not consistent.

Level of evidence

Level IV.

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Acknowledgements

IFC thanks the TERM RES-Hub, Tissue Engineering and Regenerative Medicine Infrastructure project, funded by the Portuguese Foundation for Science and Technology (FCT), and the funding through the project 2IQBIONEURO (ref. 0624_2IQBIONEURO_6_E). The FCT distinctions attributed to IFC under the Estímulo ao Emprego Científico program (2021.01969.CEECIND), and to JS-C under the Investigator FCT program (IF/00115/2015) are also greatly acknowledged.

Funding

The TERM RES-Hub, Tissue Engineering and Regenerative Medicine Infrastructure project, funded by the Portuguese Foundation for Science and Technology (FCT), the project 2IQBIONEURO (ref. 0624_2IQBIONEURO_6_E), and the Estímulo ao Emprego Científico program of FCT (2021.01969.CEECIND).

Author information

Authors and Affiliations

  1. 3B’s Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal

    Hélder Pereira, Ibrahim Fatih Cengiz, Joana Silva-Correia, Joaquim M. Oliveira, Rui L. Reis & João Espregueira-Mendes

  2. ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal

    Hélder Pereira, Ibrahim Fatih Cengiz, Joana Silva-Correia, Joaquim M. Oliveira, Rui L. Reis & João Espregueira-Mendes

  3. Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal

    José C. Vasconcelos, Sérgio Gomes & João Espregueira-Mendes

  4. Orthopedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal

    Hélder Pereira

  5. Ripoll y de Prado Sports Clinic-FIFA Medical Centre of Excellence, Murcia-Madrid, Spain

    Hélder Pereira & Pedro L. Ripoll

  6. Sahlgrenska Sports Medicine Center, Gothenburg, Sweden

    Jón Karlsson

  7. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  8. Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Jón Karlsson

Authors
  1. Hélder Pereira
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  2. Ibrahim Fatih Cengiz
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  3. Joana Silva-Correia
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  4. Joaquim M. Oliveira
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  5. José C. Vasconcelos
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  6. Sérgio Gomes
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  7. Pedro L. Ripoll
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  8. Jón Karlsson
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  9. Rui L. Reis
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  10. João Espregueira-Mendes
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Contributions

HP: conceptualization and methodology, and manuscript writing and review; IFC: manuscript writing and review; JS-C: manuscript writing and review; JMO: manuscript writing and review, and funding acquisition; JCV: manuscript writing and review; SG: manuscript writing and review; PLR: manuscript writing and review RLR: manuscript review, and funding acquisition; JE-M: manuscript review. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hélder Pereira.

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This study received approval from the local Ethical Committee.

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Pereira, H., Cengiz, I.F., Silva-Correia, J. et al. Integration of polyurethane meniscus scaffold during ACL revision is not reliable at 5 years despite favourable clinical outcome. Knee Surg Sports Traumatol Arthrosc 30, 3422–3427 (2022). https://doi.org/10.1007/s00167-022-06946-z

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