Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection: A 2-Year Clinical Follow-Up

Abstract

Objective: To collect and analyze the 2-year follow-up clinical and MRI results of patients treated with an arthroscopic technique of collagen membrane-based meniscus repair.

Design: 53 consecutive patients with combined (horizontal and radial or longitudinal component) and complex meniscal tears (tear extended through avascular zones or/and composed with two or more morphological tear pattern) were treated with an "all-inside" arthroscopic suture of meniscus and wrapping with a collagen membrane (Chondro-Gide) technique with bone marrow blood injection. The IKDC 2000 subjective score, IKDC 2000 clinical evaluation score, Lysholm score and Barret clinical criteria of meniscal healing were recorded. All patients were examinated by MRI 2 years postoperatively, using modified WORMS criteria for meniscal integrity.

Results: The 2 year follow-up was achieved in 50 cases. Of these, 2 patients were excluded from the evaluation due to incomplete data and 2 patients underwent partial meniscectomy and were classified as failures. In 46 patients (86.8% of the intended to treat cases), a statistically significant improvement in IKDC 2000 subjective, Lysholm scores and IKDC 2000 clinical assessment between preoperative and the 2-year follow-up time points were obsereved. Barret criteria demonstrated an improved clinical outcome between pre- and post-operative values. MRI revealed a non-homogeneous signal without meniscal tear (WORMS grade 1) in 76% of the operated menisci (13% WORMS grade 2).

Conclusions: The 2-year follow-up data demonstrate that this technique is safe and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. Level of evidence IV.

Keywords: arthroscopic; collagen membrane; combined; complex; meniscus wraping.

Conflict of interest statement

Declaration of Conflicting Interests: Prof. Jakob serves as a paid consultant to Geistlich Pharma AG. Dr Slomczykowski serves as a Medical Director to Geistlich Pharma AG. The other authors do not report any conflicts of interest.

Figures

Figure 1.

An example of meniscus injury treated as a part of this study.

Figure 2.

Schematic drawing of a meniscus injury treated as a part of this study.

Figure 3.

An example of suture placement and meniscus wrapping with collagen matrix.

Figure 4.

Schematic drawing of a suture placement and meniscus wrapping.

Figure 5.

CONSORT (Consolidated Standards of Reporting Trials) case series diagram. SAE, severe adverse event (according to ISO 14155).

Figure 6.

An example of sagittal proton density–weighted fat-saturated image magnetic resonance iamging (MRI) of a 50-year-old man who had undergone medial meniscus regeneration with arthroscopic technique of collagen matrix-based meniscus repair (AMMR) and cartilage regeneration of medial femoral condyle with arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure in one-stage knee arthroscopy. (A) Six-month follow-up. Abnormal signal of the medial meniscus (thick arrow), bone marrow edema (asterisk), a parameniscal cyst (thin arrow), and abnormal signal from regenerated cartilage area (dotted line arrow). (B) Six-month follow-up. Abnormal signal extending to the superior surface of the body of the medial meniscus (thick arrow). (C) Twenve-month follow-up. Normal signal of the medial meniscus (thick arrow), a parameniscal small cysts containing Fast-Fix anchors (thin arrow), bone marrow edema (asterisk), and abnormal signal from regenerated cartilage area (dotted line arrow). (D) Twenty-four-month follow-up. Normal signal of the medial meniscus with scar tissue (thick arrow), Fast-Fix anchors with small cysts (thin arrow), normal signal from bone marrow (asterisk) and normal signal from the regenerated cartilage area (dotted line arrow).