The challenge of implant integration in partial meniscal replacement: an experimental study on a silk fibroin scaffold in sheep.

Authors:
Daniela Warnecke
Daniela Warnecke
Institute of Orthopedic Research and Biomechanics
Cristina Gentilini
Cristina Gentilini
Imperial College London
United Kingdom
Nick Skaer
Nick Skaer
University of Cambridge
United Kingdom
Robert Walker
Robert Walker
University of Otago
Oliver Kessler
Oliver Kessler
University of Zurich
Switzerland
Anita Ignatius
Anita Ignatius
University of Ulm
Germany

Knee Surg Sports Traumatol Arthrosc 2018 Sep 27. Epub 2018 Sep 27.

Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Helmholtzstraße 14, 89081, Ulm, Germany.

Purpose: To restore meniscal function after excessive tissue damage, a silk fibroin implant for partial meniscal replacement was developed and investigated in an earlier sheep model. After 6 months implantation, it showed promising results in terms of chondroprotection and biocompatibility. To improve surgical fixation, the material was subjected to optimisation and a fibre mesh was integrated into the porous matrix. The aim of the study was the evaluation of this second generation of silk fibroin implants in a sheep model.

Methods: Nine adult merino sheep received subtotal meniscal replacement using the silk fibroin scaffold. In nine additional animals, the defect was left untreated. Sham surgery was performed in another group of nine animals. After 6 months of implantation macroscopic, biomechanical and histological evaluations of the scaffold, meniscus, and articular cartilage were conducted.

Results: Macroscopic evaluation revealed no signs of inflammation of the operated knee joint and most implants were located in the defect. However, there was no solid connection to the remaining peripheral meniscal rim and three devices showed a radial rupture at the middle zone. The equilibrium modulus of the scaffold increased after 6 months implantation time as identified by biomechanical testing (before implantation 0.6 ± 0.3 MPa; after implantation: 0.8 ± 0.3 MPa). Macroscopically and histologically visible softening and fibrillation of the articular cartilage in the meniscectomy- and implant group were confirmed biomechanically by indentation testing of the tibial cartilage.

Conclusions: In the current study, biocompatibility of the silk fibroin scaffold was reconfirmed. The initial mechanical properties of the silk fibroin implant resembled native meniscal tissue. However, stiffness of the scaffold increased considerably after implantation. This might have prevented integration of the device and chondroprotection of the underlying cartilage. Furthermore, the increased stiffness of the material is likely responsible for the partial destruction of some implants. Clinically, we learn that an inappropriate replacement device might lead to similar cartilage damage as seen after meniscectomy. Given the poor acceptance of the clinically available partial meniscal replacement devices, it can be speculated that development of a total meniscal replacement device might be the less challenging option.

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http://dx.doi.org/10.1007/s00167-018-5160-7DOI Listing

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September 2018
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References

(Supplied by CrossRef)
Article in J Biomed Mater Res A
E Balint et al.
J Biomed Mater Res A 2012
Article in J Orthop Res
HN Chia et al.
J Orthop Res 2008
Article in J Allergy Clin Immunol
M Dewair et al.
J Allergy Clin Immunol 1985
Article in J Biomech Eng
JJ Elsner et al.
J Biomech Eng 2010
Article in Knee Surg Sports Traumatol Arthrosc
K Gruchenberg et al.
Knee Surg Sports Traumatol Arthrosc 2018
Article in Knee Surg Sports Traumatol Arthrosc
K Gruchenberg et al.
Knee Surg Sports Traumatol Arthrosc 2015
Article in Clin Orthop Relat Res
I Guisasola et al.
Clin Orthop Relat Res 2002
Article in J Mater Sci Mater Med
RG Heijkants et al.
J Mater Sci Mater Med 2004
Article in Am J Sports Med
BT Kelly et al.
Am J Sports Med 2007
Article in Vet Comp Orthop Traumatol
NK Lee-Shee et al.
Vet Comp Orthop Traumatol 2007
Article in Arthroscopy
SA Maher et al.
Arthroscopy 2010

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