Over the past 2 decades there has been a profound shift in our perception of the role of the meniscus in the knee joint. Orthopaedic opinion now favors salvaging and restoring the damaged meniscus where possible. Basic science is characterizing its form (anatomy) and functionality (biological and biomechanical) in an attempt to understand the effect of meniscal injury and repair on the knee joint as a whole. The meniscus is a complex tissue and has warranted extensive basic science, translational, and clinical research to identify techniques to augment healing and even replace the meniscus. The application of quantitative magnetic resonance image sequencing to the meniscus and articular cartilage of the affected compartment promises to add a quantifiable outcome measure to the body of clinical evidence that supports restoration of the meniscus. This article discusses the recent advances and outcomes in the pursuit of meniscal restoration with particular focus on the use of augmentation strategies in meniscal repair, meniscal imaging, and translational strategies.
AbatFGelberPEErquiciaJITeyMGonzalez-LucenaGMonllauJC. Prospective comparative study between two different fixation techniques in meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc. 2013;21:1516-1522.
2.
AlhalkiMMHowellSMHullML. How three methods for fixing a medial meniscal autograft affect tibial contact mechanics. Am J Sports Med. 1999;27(3):320-328.
3.
ArnoczkySP. Building a meniscus. Biologic considerations. Clin Orthop Relat Res. 1999;(suppl 367):S244-253.
4.
ArnoczkySPWarrenRF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10(2):90-95.
5.
ArnoczkySPWarrenRF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med. 1983;11(3):131-141.
6.
ArnoczkySPWarrenRFSpivakJM. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg Am. 1988;70(8):1209-1217.
BakerBMShahRPSilversteinAMEsterhaiJLBurdickJAMauckRL. Sacrificial nanofibrous composites provide instruction without impediment and enable functional tissue formation. Proc Natl Acad Sci U S A. 2012;109(35):14176-14181.
9.
BalintEGattCJJrDunnMG. Design and mechanical evaluation of a novel fiber-reinforced scaffold for meniscus replacement. J Biomed Mater Res A. 2012;100(1):195-202.
BaratzMEFuFHMengatoR. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986;14(4):270-275.
12.
BarciaAMKozlowskiEJTokishJM. Return to sport after meniscal repair. Clin Sports Med. 2012;31(1):155-166.
13.
BediAKellyNHBaadM. Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg Am. 2010;92(6):1398-1408.
14.
BrophyRHLymanSChehabELBarnesRPRodeoSAWarrenRF. Predictive value of prior injury on career in professional American football is affected by player position. Am J Sports Med. 2009;37(4):768-775.
15.
BulgheroniPMurenaLRattiCBulgheroniERongaMCherubinoP. Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Knee. 2010;17(3):224-229.
16.
CaplanAICorreaD. The MSC: an injury drugstore. Cell Stem Cell. 2011;9(1):11-15.
17.
CastilloTNPouliotMAKimHJDragooJL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med. 2011;39(2):266-271.
18.
ChoiNHKimTHVictoroffBN. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair. Am J Sports Med. 2009;37(11):2144-2150.
19.
DallingaJMBenjaminseALemminkKA. Which screening tools can predict injury to the lower extremities in team sports?: a systematic review. Sports Med. 2012;42(9):791-815.
20.
de BoerHHKoudstaalJ. Failed meniscus transplantation. A report of three cases. Clin Orthop Relat Res. 1994;306:155-162.
21.
DriscollTPNerurkarNLJacobsNTElliottDMMauckRL. Fiber angle and aspect ratio influence the shear mechanics of oriented electrospun nanofibrous scaffolds. J Mech Behav Biomed Mater. 2011;4(8):1627-1636.
22.
EfeTGetgoodASchoferMD. The safety and short-term efficacy of a novel polyurethane meniscal scaffold for the treatment of segmental medial meniscus deficiency. Knee Surg Sports Traumatol Arthrosc. 2012;20:1822-1830.
23.
EggliSWegmullerHKosinaJHuckellCJakobRP. Long-term results of arthroscopic meniscal repair. An analysis of isolated tears. Am J Sports Med. 1995;23(6):715-720.
24.
ElattarMDhollanderAVerdonkRAlmqvistKFVerdonkP. Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):147-157.
25.
FairbankTJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30-B(4):664-670.
26.
FermorBJeffcoatDHennerbichlerAPisetskyDSWeinbergJBGuilakF. The effects of cyclic mechanical strain and tumor necrosis factor alpha on the response of cells of the meniscus. Osteoarthritis Cartilage. 2004;12(12):956-962.
27.
FerrettiMMadhavanSDeschnerJRath-DeschnerBWypasekEAgarwalS. Dynamic biophysical strain modulates proinflammatory gene induction in meniscal fibrochondrocytes. Am J Physiol Cell Physiol. 2006;290(6):C1610-1615.
28.
FisherMBHenningEASoegaardNEsterhaiJLMauckRL. Organized nanofibrous scaffolds that mimic the macroscopic and microscopic architecture of the knee meniscus. Acta Biomater. 2013;9(1):4496-4504.
29.
FoxDBWarnockJJ. Cell-based meniscal tissue engineering: a case for synoviocytes. Clin Orthop Relat Res. 2011;469(10):2806-2816.
30.
GalleyNKGleghornJPRodeoSWarrenRFMaherSABonassarLJ. Frictional properties of the meniscus improve after scaffold-augmented repair of partial meniscectomy: a pilot study. Clin Orthop Relat Res. 2011;469(10):2817-2823.
31.
GatehousePDHeTPuriBKThomasRDResnickDBydderGM. Contrast-enhanced MRI of the menisci of the knee using ultrashort echo time (UTE) pulse sequences: imaging of the red and white zones. Br J Radiol. 2004;77(920):641-647.
32.
GrafKWJrSekiyaJKWojtysEM. Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study. Arthroscopy. 2004;20(2):129-140.
33.
GrantJAWildeJMillerBSBediA. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med. 2012;40(2):459-468.
34.
GulottaLVWizniaDCunninghamMFortierLMaherSRodeoSA. What's new in orthopaedic research. J Bone Joint Surg Am. 2011;93(22):2136-2141.
35.
GunjaNJAthanasiouKA. Passage and reversal effects on gene expression of bovine meniscal fibrochondrocytes. Arthritis Res Ther. 2007;9(5):R93.
36.
GunjaNJAthanasiouKA. Effects of co-cultures of meniscus cells and articular chondrocytes on PLLA scaffolds. Biotechnol Bioeng. 2009;103(4):808-816.
37.
GunjaNJAthanasiouKA. Effects of hydrostatic pressure on leporine meniscus cell-seeded PLLA scaffolds. J Biomed Mater Res A. 2010;92(3):896-905.
38.
GunjaNJUthamanthilRKAthanasiouKA. Effects of TGF-β1 and hydrostatic pressure on meniscus cell-seeded scaffolds. Biomaterials. 2009;30(4):565-573.
39.
HarstonANylandJBrandEMcGinnisMCabornDN. Collagen meniscus implantation: a systematic review including rehabilitation and return to sports activity. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):135-146.
40.
Haut DonahueTLHullMLRashidMMJacobsCR. How the stiffness of meniscal attachments and meniscal material properties affect tibio-femoral contact pressure computed using a validated finite element model of the human knee joint. J Biomech. 2003;36(1):19-34.
41.
HeWLiuYJWangZGGuoZKWangMXWangN. Enhancement of meniscal repair in the avascular zone using connective tissue growth factor in a rabbit model. Chin M J. 2011;124(23):3968-3975.
42.
HollowayJLLowmanAMPalmeseGR. Mechanical evaluation of poly(vinyl alcohol)-based fibrous composites as biomaterials for meniscal tissue replacement. Acta Biomater. 2010;6(12):4716-4724.
HorieMDriscollMDSampsonHW. Implantation of allogenic synovial stem cells promotes meniscal regeneration in a rabbit meniscal defect model. J Bone Joint Surg Am. 2012;94(8):701-712.
45.
IshidaKKurodaRMiwaM. The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng. 2007;13(5):1103-1112.
46.
KamimuraTKimuraM. Repair of horizontal meniscal cleavage tears with exogenous fibrin clots. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1154-1157.
47.
KatzJNBrophyRHChaissonCE. Surgery versus physical therapy for a meniscal tear and osteoarthritis. New Engl J Med. 2013;368(18):1675-1684.
48.
KlompmakerJJansenHWVethRPNielsenHKde GrootJHPenningsAJ. Porous implants for knee joint meniscus reconstruction: a preliminary study on the role of pore sizes in ingrowth and differentiation of fibrocartilage. Clin Mater. 1993;14(1):1-11.
49.
KlompmakerJVethRPJansenHWNielsenHKde GrootJHPenningsAJ. Meniscal replacement using a porous polymer prosthesis: a preliminary study in the dog. Biomater. 1996;17(12):1169-1175.
50.
KoFCDragomirCPlumbDA. In vivo cyclic compression causes cartilage degeneration and subchondral bone changes in mouse tibiae. Arthritis Rheum. 2013;65:1569-1578.
51.
KopfSBirkenfeldFBeckerR. Local treatment of meniscal lesions with vascular endothelial growth factor. J Bone Joint Surg Am. 2010;92(16):2682-2691.
52.
KurosawaHFukubayashiTNakajimaH. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res. 1980;149:283-290.
53.
LeeYHCabornDN. A new technique for arthroscopic meniscus transplant using soft tissue fixation and anatomical meniscal root reinsertion. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):904-908.
54.
LoeserRFGoldringSRScanzelloCRGoldringMB. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum. 2012;64(6):1697-1707.
LubowitzJHVerdonkPCReidJBIIIVerdonkR. Meniscus allograft transplantation: a current concepts review. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):476-492.
57.
MaakTGFabricantPDWickiewiczTL. Indications for meniscus repair. Clin Sports Med. 2012;31(1):1-14.
58.
MakrisEAHadidiPAthanasiouKA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomater. 2011;32(30):7411-7431.
59.
McDermottI. Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee. Br J Sports Med. 2011;45(4):292-297.
60.
McDermottIDLieDTEdwardsABullAMAmisAA. The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures. Knee Surg Sports Traumatol Arthrosc. 2008;16(6):553-560.
61.
MiaoYYuJKAoYFZhengZZGongXLeungKK. Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging. Am J Sports Med. 2011;39(4):735-742.
62.
MonllauJCGelberPEAbatF. Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years' follow-up. Arthroscopy. 2011;27(7):933-943.
63.
MoriguchiYTateishiKAndoW. Repair of meniscal lesions using a scaffold-free tissue-engineered construct derived from allogenic synovial MSCs in a miniature swine model. Biomaterials. 2013;34(9):2185-2193.
NaritaATakaharaMOginoTFukushimaSKimuraYTabataY. Effect of gelatin hydrogel incorporating fibroblast growth factor 2 on human meniscal cells in an organ culture model. Knee. 2009;16(4):285-289.
66.
NaritaATakaharaMSatoD. Biodegradable gelatin hydrogels incorporating fibroblast growth factor 2 promote healing of horizontal tears in rabbit meniscus. Arthroscopy. 2012;28(2):255-263.
67.
NoyesFRBarber-WestinSD. Management of meniscus tears that extend into the avascular region. Clin Sports Med. 2012;31(1):65-90.
68.
NoyesFRHeckmannTPBarber-WestinSD. Meniscus repair and transplantation: a comprehensive update. J Orthop Sports Phys Ther. 2012;42(3):274-290.
69.
PaxtonESStockMVBrophyRH. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011;27(9):1275-1288.
70.
PiontekTCiemniewska-GorzelaKSzulcASlomczykowskiMJakobR. All-arthroscopic technique of biological meniscal tear therapy with collagen matrix. Pol Orthop Traumatol. 2012;77:39-45.
71.
PotterHGChong leR. Magnetic resonance imaging assessment of chondral lesions and repair. J Bone Joint Surg Am. 2009;91(suppl 1):126-131.
72.
PuetzerJLBrownBBallynsJJBonassarLJ. The effect of IGF-I on anatomically-shaped tissue engineered menisci. Tissue Eng Part A. 2013;19:1443-1450.
73.
RathERichmondJCYassirWAlbrightJDGundoganF. Meniscal allograft transplantation. Two- to eight-year results. Am J Sports Med. 2001;29(4):410-414.
74.
ReguzzoniMManelliARongaMRaspantiMGrassiFA. Histology and ultrastructure of a tissue-engineered collagen meniscus before and after implantation. J Biomed Mater Res B Appl Biomater. 2005;74(2):808-816.
75.
RevellCMAthanasiouKA. Success rates and immunologic responses of autogenic, allogenic, and xenogenic treatments to repair articular cartilage defects. Tissue Eng Part B. 2009;15(1):1-15.
76.
RodeoSA. Meniscal allografts—where do we stand?Am J Sports Med. 2001;29(2):246-261.
77.
RodeoSASeneviratneASuzukiKFelkerKWickiewiczTLWarrenRF. Histological analysis of human meniscal allografts. A preliminary report. J Bone Joint Surg Am. 2000;82(8):1071-1082.
78.
RodkeyWGDeHavenKEMontgomeryWHIII. Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am. 2008;90(7):1413-1426.
79.
RongaMGrassiFAManelliABulgheroniP. Tissue engineering techniques for the treatment of a complex knee injury. Arthroscopy. 2006;22(5):576-e571-573.
80.
RoosHLaurenMAdalberthTRoosEMJonssonKLohmanderLS. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998;41(4):687-693.
81.
Ruiz-IbanMADiaz-HerediaJElias-MartinEMoros-MarcoSCebreiro Martinez Del ValI. Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. Am J Sports Med. 2012;40:2289-2295.
82.
SaltzmanBMBajajSSalataM. Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up. J Knee Surg. 2012;25(2):165-175.
83.
ScottiCMangiaviniLBoschettiF. Effect of in vitro culture on a chondrocyte-fibrin glue hydrogel for cartilage repair. Knee Surg Sports Traumatol Arthrosc. 2010;18(10):1400-1406.
84.
SpencerSJSaithnaACarmontMRDhillonMSThompsonPSpaldingT. Meniscal scaffolds: Early experience and review of the literature. Knee. 2012;19(6):760-765.
85.
SpilkerRLDonzelliPSMowVC. A transversely isotropic biphasic finite element model of the meniscus. J Biomech. 1992;25(9):1027-1045.
86.
StabileKJOdomDSmithTL. An acellular, allograft-derived meniscus scaffold in an ovine model. Arthroscopy. 2010;26(7):936-948.
87.
SteadmanJRRodkeyWG. Tissue-engineered collagen meniscus implants: 5- to 6-year feasibility study results. Arthroscopy. 2005;21(5):515-525.
88.
SteinertAFPalmerGDPilapilCNothUEvansCHGhivizzaniSC. Enhanced in vitro chondrogenesis of primary mesenchymal stem cells by combined gene transfer. Tissue Eng Part A. 2009;15(5):1127-1139.
89.
SteinertAFWeissenbergerMKunzM. Indian hedgehog gene transfer is a chondrogenic inducer of human mesenchymal stem cells. Arthritis Res Ther. 2012;14(4):R168.
90.
StoneKRSteadmanJRRodkeyWGLiST. Regeneration of meniscal cartilage with use of a collagen scaffold. Analysis of preliminary data. J Bone Joint Surg Am. 1997;79(12):1770-1777.
van der WalRJThomassenBJvan ArkelER. Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med. 2009;37(11):2134-2139.
93.
van TrommelMFPotterHGErnbergLASimonianPTWickiewiczTL. The use of noncontrast magnetic resonance imaging in evaluating meniscal repair: comparison with conventional arthrography. Arthroscopy. 1998;14(1):2-8.
94.
van TrommelMFSimonianPTPotterHGWickiewiczTL. Different regional healing rates with the outside-in technique for meniscal repair. Am J Sports Med. 1998;26(3):446-452.
95.
VenkatachalamSGodsiffSPHardingML. Review of the clinical results of arthroscopic meniscal repair. Knee. 2001;8(2):129-133.
96.
VerdonkPBeaufilsPBellemansJ. Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: two-year safety and clinical outcomes. Am J Sports Med. 2012;40:844-853.
97.
VerdonkPCDemurieAAlmqvistKFVeysEMVerbruggenGVerdonkR. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am. 2005;87(4):715-724.
98.
VerdonkPCVerstraeteKLAlmqvistKF. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):694-706.
99.
VerdonkRVerdonkPHuysseWForsythRHeinrichsEL. Tissue ingrowth after implantation of a novel, biodegradable polyurethane scaffold for treatment of partial meniscal lesions. Am J Sports Med. 2011;39(4):774-782.
100.
von LewinskiGMilachowskiKAWeismeierKKohnDWirthCJ. Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament. Knee Surg Sports Traumatol Arthrosc. 2007;15(9):1072-1082.
101.
VundelinckxBBellemansJVanlauweJ. Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sports Med. 2010;38(11):2240-2247.
102.
WangYXGriffithJFAhujaAT. Non-invasive MRI assessment of the articular cartilage in clinical studies and experimental settings. World J Radiol. 2010;2(1):44-54.
103.
WeibrichGKleisWKStreckbeinPMoergelMHitzlerWEHafnerG. Comparison of point-of-care methods for preparation of platelet concentrate (platelet-rich plasma). Int J Oral Maxillofac Implants. 2012;27(4):762-769.
104.
WeinandCPerettiGMAdamsSBJrBonassarLJRandolphMAGillTJ. An allogenic cell-based implant for meniscal lesions. Am J Sports Med. 2006;34(11):1779-1789.
105.
WelsingRTvan TienenTGRamrattanN. Effect on tissue differentiation and articular cartilage degradation of a polymer meniscus implant: a 2-year follow-up study in dogs. Am J Sports Med. 2008;36(10):1978-1989.
106.
WirthCJPetersGMilachowskiKAWeismeierKGKohnD. Long-term results of meniscal allograft transplantation. Am J Sports Med. 2002;30(2):174-181.
107.
ZaffagniniSMarcheggiani MuccioliGMBulgheroniP. Arthroscopic collagen meniscus implantation for partial lateral meniscal defects: a 2-year minimum follow-up study. Am J Sports Med. 2012;40:2281-2288.
108.
ZaffagniniSMarcheggiani MuccioliGMLopomoN. Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10-year follow-up study. Am J Sports Med. 2011;39(5):977-985.
109.
ZellnerJMuellerMBernerA. Role of mesenchymal stem cells in tissue engineering of meniscus. J Biomed Mater Res A. 2010;94(4):1150-1161.
110.
ZhangZArnoldJAWilliamsTMcCannB. Repairs by trephination and suturing of longitudinal injuries in the avascular area of the meniscus in goats. Am J Sports Med. 1995;23(1):35-41.
111.
ZurGLinder-GanzEElsnerJJ. Chondroprotective effects of a polycarbonate-urethane meniscal implant: histopathological results in a sheep model. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):255-263.
