Clinical application of polyurethane meniscal scaffold: A meta-analysis

Abstract

Objective: In patients with partial meniscus defect, the implantation of polyurethane meniscal scaffold has become a common method for the treatment of meniscus vascular entry and tissue regeneration. However, it is unclear whether polyurethane meniscal scaffold will yield better clinical and MRI results after surgery. This meta-analysis compared the clinical and MRI results of polyurethane meniscal scaffold in some patients with meniscus defects.

Methods: By searching PubMed, Embase, and Cochrane Library, a systematic review of studies evaluating the clinical outcomes of patients with polyurethane meniscal scaffold implantation. The search terms used are: "meniscus", "meniscal", "scaffold", "Actifit" "polyurethane" and "implant". The study was evaluated based on the patient's reported outcome score, accompanying surgery, and radiology results. Genovese scale was used to evaluate morphology and signal intensity, and Yulish score was used to evaluate the imaging performance of articular cartilage.

Results: There were 16 studies that met the inclusion criteria, a total of 613 patients, and the overall average follow-up time was 41 months. The clinical scores at the final follow-up, such as VAS, IKDC, Tegner, and KOOS, were significantly improved compared with preoperatively. The MS, SI, and IIRMC scores evaluated in MRI showed no significant difference between preoperative and final follow-up. However, for AC (OR 0.34, 95% CI 0.11-1.00; P = 0.05) and AME (OR 0.08, 95% CI 0.03-0.22; P < 0.01), the final follow-up results were worse than preoperatively.

Conclusions: This meta-analysis found that compared with preoperative, the clinical effect of the final follow-up was significantly improved. However, MS, SI, and IIRMC in MRI parameters did not change significantly. In addition, the final follow-up results of AC and AME showed a deteriorating trend. Therefore, for patients with partial meniscus defects, polyurethane meniscal scaffold seem to be a viable option, and further research is needed to determine whether the deterioration of AC and AME is clinically relevant.

Keywords: Meniscus; Meta-analysis; Polyurethane; Scaffold.

Fig. 1

Study flow diagram.

Fig. 2

(A) Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. (B) Risk of bias graph: review authors' judgements about each risk of bias item for each included study.

Fig. 3

Results of aggregate analysis for comparison of Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and Tegner score between at baseline and at final follow-up.

Fig. 4

Results of aggregate analysis for comparison of Knee Injury and Osteoarthritis Outcomes Score (KOOS) between at baseline and at final follow-up, including subgroup analysis by pain, symptoms, activities of daily living (ADL), sport/recreation.

Fig. 5

Results of aggregate analysis for comparison of articular cartilage (AC) and absolute meniscal extrusion (AME) between at baseline and at fnal follow-up.

Fig. 6

Results of aggregate analysis for comparison of morphology and size (MS), signal intensity (SI) of meniscal implant, and interface of the implant–residual meniscus complex (IIRMC) between at baseline and at final follow-up.