Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jul 24;11(3):e12108.
doi: 10.1002/jeo2.12108. eCollection 2024 Jul.

Addressing meniscal deficiency part 2: An umbrella review of systematic reviews and meta-analyses on meniscal scaffold-based approaches

Kevin A Wu  1 , Aaron D Therien  1 , Lulla V Kiwinda  1 , Christian J Castillo  2 , Stephanie Hendren  3 , Jason S Long  1 , Annunziato Amendola  1 , Brian C Lau  1
Affiliations
Review

Addressing meniscal deficiency part 2: An umbrella review of systematic reviews and meta-analyses on meniscal scaffold-based approaches

Kevin A Wu et al. J Exp Orthop. .

Abstract

Purpose: Meniscal injuries are common in knee surgery and often require preservation techniques to prevent secondary osteoarthritis. Despite advancements in repair techniques, some patients undergo partial meniscectomy, which can lead to postmeniscectomy syndrome. To address these challenges, meniscal substitution techniques like scaffolds have been developed. However, a comprehensive synthesis of the existing evidence through an umbrella review is lacking.

Methods: A comprehensive search was conducted in the MEDLINE, Embase and Scopus databases to identify relevant systematic reviews and meta-analyses. Studies were screened based on predefined inclusion and exclusion criteria. The quality of included studies was assessed using the AMSTAR-2 tool.

Results: A total of 17 studies met the inclusion criteria and were included in the review. Most studies focused on the use of collagen-based scaffolds, with fewer studies evaluating synthetic scaffolds. The majority of studies (52.9%) were rated as having 'Critically Low' overall confidence, with only one study (5.9%) rated as 'High' confidence and most studies exhibiting methodological limitations, such as small sample sizes and lack of long-term follow-up. Despite these limitations, the majority of studies reported positive short-term outcomes, including pain relief and functional improvement, following scaffold implantation. However, some studies noted a relatively high failure rate. Radiographically, outcomes also varied, with some studies reporting morphological deterioration of the implant seen on MRI, while others noted possible chondroprotective effects.

Conclusions: Meniscal scaffold-based approaches show promise in the management of meniscal deficiency; however, the current evidence is limited by methodological shortcomings. One notable gap in the literature is the lack of clear guidelines for patient selection and surgical technique. Future research should focus on conducting well-designed randomized controlled trials with long-term follow-up to further elucidate the benefits and indications of these techniques in clinical practice. Additionally, efforts should be made to develop consensus guidelines to standardize the use of meniscal scaffolds and improve patient outcomes. Despite limited availability, synthesizing the literature on meniscal scaffold-based approaches is crucial for understanding research, guiding clinical decisions and informing future directions.

Level of evidence: Level IV.

Keywords: meniscal allograft transplantation; meniscal scaffold; osteoarthritis; scaffold‐based strategies; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flowchart illustrates the screening process and selection of final articles for reviews focusing on meniscal scaffold‐based approaches.
Figure 2
Figure 2
Various scaffold implants available: (a) collagen meniscus implant, (b) actifit implant (image adapted from Baynat and colleagues) and (c) NUsurface meniscus implant.
See this image and copyright information in PMC

References

    1. Alley, R. , Alfred, R. , Edelson, R. , Greenleaf, J. , Gersoff, W. , Gomoll, A. et al. (2020) Clinical results of the NUsurface® meniscus implant versus non‐surgical controls at 24 months: data from a Pooled cohort of a randomized controlled study and single arm study. Orthopaedic Journal of Sports Medicine, 8, 2325967120S2325900367. Available from: 10.1177/2325967120S00367 - DOI
    1. Almeida, M.O. , Yamato, T.P. , Parreira, P.C.S. , Costa, L.O.P. , Kamper, S. & Saragiotto, B.T. (2020) Overall confidence in the results of systematic reviews on exercise therapy for chronic low back pain: a cross‐sectional analysis using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool. Brazilian Journal of Physical Therapy, 24, 103–117. Available from: 10.1016/j.bjpt.2019.04.004 - DOI - PMC - PubMed
    1. Baynat, C. , Andro, C. , Vincent, J.P. , Schiele, P. , Buisson, P. , Dubrana, F. et al. (2014) Actifit synthetic meniscal substitute: experience with 18 patients in Brest, France. Orthopaedics & Traumatology: Surgery & Research, 100, S385–S389. Available from: 10.1016/j.otsr.2014.09.007 - DOI - PubMed
    1. Bian, Y. , Cai, X. , Wang, H. , Xu, Y. , Lv, Z. , Feng, B. et al. (2024) Short‐term but not long‐term knee symptoms and functional improvements of tissue engineering strategy for meniscus defects: a systematic review of clinical studies. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 40, 983–995. Available from: 10.1016/j.arthro.2023.06.043 - DOI - PubMed
    1. Bin, S.I. , Kim, H.J. & Lee, D.H. (2018) Graft extrusion after medial and lateral MAT differs according to surgical technique: a meta‐analysis. Archives of Orthopaedic and Trauma Surgery, 138, 843–850. Available from: 10.1007/s00402-018-2922-0 - DOI - PubMed