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. 2024 Jun 14;13(10):103072.
doi: 10.1016/j.eats.2024.103072. eCollection 2024 Oct.

Revision Meniscal Repair With Amniotic Membrane Augmentation

Scott M Feeley  1   2 , Matthew W Feldman  3 , Conor F McCarthy  1   2 , Donald F Colantonio  4 , John M Tokish  5 , Christopher J Tucker  1   2   4
Affiliations

Revision Meniscal Repair With Amniotic Membrane Augmentation

Scott M Feeley et al. Arthrosc Tech. .

Abstract

Meniscal injury is common, and despite modern techniques, the failure rate following repair remains high. While there are recent treatment advances in the form of biologics, there is limited evidence and agreement on these emerging therapies and their role in meniscal healing. Amniotic tissue (umbilical cord allograft) is a biologic augmentation therapy that has been utilized in other musculoskeletal applications but has not been reported for use in meniscal repair. We describe a technique to deliver an allograft amniotic membrane into a meniscus tear repair site, potentially optimizing healing.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: J.M.T. is a board member of the 10.13039/100008542Arthroscopy Association of North America, Orthopedics Today, and Journal of Shoulder and Elbow Surgery; is a consultant or advisor for 10.13039/100004331Johnson & Johnson and Arthrex; receives speaking and lecture fees from Arthrex; and receives funding grants and nonfinancial support from the Journal of Shoulder and Elbow Surgery. C.J.T. is a board member of the Society of Military Orthopaedic Surgeons and is Podcast Editor for Arthroscopy Journal. All other authors (S.M.F., M.W.F., C.F.M., D.F.C.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
Amnion 5-mm × 40-mm streamer (Arthrex) is loaded into the AmnionXpress Delivery Device (Arthrex) on the back table in the operating room for arthroscopic implantation into the meniscal repair site. The sled is used through the anteromedial portal to guide the delivery device through the soft tissues into the knee joint.
Fig 2
Fig 2
Viewing the medial compartment of a right knee from the anterolateral portal. (A) An arthroscopic probe is utilized to assess the tear site and measure the length of the tear for graft implantation. (B) The delivery device is inserted through the anteromedial portal on top of the sled to avoid getting caught in the soft tissues or causing iatrogenic chondral or meniscal injury. (C) Once the delivery device has been inserted into the tear site using the measured markings for reference, the thumb slide plunger is advanced to the measured depth for the meniscal tear length to implant the amniotic membrane allograft. (D) Following retraction of the delivery device, a probe can position any remaining graft into the tear site prior to meniscal repair.
Fig 3
Fig 3
A posterior horn/body medial meniscal repair is viewed with a 30° arthroscope from the anterolateral portal in a right knee. (A) Meniscal-based suturing with a Novostitch all-inside meniscal repair system (Smith & Nephew) achieves vertical compressive forces across the tear site while capturing the implanted graft. (B) Capsular-based suturing with a FiberStitch knotless all-inside implant system (Arthrex) achieves horizontal compressive forces.
See this image and copyright information in PMC

References

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