Eli Nnaemeka, Oragui Emeka, Khan Wasim
Department of Trauma & Orthopaedics, Queen's Hospital, Barking, Havering & Redbridge NHS Trust, London, UK.
Ortop Traumatol Rehabil. 2011 Jul-Aug;13(4):319-26. doi: 10.5604/15093492.950415.
Injuries and lesions to the meniscal cartilage of the knee joint are common. As a result of its limited regenerative capacity, early degenerative changes to the articular surface frequently occur, resulting in pain and poor function. Currently available surgical interventions include repair of tears, and partial and total meniscectomy but the results are inconsistent and often poor. Interest in the field of meniscal tissue engineering with the possibilities of better treatment outcomes has grown in recent times. Current research has focused on the use of mesenchymal stem cells, fibrochondrocytes, meniscal derived cells and fibroblast-like synoviocytes in tissue engineering. Mesenchymal stem cells are multipotent cells that have been identified in a number of tissues including bone marrow and synovium. Current research is aimed at defining the correct combination of cytokines and growth factors necessary to induce specific tissue formation and includes transforming growth factor-β (TGF-β), Platelet Derived Growth Factor (PDGF) and Fibroblast Growth Factor 2 (FGF2). Scaffolds provide mechanical stability and integrity, and supply a template for three-dimensional organization of the developing tissue. A number of experimental and animal models have been used to investigate the ideal scaffolds for meniscal tissue engineering. The ideal scaffold for meniscal tissue engineering has not been identified but biodegradable scaffolds have shown the most promising results. In addition to poly-glycolic acid (PGA) and poly-lactic acid (PLLA) scaffolds, new synthetic hydrogels and collagen sponges are also being explored. There are two synthetic meniscal implants currently in clinical use and there are a number of clinical trials in the literature with good short- and medium-term results. Both products are indicated for segmental tissue loss and not for complete meniscal replacement. The long-term results of these implants are unknown and we wait to see whether they will be proved to have benefits in delaying arthritic change and chondral damage.
膝关节半月板软骨损伤和病变很常见。由于其再生能力有限，关节表面经常出现早期退行性变化，导致疼痛和功能不佳。目前可用的手术干预措施包括撕裂修复、部分和全半月板切除术，但结果并不一致，而且往往很差。近年来，人们对半月板组织工程领域的兴趣日益浓厚，因为它有可能带来更好的治疗效果。目前的研究集中在组织工程中使用间充质干细胞、纤维软骨细胞、半月板衍生细胞和成纤维样滑膜细胞。间充质干细胞是多能细胞，已在包括骨髓和滑膜在内的多种组织中被发现。目前的研究旨在确定诱导特定组织形成所需的细胞因子和生长因子的正确组合，包括转化生长因子-β（TGF-β）、血小板衍生生长因子（PDGF）和成纤维细胞生长因子2（FGF2）。支架提供机械稳定性和完整性，并为发育中的组织提供三维组织模板。已经使用了许多实验和动物模型来研究半月板组织工程的理想支架。半月板组织工程的理想支架尚未确定，但可生物降解支架已显示出最有希望的结果。除了聚乙醇酸（PGA）和聚乳酸（PLLA）支架外，新型合成水凝胶和胶原海绵也在探索中。目前有两种合成半月板植入物正在临床使用，文献中有一些临床试验取得了良好的短期和中期结果。这两种产品都适用于节段性组织缺损，而不适用于完全半月板置换。这些植入物的长期结果尚不清楚，我们拭目以待它们是否能被证明在延缓关节炎变化和软骨损伤方面有好处。
