fibrin and Knee-Injuries

Tissue adhesives (TAs) represent a promising alternative or augmentation method to conventional tissue repair techniques. In sports medicine, TA use has been suggested and implemented in the treatment of meniscal tears. The aim of this review was to present and discuss the current evidence and base of knowledge regarding the clinical usage of TAs for meniscal repair.. Systematic review; Level of evidence, 4.. A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases for studies reporting on clinical outcomes of TA usage for meniscal repair in humans in the English language published before January 2020.. Ten studies were eligible for review and included 352 meniscal repairs: 94 (27%) were TA-based repairs and 258 (73%) were combined suture and TA repairs. Concomitant anterior cruciate ligament reconstruction was performed in 224 repairs (64%). All included studies utilized fibrin-based TA. Of the 10 studies, 9 were evidence level 4 (case series), and 8 reported on a cohort of ≤40 meniscal repairs. Rates of meniscal healing were evaluated in 9 of 10 studies, with repair failure seen in 39 repairs (11%).. The use of TAs, specifically fibrin-based TAs, for meniscal repair shows good results as either an augmentation or primary repair of various configurations of meniscal tears. However, this review reveals an absence of comparative high-quality evidence supporting the routine use of TAs for meniscal repair and emphasizes the lack of an ideal TA designed for that purpose. Further high-quality research, basic science and clinical, will facilitate the development of new materials and enable testing their suitability for use in meniscal repair.

Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Fibrin; Humans; Knee Injuries; Menisci, Tibial; Tibial Meniscus Injuries; Tissue Adhesives

The purpose of this study was to examine the results of meniscal repair performed for symptomatic degenerative medial meniscal tears.. Twenty-four knees in 24 patients with symptomatic degenerative medial meniscal tears (mostly complex horizontal tears) who underwent isolated arthroscopic repair combined with autologous fibrin clot implantation were included in this study. The patients were followed up for a minimum of 2 years. The overall clinical outcome was evaluated using the Lysholm score, while the activity level was graded on the Tegner Activity Scale. The assessment of healing status at the repair site was based on clinical signs/symptoms and follow-up MRI examination results. In addition, the effects of the patient's clinical and radiological factors on healing of the repaired menisci were analyzed.. The mean age of the study subjects was 47.0 ± 8.1 years with a mean follow-up period of 39.3 ± 11.6 months. The Lysholm score significantly improved after surgery (P < 0.01). During the follow-up period, meniscal repairs were deemed to have failed in 6 of the 24 knees (25%). In the analysis of factors influencing meniscal healing, varus deformity (% of mechanical axis < 30%) was identified in all knees in the repair failure group, and the presence of varus deformity was shown to be a significant risk factor correlated with repair failure, while other factors did not significantly influence the healing status.. The short-term follow-up results showed that arthroscopic repair of degenerative medial meniscal tears combined with fibrin clot implantation attained clinical healing in 18 of 24 knees (75%) of patients, while 6 of the 24 knees (25%) of patients experienced clinical failure. The presence of varus deformity negatively affects the healing rate. In well-aligned knees, degenerative medial meniscal tears are successfully treated by isolated repair with fibrin clot implantation.. IV.

Topics: Adult; Aged; Arthroscopy; Blood Coagulation; Female; Fibrin; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Menisci, Tibial; Middle Aged; Retrospective Studies; Risk Factors; Suture Techniques; Tibial Meniscus Injuries

Anterior cruciate ligament (ACL) rupture is the most common complete ligamentous injury in the knee. Many studies explored ACL graft integration and maturation, but only a few assessed the application of platelet rich fibrin matrix (PRFM) as augmentation for ACL reconstruction. The main aim of this study was to test the PRFM augmentation in terms of graft-bone integration and knee stability. The secondary aim was to investigate patient-reported functional status.. Prospective evaluation has been done in two consecutive series of patients who underwent ACL reconstruction with semitendinosus and gracilis (STG) grafts: 14 patients were operated with PRFM augmentation and 14 patients without PRFM augmentation. Objective clinical evaluation (Rolimeter) and MRI evaluation were performed at 1 year from surgery. Subjective evaluation (IKDC) was performed pre-operatively and at 6 months, 1 and 2 years from surgery.. A statistically significant difference was not detected between the two groups in terms of MRI and objective clinical evaluation, although PRFM-augmented patients showed a statistically significant higher clinical improvement.. The procedure described for PRFM augmentation in ACL STG reconstruction does not improve radiologic graft integration and knee stability after 1 year and should not be used by clinicians to this purpose. However, it may result in a short-term improvement of patient-reported knee function, and future research should focus on further developing PRP treatment to optimize ACL clinical outcome.. III.

Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Female; Fibrin; Follow-Up Studies; Humans; Joint Instability; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Platelet-Rich Plasma; Prospective Studies; Rupture

The effect of autologous platelet rich fibrin (PRF), a second generation platelet product, on the healing of experimental articular cartilage lesions was evaluated in an animal model. Full thickness cartilage lesions with a diameter of 6 mm and depth of 5 mm were created in the weight bearing area of femoral condyles of both hind limbs in 12 adult mixed breed dogs. Defects in the left hind limb of each dog were repaired by PRF implantation whereas those in the right hind limb were left empty. The animals were euthanized at 4, 16, and 24 weeks following surgery and the resultant repair tissue was investigated macroscopically and microscopically. The results of macroscopic and histological evaluations indicated that there were significant differences between the PRF treated and untreated defects. In conclusion, the present study indicated that the use of platelet rich fibrin as a source of autologous growth factors leads to improvement in articular cartilage repair.

Topics: Animals; Blood Platelets; Cartilage, Articular; Disease Models, Animal; Dogs; Fibrin; Knee Injuries; Male; Regeneration

The treatment of osteochondral articular defects has been challenging physicians for many years. The better understanding of interactions of articular cartilage and subchondral bone in recent years led to increased attention to restoration of the entire osteochondral unit. In comparison to chondral lesions the regeneration of osteochondral defects is much more complex and a far greater surgical and therapeutic challenge. The damaged tissue does not only include the superficial cartilage layer but also the subchondral bone. For deep, osteochondral damage, as it occurs for example with osteochondrosis dissecans, the full thickness of the defect needs to be replaced to restore the joint surface (1). Eligible therapeutic procedures have to consider these two different tissues with their different intrinsic healing potential (2). In the last decades, several surgical treatment options have emerged and have already been clinically established (3-6). Autologous or allogeneic osteochondral transplants consist of articular cartilage and subchondral bone and allow the replacement of the entire osteochondral unit. The defects are filled with cylindrical osteochondral grafts that aim to provide a congruent hyaline cartilage covered surface (3,7,8). Disadvantages are the limited amount of available grafts, donor site morbidity (for autologous transplants) and the incongruence of the surface; thereby the application of this method is especially limited for large defects. New approaches in the field of tissue engineering opened up promising possibilities for regenerative osteochondral therapy. The implantation of autologous chondrocytes marked the first cell based biological approach for the treatment of full-thickness cartilage lesions and is now worldwide established with good clinical results even 10 to 20 years after implantation (9,10). However, to date, this technique is not suitable for the treatment of all types of lesions such as deep defects involving the subchondral bone (11). The sandwich-technique combines bone grafting with current approaches in Tissue Engineering (5,6). This combination seems to be able to overcome the limitations seen in osteochondral grafts alone. After autologous bone grafting to the subchondral defect area, a membrane seeded with autologous chondrocytes is sutured above and facilitates to match the topology of the graft with the injured site. Of course, the previous bone reconstruction needs additional surgical time and often even an

Topics: Animals; Blood Coagulation; Bone Marrow Cells; Cartilage, Articular; Fibrin; Knee Injuries; Knee Joint; Male; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Rabbits; Tissue Engineering; Transplantation, Homologous

Platelets are one of the most biocompatible and cost-effective sources of growth factors. Attention is being paid to autologous platelets and platelet-rich plasma. We developed a novel compact platelet-rich fibrin scaffold (CPFS) that was produced from blood and calcium gluconate only. The objective of this study was to investigate the potential of CPFS as a provisional scaffold in two rabbit models.. In the first rabbit model, the central half of the patellar tendon was resected bilaterally. Allogenic CPFS was attached to the defect in the right knee, while the left knee was untreated. In the other model, the medial collateral ligament was removed bilaterally. The ligament of the right knee was reconstructed with allogenic CPFS, whereas the left knee was untreated.. After 12weeks, the ultimate failure load and stiffness were higher for the right patellar tendon than for the left patellar tendon in the former model. It was found that CPFS promoted ligament repair tissue in contrast with that on the untreated side in the latter model. The ultimate failure load of the CPFS repair tissue at 20weeks was 78% of that in healthy controls of the same age.. CPFS enhanced the healing of tendons and ligaments.. CPFS has the potential to accelerate healing of tendons and ligaments as a provisional bioscaffold or a material for graft augmentation.

Topics: Animals; Biopsy, Needle; Collateral Ligaments; Disease Models, Animal; Fibrin; Immunohistochemistry; Knee Injuries; Male; Patellar Ligament; Plastic Surgery Procedures; Platelet-Rich Plasma; Rabbits; Random Allocation; Tendon Injuries; Tensile Strength; Tissue Scaffolds; Transplantation, Homologous; Wound Healing

Severe symptomatic and unstable osteochondral defects of the knee are difficult to treat. A variety of surgical techniques have been developed. However, the optimal surgical technique is still controversial. We present a novel technique in which autologous bone grafting is combined with gel-type autologous chondrocyte implantation (GACI).. Isolated severe osteochondral defects of the medial or lateral femoral condyle were treated by a two-step procedure. Firstly, chondrocytes were harvested during arthroscopy and cultured for 6 weeks. Secondly, a full thickness corticospongious autologuos bone graft, harvested from the medial or lateral femur condyle, is impacted in the defect and covered by GACI. The fibrin gel fills up to the exact shape of the chondral lesion and polymerizes within 3 min after application.. From 2009 to 2011, 9 patients, median age 35 years (range 23–47), were treated by the combined autologous bone grafting and GACI technique. Median defect size was 7.1 cm2 (range 2.5–12.0), and median depth of the lesion was 0.9 cm (range 0.8–1.2). Median follow-up was 9 months (range 6–12 months). Six patients were available for 12-month follow-up. The mean IKDC score showed a 6-month improvement from 35 (SD ± 16) to 51 (SD ± 18) (n = 9; p = 0.01), and a 1-year improvement from 35 (SD ± 16) to 57 (SD ± 20) (n = 6; p = 0.03). The mean KOOS improved from 44 (SD ± 16) to 62 (SD ± 19) (n = 9; p = 0.07) at 6-month follow-up and from 44 (SD ± 16) to 65 (SD ± 24) (n = 6; p = 0.1) at 12-month follow-up. There was one failure that needed conversion to a unicompartmental knee arthroplasty.. Combined autologous bone grafting and GACI may offer an alternative surgical option for severe and unstable osteochondral defects of the knee.

Topics: Adult; Cartilage, Articular; Cells, Cultured; Chondrocytes; Femur; Fibrin; Follow-Up Studies; Gels; Guided Tissue Regeneration; Humans; Knee Injuries; Magnetic Resonance Imaging; Middle Aged; Tissue Scaffolds; Transplantation, Autologous; Young Adult

A novel indication and technique using exogenous fibrin clots to repair horizontal cleavage tears of the meniscus is presented.. Vertical sutures were placed on the meniscus using FasT-Fix (Smith & Nephew Endoscopy, Andover, MA, USA), and exogenous fibrin clots were inserted within the cleft to promote healing and to preserve function.. Repeat arthroscopy showed healing and closure of the cleft of the meniscus without affecting the articular cartilage. Three medial and six lateral menisci were treated, and all of the patients showed improvements in their functional scores and their quality of life.. It appears that the exogenous fibrin clots act as a scaffold to promote the healing process and that growth factors in the fibrin clots had a beneficial effect on meniscal healing. This procedure should be considered to treat degenerative menisci for which repair options have been limited until now.. IV.

Topics: Arthroscopy; Blood Coagulation; Fibrin; Humans; Knee Injuries; Menisci, Tibial; Suture Techniques; Tibial Meniscus Injuries; Treatment Outcome; Wound Healing

Topics: Animals; Blood Platelets; Cartilage, Articular; Fibrin; Knee Injuries; Rabbits; Surface Properties; Transplantation, Autologous; Wound Healing

Autologous chondrocyte implantation (ACI) is widely used to treat symptomatic articular cartilage injury of the knee. Fibrin ACI is a new tissue-engineering technique for the treatment of full-thickness articular cartilage defects, in which autologous chondrocytes are inserted into a three-dimensional scaffold provided by fibrin gel. The objective of this study is to document and compare mean changes in overall clinical scores at both baseline and follow-up. Fibrin ACI was used to treat deep cartilage defects of the femoral condyle in 30 patients. There were 24 men and 6 women with a median age of 35 years (range 15-55) and with a mean defect size of 5.8 cm(2) (range 2.3-12). Clinical and functional knee evaluations were performed using different scoring systems, MRI was performed 24 months postoperatively, and arthroscopy was performed 12 months postoperatively. All patients achieved clinical and functional status improvements following surgery (P < 0.01). The mean scores of the Henderson classification (MRI evaluation) significantly improved from 14.4 to 7 (P = 0.001), and no graft-associated complications were noted. Arthroscopic assessments performed 12 months postoperatively produced nearly normal (grade II) International Cartilage Repair Society scores in 8 of the 10 study patients. Fibrin ACI offers the advantages of technical simplicity, minimal invasiveness, a short surgery time, and easier access to difficult sites than classical ACI. Based on the findings of this clinical pilot study, we conclude that fibrin ACI offers a reliable means of treating articular cartilage defects of the knee.

Topics: Adolescent; Adult; Cartilage, Articular; Chondrocytes; Collagen; Female; Fibrin; Follow-Up Studies; Glycosaminoglycans; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Tissue Engineering; Transplantation, Autologous; Treatment Outcome; Young Adult

A new composite scaffold containing type I collagen, hyaluronan, and fibrin was prepared with and without autologous chondrocytes and implanted into a rabbit femoral trochlea. The biophysical properties of the composite scaffold were similar to native cartilage. The macroscopic, histological, and immunohistochemical analysis of the regenerated tissue from cell-seeded scaffolds was performed 6 weeks after the implantation and predominantly showed formation of hyaline cartilage accompanied by production of glycosaminoglycans and type II collagen with minor fibro-cartilage production. Implanted scaffolds without cells healed predominantly as fibro-cartilage, although glycosaminoglycans and type II collagen, which form hyaline cartilage, were also observed. On the other hand, fibro-cartilage or fibrous tissue or both were only formed in the defects without scaffold. The new composite scaffold containing collagen type I, hyaluronan, and fibrin, seeded with autologous chondrocytes and implanted into rabbit femoral trochlea, was found to be highly effective in cartilage repair after only 6 weeks. The new composite scaffold can therefore enhance cartilage regeneration of osteochondral defects, by the supporting of the hyaline cartilage formation.

Topics: Animals; Biomechanical Phenomena; Cell Survival; Cells, Cultured; Chondrocytes; Collagen Type I; Fibrin; Hyaluronic Acid; Knee Injuries; Male; Materials Testing; Microscopy, Electron; Prostheses and Implants; Rabbits

In this series of 153 meniscus tears, 8% were isolated whereas 92% were in conjunction with anterior cruciate ligament (ACL) tears. Exogenous fibrin clot was injected with a blunt needle in the seam of the tear. One to 2 ml of clot was sufficient to fill an average defect. When gaps could not be closed, such as with a radial split or flap in the posterior one-third of the meniscus, a fascia sheath was used to cover these defects and the exogenous clot was injected under the cover of the sheath. ACL-deficient knees were stabilized with an intraarticular reconstruction. Overall results were 64% healed, 24% incompletely healed, and 12% failed (less than 50% of vertical height of tear healed). In ACL-associated knees, the failure rate was 1.5% for tears in which surgery occurred up to two months after the time of injury. The failure rate for tears surgically treated two months to several years after injury was 20%. Complex tears had an even higher failure rate of 22%. It is these tears that will be treated with the fascia sheath. The isolated tear failure rate was 41% without the exogenous fibrin clot versus 8% with the exogenous clot. Complications included retear and popliteal neurovascular injury. Repair of almost all menisci in young active athletes is possible using the transarticular arthroscopic technique with a posterior incision. Repairs of tears of less than two months' duration from the time of injury to surgery result in significantly higher healing rates than those of more chronic tears. Isolated repairs heal significantly better with exogenous fibrin clot injection.

Topics: Adolescent; Adult; Arthroscopy; Fibrin; Humans; Knee Injuries; Ligaments, Articular; Menisci, Tibial; Middle Aged; Surgical Instruments; Suture Techniques; Synovectomy; Tibial Meniscus Injuries; Time Factors

The healing process of osteochondral fracture was studied experimentally and clinically, using fibrin adhesive system (FAS) containing highly concentrated and freeze-dried fibrinogen, thrombin and factor XIII. Osteochondral fractures were made in the femoral condyle of the rabbit. Most of the adhered fibrin was gradually absorbed at the fracture site and at the same time was replaced with granulation tissue containing abundant capillaries, fibroblasts and osteoblasts, by the 10th day. Complete fracture healing was achieved histologically in one month. Fifteen cases of intraarticular osteochondral fractures in the hand were treated with FAS clinically. Complete bony union was obtained in all cases at 3 to 6 weeks postoperatively. The range of motion was limited in 3 cases, but was excellent in the other 12 cases. From our experimental and clinical results, it appears that FAS may produce no obstructive effects in bony healing. Management of intraarticular osteochondral fixation would be much easier by using FAS than by the conventional fixation materials such as metal screws or K-wire.

Topics: Adolescent; Adult; Animals; Cartilage, Articular; Child; Female; Fibrin; Finger Injuries; Fractures, Cartilage; Fractures, Open; Hand Injuries; Humans; Knee Injuries; Male; Middle Aged; Postoperative Period; Rabbits; Swine; Tissue Adhesives; Wound Healing

Topics: Adhesives; Animals; Cartilage, Articular; Dogs; Femoral Fractures; Fibrin; Fractures, Cartilage; Knee Injuries; Knee Joint; Wound Healing