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Hydrogel Meniscal Replacement in the Sheep Knee

Preliminary Evaluation of Chondroprotective Effects

Bryan T. Kelly, MD^,*, William Robertson, Hollis G. Potter, MD, Xiang-Hua Deng, MD, A. Simon Turner, MS, Stephen Lyman, PhD, Russell F. Warren, MD and Scott A. Rodeo, MD

From the Hospital for Special Surgery, New York, New York, and Colorado State University, Fort Collins, Colorado

^* Address correspondence to Bryan T. Kelly, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 (e-mail: kellyb2847{at}hotmail.com).

Background: Meniscal allograft transplantation has become a viable surgical alternative for a select group of patients with deficient or irreparable menisci. Subjective results are encouraging; long-term success, durability, and safety of allograft meniscal transplantation are uncertain.

Purposes: To evaluate a novel hydrogel meniscal replacement implant in an ovine model and assess chondroprotective effects of this hydrogel meniscal replacement using several validated outcome measures.

Study Design: Controlled laboratory study.

Methods: Fourteen skeletally mature sheep underwent hydrogel meniscal replacement; 45 additional animals had previously undergone 1 of 3 operations: lateral meniscectomy (24), meniscal allograft transplant (17), and sham (4). Animals were sacrificed at 2, 4, or 12 months. Cartilage was assessed by magnetic resonance imaging, gross inspection, biomechanical testing, and semiquantitative histological analysis.

Results: There were no differences between the sham operation and nonoperated control limbs. Compared with meniscectomy, hydrogel meniscal replacement resulted in significantly decreased cartilage degeneration with all outcome parameters (P < .05). Compared with nonoperated control limbs, hydrogel meniscal replacements demonstrated no significant differences at 2 months in any category. By 4 months, hydrogel limbs demonstrated significantly greater cartilage degeneration than did nonoperated control limbs in all categories. Compared with meniscal allograft transplantation animals, hydrogel meniscal replacements demonstrated no differences at 2 months but had significantly increased cartilage degeneration in the peripheral zone of the tibial plateau at 4 months (P < .05). At 1 year, all hydrogel implants had developed complete radial splits in the posterior third of the implant.

Conclusion: Although promising preliminary results for hydrogel meniscal replacement were seen at early time points, significant cartilage degeneration and implant failure were seen at 1 year, and overall performance was worse than was allograft transplantation. Improvements in hydrogel material properties and surface characteristics and more accurate size matching may improve outcomes.

Clinical Relevance: Improvements in the hydrogel material properties and surface characteristics and more accurate size matching may lead to the use of hydrogel implants in humans.

Key Words: hydrogel • meniscus • replacement • cartilage