2023, Vol. 27 ›› Issue (3): 420-426

Meniscal injury repair methods for non-blood supply area

Ning Ziwen, Wang Xu, Shi Zhengliang, Qin Yihua, Wang Guoliang, Jia Di, Wang Yang, Li Yanlin   

Abstract: BACKGROUND: Meniscus plays a key role in the biomechanics and cartilage protection of knee joint, and has multiple functions such as shock absorption, maintaining the stability of the knee joint force line, and reducing the wear and tear of articular cartilage. So far, the effect of surgical repair of meniscal non-blood supply area injury has been poor. If only meniscectomy is performed, the change of the overall mechanical structure of knee joint is easy to accelerate the progress of knee osteoarthritis. Therefore, in recent years, scholars are trying to use different ways to assist the repair of meniscus injury, in order to improve the prognostic effect of meniscal non-blood supply area injuries suture and slow down the progress of knee osteoarthritis.
OBJECTIVE: To summarize the repair treatment of meniscus injury for non-blood supply area in recent years, and look forward to the future development prospect and challenges in this field.
METHODS: CNKI, Wanfang, PubMed, and FMRS databases were used for literature retrieval. The retrieval range was from 2005 to 2021. All articles related to meniscus injury repair, including clinical research and tissue engineering research, were included. Finally, 60 articles were included for analysis.
RESULTS AND CONCLUSION: (1) Due to the special anatomical structure of the meniscus, there is a problem of poor blood supply in two-thirds of the medial area of the meniscus, which is difficult to heal after injury. The current methods of auxiliary meniscus injury repair include: microfracture, subpatellar fat pad crushing, mesenchymal stem cells, platelet-rich plasma, and fibrin clot. (2) Different repair methods have their own advantages and disadvantages. As clinical application methods, microfracture and comminution of subpatellar fat pad are easy to operate, but they may cause iatrogenic injury, postoperative pain, and osteoarthritis. Further fine operation to avoid injury is an inevitable topic in clinic. Although mesenchymal stem cells and platelet-rich plasma have shown good effects in basic research, their preparation methods are diverse, their application methods are not fixed, and platelet-rich plasma even has completely opposite clinical effects in clinical application. Therefore, further studying the mechanism of mesenchymal stem cells and platelet-rich plasma to improve meniscus repair potential and standardizing its preparation process and application method are still the next research direction. (3) Fibrin clot has shown good results in clinical application, but there is still a lack of more relevant research. (4) In conclusion, there are still few research contents on fibrin clot technology and comminution of subpatellar fat pad, while platelet-rich plasma has appeared polarization in clinical manifestations. Microfracture and clinical application of synovial mesenchymal stem cells are stable, which is a good supplementary method at present.
Key words: meniscus, non-blood supply area, repair method, regeneration, microfracture, mesenchymal stem cell, platelet-rich plasma, fibrin clot, tissue engineering, clinical application