Hype, Promise and Reality: Orthopaedic Use of Biologics in 2020 (AANA20)-Biologics for Treatment of Meniscus Pathology

Biologics for Treatment of Meniscus Pathology_ W here Are We in 2020-Dr. Scott Rodeo

Pdf Summary

At the 2020 Arthroscopy Association of North America meeting, Dr. Scott A. Rodeo discussed biologic approaches to meniscus pathology treatment, emphasizing current limitations and future directions. Meniscus preservation and repair remain standard, but healing is hampered by poor vascularity, cellular scarcity, lack of signaling molecules, inflammatory joint environments, and mechanical stress.<br /><br />Clinical data, particularly from the MOON Group, show meniscus repair yields better outcomes than excision, yet medial meniscus treatments still face joint space narrowing and worse patient-reported results, highlighting need for optimized biologic and mechanical environments.<br /><br />Biologic augmentation methods include synovial abrasion, fibrin clot application, marrow venting/microfracture, platelet-rich plasma (PRP), and cell-based therapies. PRP studies have mixed results; some show no significant benefit, while others demonstrate improved healing rates and patient outcomes. Variability in PRP preparations and patient factors limit consistent conclusions.<br /><br />Cell-based therapies utilize bone marrow aspirate concentrate (BMAC), adipose-derived cells, and synovial mesenchymal stem cells (MSCs). Animal studies suggest BMAC improves healing more effectively than PRP. Human studies with MSC injections show potential meniscal regeneration but data remain limited. Regulatory constraints and uncertainties about cell functionality after transplantation challenge clinical adoption.<br /><br />Instead of transplanting exogenous cells, stimulating the intrinsic progenitor cell niche within the meniscus and synovium emerges as a promising alternative. Injured meniscus mobilizes resident progenitor cells capable of healing, and synovial MSC populations increase post-injury. Experimental approaches employing growth factors (CTGF, TGF-β3) to recruit and differentiate these cells show encouraging results.<br /><br />Additional biologic augmentation tools include scaffolds, tissue adhesives, cytokines, and modulation of the inflammatory intra-articular environment. Elevated inflammatory mediators and matrix metalloproteinases (MMPs) in injured knees impair healing; targeting these factors may enhance repair.<br /><br />In summary, effective biologic augmentation for meniscus healing likely requires integrated strategies combining scaffolds, cells, and signaling molecules while addressing joint inflammation. Variability in biologics such as PRP, regulatory hurdles in stem cell therapies, and complex joint milieu pose challenges. Future research should focus on stimulating intrinsic repair mechanisms and modulating the joint environment to improve meniscus healing outcomes.

Keywords

meniscus pathology

biologic augmentation

meniscus repair

platelet-rich plasma

cell-based therapies

mesenchymal stem cells

intrinsic progenitor cells

synovial mesenchymal stem cells

inflammatory joint environment

scaffolds and tissue adhesives