Marrow stimulation improves meniscal healing at early endpoints in a rabbit meniscal injury model

Matthew D. Driscoll, Brett N. Robin, Masafumi Horie, Zachary T. Hubert, H. Wayne Sampson, Daniel Jupiter, Binu Tharakan, Robert E. Reeve

Research output: Contribution to journalArticle

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Abstract

Purpose: To critically evaluate the effect of marrow stimulation (MS) on the extent of healing and the local biological environment after meniscal injury in ligamentously stable knees in a rabbit model. Methods: A reproducible 1.5-mm cylindrical defect was created in the avascular portion of the anterior horn of the medial meniscus bilaterally in 18 New Zealand White rabbits (36 knees). In right knees (MS knees), a 2.4-mm Steinman pin was drilled into the apex of the femoral intercondylar notch and marrow contents were observed spilling into the joint. Left knees served as controls. Rabbits were killed in 3 groups (n = 6 rabbits each) at 1, 4, and 12 weeks with meniscal harvest and blinded histomorphometric and histologic evaluation using an established 3-component tissue quality score (range, 0 to 6). One-week specimens were also evaluated for the presence of proregenerative cytokines using immunohistochemistry. Results: The mean proportion of the avascular zone defect bridged by reparative tissue was greater in MS knees than in controls at each endpoint (1 week, 55% v 30%, P =.02; 4 weeks, 71% v 53%, P =.047; 12 weeks, 96% v 77%, P =.16). Similarly, there was a consistent trend toward superior tissue quality scores in knees treated with MS compared with controls (1 week, 1.8 v 0.3, P =.03; 4 weeks, 4.3 v 2.8, P =.08; 12 weeks, 5.9 v 4.5, P =.21). No statistically significant differences, however, were observed at the 12-week endpoint. Increased staining for insulin-like growth factor I, transforming growth factor-β, and platelet-derived growth factor was observed in regenerated tissue, compared with native meniscal tissue, in all specimens at 1 week. Staining density for all growth factors was similar, however, in reparative tissue of MS and control knees. Conclusions: The results of this study suggest that marrow stimulation leads to modest improvements in quality and quantity of reparative tissue bridging a meniscal defect, particularly during the early recovery period. Clinical Relevance: Clinical evaluation of marrow stimulation techniques designed to enhance healing in isolated meniscus repair surgery may be indicated.

Original languageEnglish (US)
Pages (from-to)113-121
Number of pages9
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume29
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

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Knee
Bone Marrow
Rabbits
Wounds and Injuries
Staining and Labeling
Tibial Meniscus
Platelet-Derived Growth Factor
Transforming Growth Factors
Horns
Quality Improvement
Thigh
Insulin-Like Growth Factor I
Intercellular Signaling Peptides and Proteins
Joints
Immunohistochemistry
Cytokines

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Marrow stimulation improves meniscal healing at early endpoints in a rabbit meniscal injury model. / Driscoll, Matthew D.; Robin, Brett N.; Horie, Masafumi; Hubert, Zachary T.; Sampson, H. Wayne; Jupiter, Daniel; Tharakan, Binu; Reeve, Robert E.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 29, No. 1, 01.2013, p. 113-121.

Research output: Contribution to journalArticle

Driscoll, Matthew D. ; Robin, Brett N. ; Horie, Masafumi ; Hubert, Zachary T. ; Sampson, H. Wayne ; Jupiter, Daniel ; Tharakan, Binu ; Reeve, Robert E. / Marrow stimulation improves meniscal healing at early endpoints in a rabbit meniscal injury model. In: Arthroscopy - Journal of Arthroscopic and Related Surgery. 2013 ; Vol. 29, No. 1. pp. 113-121.
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AU - Robin, Brett N.

AU - Horie, Masafumi

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AU - Sampson, H. Wayne

AU - Jupiter, Daniel

AU - Tharakan, Binu

AU - Reeve, Robert E.

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N2 - Purpose: To critically evaluate the effect of marrow stimulation (MS) on the extent of healing and the local biological environment after meniscal injury in ligamentously stable knees in a rabbit model. Methods: A reproducible 1.5-mm cylindrical defect was created in the avascular portion of the anterior horn of the medial meniscus bilaterally in 18 New Zealand White rabbits (36 knees). In right knees (MS knees), a 2.4-mm Steinman pin was drilled into the apex of the femoral intercondylar notch and marrow contents were observed spilling into the joint. Left knees served as controls. Rabbits were killed in 3 groups (n = 6 rabbits each) at 1, 4, and 12 weeks with meniscal harvest and blinded histomorphometric and histologic evaluation using an established 3-component tissue quality score (range, 0 to 6). One-week specimens were also evaluated for the presence of proregenerative cytokines using immunohistochemistry. Results: The mean proportion of the avascular zone defect bridged by reparative tissue was greater in MS knees than in controls at each endpoint (1 week, 55% v 30%, P =.02; 4 weeks, 71% v 53%, P =.047; 12 weeks, 96% v 77%, P =.16). Similarly, there was a consistent trend toward superior tissue quality scores in knees treated with MS compared with controls (1 week, 1.8 v 0.3, P =.03; 4 weeks, 4.3 v 2.8, P =.08; 12 weeks, 5.9 v 4.5, P =.21). No statistically significant differences, however, were observed at the 12-week endpoint. Increased staining for insulin-like growth factor I, transforming growth factor-β, and platelet-derived growth factor was observed in regenerated tissue, compared with native meniscal tissue, in all specimens at 1 week. Staining density for all growth factors was similar, however, in reparative tissue of MS and control knees. Conclusions: The results of this study suggest that marrow stimulation leads to modest improvements in quality and quantity of reparative tissue bridging a meniscal defect, particularly during the early recovery period. Clinical Relevance: Clinical evaluation of marrow stimulation techniques designed to enhance healing in isolated meniscus repair surgery may be indicated.

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