The concept of a permanent synthetic meniscus prosthesis: a critical discussion after 5 years of experimental investigations using Dacron and Teflon implants.
The requirement of biocompatibility severely limits the access to synthetic materials for meniscal substitution with adequate material properties. Therefore, the possible advantages of a synthetic meniscal substitute over allografts, such as availability and freedom from disease transmission, are overshadowed by factors such as sizing problems, inferior material properties and wear. Using some of the available materials, such as Dacron and Teflon, knee joint stability with intact cruciate ligaments seems to be a basic requirement for the incorporation and fixation of the synthetic material into the biological environment. Similar to using allografts or biological implants, normal posterior and anterior attachment sites could not be reconstructed with the synthetic materials, which may be one of the main causes of insufficient cartilage preservation after meniscal substitution. Further, it was shown that synthetic implants without a polyurethane coating failed because of wear and changes in shape; meanwhile the coated, more inflexible implants often caused osteophyte formation and synovitis. In conclusion, with the materials and designs tested the concept of a permanent meniscal prosthesis does not seem clinically applicable at the moment. Nevertheless, the beneficial effects on cartilage preservation which were seen with slight improvements in prosthesis size, design and material properties may point to a future potential for this concept.
Department of Orthopaedics and Sports Medicine, University Hospital, Linköping, Sweden.
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Messner
D000818:Animals; D001672:Biocompatible Materials; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects / Q000379:methods*; D008592:Menisci, Tibial / Q000601:surgery*; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D013585:Synovitis / Q000209:etiology
D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene