title: Actifit synthetic meniscal substitute: experience with 18 patients in Brest, France.
abstract: BACKGROUND
  The management of post-meniscectomy pain is poorly standardised. Allogeneic transplantation may be appropriate in some patients after total meniscectomy. After partial meniscectomy, the synthetic meniscal substitute Actifit may constitute a valid option if the knee is stable or stabilised and aligned or re-aligned. The interconnected pore structure of Actifit promotes tissue regeneration from the meniscal wall. Arthroscopy is used to position the implant, which is then sutured to the remaining native meniscus using horizontal stitches and to the meniscal wall using vertical stitches. However, a burdensome programme of rigorous rehabilitation is required after Actifit implantation.
  
  
  OBJECTIVE
  We hypothesised that implantation of a meniscal substitute effectively alleviated pain without adversely affecting the knee.
  
  
  OBJECTIVE
  To assess the intra-articular behaviour of Actifit and the outcomes of Actifit implantation in a prospective case-series of patients monitored using arthroscopy, pathology, and imaging studies, as well as the Lysholm score to assess clinical benefits on daily activities.
  
  
  METHODS
  Between October 2009 and April 2012, 18 patients underwent Actifit implantation at the military hospital in Brest, France. All procedures were performed by the same surgeon, who had extensive experience with meniscal suturing. There were 13 males and 5 females aged 20 to 46 years. The medial meniscus was involved in 13 patients and the lateral meniscus in 5 patients. Actifit implantation was used alone in 6 patients and in combination with anterior cruciate ligament reconstruction and/or realignment osteotomy in 12 patients. All patients were followed-up for at least 2 years.
  
  
  RESULTS
  The mean Lysholm score after 1 year was 92%, indicating excellent outcomes. Magnetic resonance imaging showed no damage to the implant or degeneration of the neighbouring cartilage. Histological examination of meniscal substitute biopsies taken 1 year after implantation showed polymer ingrowth by normal chondrocytes and fibrochondrocytes. The clinical and radiographic outcomes compared favourably with those seen after isolated procedures on bone or ligaments.
  
  
  CONCLUSIONS
  Actifit has no deleterious effects on patients. The implant induces and promotes meniscal regeneration. Actifit constitutes a major addition to our therapeutic armamentarium. We provide convincing evidence that meniscal reconstruction can be highly beneficial in decreasing the risk of progression to knee osteoarthritis.
  
  
  METHODS
  IV.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital d'Instruction des Armées Clermont-Tonnerre, rue du Colonel-Fontferrier, BP 41, 29240 Brest, France. Electronic address: cecile.baynat@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Baynat
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital d'Instruction des Armées Clermont-Tonnerre, rue du Colonel-Fontferrier, BP 41, 29240 Brest, France.
authors.forename: C
authors.initials: C
authors.lastname: Andro
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU La Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Vincent
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital d'Instruction des Armées Clermont-Tonnerre, rue du Colonel-Fontferrier, BP 41, 29240 Brest, France.
authors.forename: P
authors.initials: P
authors.lastname: Schiele
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Hôpital d'Instruction des Armées Clermont-Tonnerre, rue du Colonel-Fontferrier, BP 41, 29240 Brest, France.
authors.forename: P
authors.initials: P
authors.lastname: Buisson
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU La Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Dubrana
authors.affiliation: Clinique mutualiste de la Porte de L'Orient, 3, rue Robert-de-la-Croix, 56100 Lorient, France.
authors.forename: F X
authors.initials: FX
authors.lastname: Gunepin
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002208:Caproates; D019902:Chondrocytes / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D007783:Lactones; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011140:Polyurethanes; D011446:Prospective Studies; D019736:Prostheses and Implants; D011474:Prosthesis Design; D000070600:Tibial Meniscus Injuries; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D002208:Caproates; D007783:Lactones; D011140:Polyurethanes; C121056:caprolactone
keywords: Lysholm score; Realignment osteotomy; Synthetic meniscal substitute Actifit(®); Total meniscectomy