Surgical Feasibility of a One-Stage Cell-Based Arthroscopic Procedure for Meniscus Regeneration.

PURPOSE: To test the technical aspects and feasibility of seeding a combination of meniscus cells isolated from a rapid digestion protocol and mesenchymal stromal cells (MSCs) (20: 80 ratio) into a meniscus scaffold for the development of a one-stage arthroscopic procedure for meniscus regeneration.

METHODS: A cadaveric study was performed using nine fresh frozen human cadaveric knee joints. Two different arthroscopic cell-seeding methods were applied to the Collagen Meniscus Implant (CMI®) as carrier scaffold: either 1) seeding before arthroscopic surgical implantation of the scaffold, or 2) after implantation of the scaffold. The cells were injected inside the scaffold, using fast green-stained fibrin glue as carrier, to macroscopically visualize the amount of fibrin glue. Macroscopic pictures and confocal microscopy analyses were used to determine cell distribution and viability. In addition, the DNA content in the cell-seeded scaffold was determined. In addition, different concentrations of Liberase were examined to find the optimal concentration for rapid digestion of meniscus tissue.

RESULTS: Macroscopically, seeding before implantation showed a better distribution of fast green-stained fibrin glue carrier compared to seeding the scaffold before surgical implantation. In addition, it resulted in significantly more cells and a better cell distribution compared to seeding the scaffold after arthroscopic implantation. Both seeding methods did not affect cell viability. Following rapid digestion, 0.0125% Liberase resulted in the highest cell isolation efficiency.

CONCLUSIONS: This study demonstrates that living human meniscus cells can be isolated efficiently, combined with MSCs in 20: 80 ratio, and uniformly delivered into a currently-available meniscus scaffold. This scaffold can then be arthroscopically implanted, creating a one-stage solution for partial meniscal deficiency.