Meniscal scaffolds: results and indications. A systematic literature review

Purpose: The aim of this systematic review was to document the available clinical evidence to support meniscal scaffold implantation, analysing results and indications for the treatment of meniscal loss. Methods: The systematic review of the literature was performed searching three medical electronic databases: PubMed, Scopus, and the Cochrane Collaboration. The guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) were used. Relevant data were then extracted and collected in a unique database with consensus of two observers. To assess the methodological quality of the collected data, the subscales of a modified Coleman methodology score (CMS) were determined. Results: A total of 23 studies on two scaffolds (CMI®, Ivy Sports Medicine GmbH, Germany; Actifit, Orteq, United Kingdom) met the inclusion criteria and were used for the final analysis, of which more than half have been published in the last three years. Good clinical results have been documented in 613 patients, mainly young men affected by symptomatic chronic lesions, with a cumulative failure rate of 6.1 % and presence of newly formed tissue documented both at histological and MRI evaluation in most cases. However, there is a lack of comparative trials and the average study quality is low. Conclusion: An increase in publications regarding this topic has been seen recently, due to the introduction in the clinical practice of the second synthetic scaffold. Safety and positive results have been shown for both scaffolds. Although, literature lacks randomized trials at long-term follow-up to confirm real potential and most appropriate indications of meniscal scaffold implantation.