Menisküs Cerrahisinin Geleceği; Menisküs Doku Mühendisliği

Year 2017, Volume: 14 Issue: 2, 128 - 140, 31.08.2017

Mehmet Akif Altay , Baki Volkan Çetin

Abstract

Son yıllarda yapılan bilimsel çalışmalarla diz eklemi için
menisküslerin anatomik, biyomekanik ve fonksiyonel
önemi ortaya konmuştur. Menisküs, eklemin hayati bir
parçası olarak eklem kıkırdağının bozulmasını ve osteoartit
gelişimini engellemektedir. Günümüz onarım teknikleri
menisküsün periferal vaskülarize bölgesindeki sınırlı
lezyonlarda etkili olmaktadır. Fonksiyonu, eklem
fonksiyonuyla direk ilişkili merkezi avasküler bölge
lezyonunun tedavisi ise ciddi bir sorun olarak
bulunmaktadır.
Tüm yaş grupları özellikle çocuklar artan şekilde daha
zorlu, yarışmalı ve hatta profesyonel sporlarla
uğraşmaktadır. Bunun sonucu olarak menisküs cerrahisi
daha genç yaşlarda uygulanmakta ve uzun yaşam süreci
içerisinde daha az sağlam menisküs dokusu
korunabilmektedir. Genç ve aktif hastalarda parsiyel
mediyal menisektomi sadece mekanik aksı hafifçe varusa
kaydırsa da diz dengesinin bozulmasında başlangıç noktası
olacaktır. Bozulan diz dengesi ve artan yüklenmenin
ardından kaçınılmaz bir şekilde osteoartit gelişimine neden
olmaktadır. Bu yüzden genç ve orta yaş hastalar için yeni
rejeneratif stratejilere ihtiyaç olduğu açıktır.
Bugüne kadar belli ölçüde menisküs lezyonlarının
restorasyonuyla anatomik ve fonksiyonel bütünlüğünün
sağlanması için invitro menisküs yapısı elde etmeye
yönelik farklı yaklaşım ve stratejiler denenmiştir.
Uygun hücre kaynaklarının seleksiyonu (otolog, allogenik,
ksenogenik ve kök hücreler) menisküs onarım
mühendisliğinde anahtar noktalardan biridir. Ayrıca çeşitli
skafoldlar geliştirilmiştir. Bunlar deneysel ve klinik
çalışmalarla üretilmekte ancak bazı problemlerde
beraberinde gelişmektedir (stresi perdeleme, degradasyon
sonucu meydana gelen yan ürünler vb). Bu problemler yeni
stratejilerin geliştirilme ihtiyacını doğurmuştur. Skafoldsuz
yaklaşımlar, kendi kendine toplanarak (self – assembly)
çoğalma, birçok kimyasal/biyokimyasal ve mekanik
uyaranın, ayrıca gen terapisinin de fonksiyonel yeni doku
formasyonu oluşumundaki yeri araştırılmıştır.
Bu yazı yeni menisküs rejenerasyon stratejilerine olan
ihtiyacı ortaya koyacak şekilde günümüzdeki son duruma
bir bakış sağlarken geleceğe yönelik yapılması gerekli
çalışmalar hakkında klinisyene fikir vermektedir.
Anahtar Kelimeler: 

Keywords

Menisküs, Cerrahi, Doku

Future of Meniscus Surgery; Meniscus Tissue Engineering

Abstract

In recent years scientific researches have established the
anatomical, biomechanical, and functional importance that
the meniscus holds within the knee joint. As a vital part of
the joint, meniscus acts to prevent the degeneration of
articular cartilage, and the development of osteoarthritis.
Current repair techniques are only effective in treating
lesions located in the peripheral vascularized region of the
meniscus. Healing lesions found in the iner avascular
region, which functions direct related to joint function, is
considered to be a significant challenge.
All age groups and in particular children increasingly
participate in more extreme, competitive or even
professional sports. The consequence of this fact is that
meniscal surgery is performed at a younger age, and less
meniscus tissue is preserved for a lifetime period. In young,
active patients a partial medial meniscectomy will be the
starting point for a disturbed homeostasis of the knee, even
if the mechanical axis is only slightly varus aligned. This
altered knee homeostasis and increased loading the
inevitably leads to the development of osteoarthritis.
Therefore there is a clear need for regenerative strategies in
these young and middle aged patients. So far, different
approaches and strategies have contributed to the in vitro
generation of meniscus constructs, which are capable of
restoring meniscal lesions to some extent, both functionally
as well as anatomically. The selection of the appropriate
cell source (autologous, allogeneic, or xenogeneic cells, or
stemcells) is regarded as one of key points for meniscal
tissue engineering. Furthermore, a large variation of
scaffolds for tissue engineering have been proposed and
produced in experimental and clinical studies although a
few problems with these (byproducts of degradation,
stressshielding). Problems have shifted research interest
toward new strategies (scaffoldless approaches, selfassembly).
A large number of different
chemical/biochemical and mechanical stimuli and also
gene therapy have been investigated, in terms of
encouraging functional tissue formation. In this review, we
will give an overview on the need of research for meniscus
regeneration, and provide a perspective, from the
clinician’s standpoint, for designing future regenerative
strategies.
Key words:

Keywords

Meniscus, Surgery

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