Amniotic umbilical cord tissue may be effective adjunct for meniscectomy
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Key takeaways:
- Amniotic umbilical cord tissue was linked with improved patient-reported outcomes as an adjunctive therapy for meniscectomy.
- Use of this tissue was associated with fewer reoperations vs. platelet-rich plasma.
Amniotic umbilical cord tissue may be an effective adjunctive therapy in patients undergoing meniscectomy, according to published results.
“In our study population, arthroscopic meniscectomy with adjunctive use of [amniotic umbilical cord] AMUC tissue improved patient-reported outcomes and reduced the reoperation rate compared to conventional surgery or adjunctive use of [platelet-rich plasma] PRP,” Nneoma Duru, MD, general surgery resident at Baylor College of Medicine, and colleagues wrote in the study.
Duru and colleagues retrospectively analyzed data from 113 patients who underwent arthroscopic meniscectomy between November 2010 and March 2017. Researchers stratified patients into groups based on whether they underwent arthroscopic meniscectomy with adjunctive PRP (n = 40), with AMUC tissue (n = 24) or without biologics (n = 49).
Outcomes measured included VAS pain scores, IKDC Subjective Knee Evaluation Form, Lysholm Knee Scoring Scale, SF-12 survey and KOOS scores.
At 6 months postoperatively, Duru and colleagues found patients in the AMUC tissue group reported significantly decreased pain severity, as well as improvements in IKDC and KOOS subscales of pain, symptoms, activities of daily living and sport and recreation function. According to the study, patients in the PRP group reported improvements for KOOS pain, symptoms, sport and recreation function and knee-related quality of life subscales at 3 months postoperatively.
In addition, Duru and colleagues found patients in the PRP and control groups were more likely to have complications and undergo follow-up procedures vs. the AMUC tissue group. Follow-up procedures occurred in 40.8% of the control group, 30% in the PRP group and 8.3% in the AMUC cohort.
“Future prospective, controlled studies with longer-term follow-up are required to confirm the use of biologics in meniscal surgery,” Duru and colleagues concluded.
Perspective
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This study reports a positive effect of “amniotic umbilical cord tissue” as an adjunct to arthroscopic meniscectomy, based on patient-reported outcomes. Patients treated with this material had superior outcomes compared to patients receiving concomitant platelet-rich plasma or no adjunctive treatment. Prior studies demonstrate that perinatal formulations (umbilical cord blood, amniotic fluid, amniotic membrane, placenta-derived tissues) contain anti-inflammatory and immune modulating factors, likely improving symptoms. However, these formulations contain no true "stem cells" and studies reveal few viable cells. This suggests these treatments are "symptom-modifying" but not "structure-modifying" (ie, these do not lead to true tissue regeneration). The high rate of "follow-up procedures" (eg, 41% in the control group) suggests concomitant arthrosis.
The challenge in orthobiologics is heterogeneity of these formulations. It is unclear if the study material was from amniotic membrane, amniotic fluid or umbilical cord tissue. Advances in biologic therapies require characterization of the composition and activity of these materials and correlation with clinical outcomes. Established markers of purity, potency and biologic activity are needed to allow advances in the area of orthobiologics.
These peri-natal tissues can only be used under an investigational new drug application in FDA-approved trials. Patients should understand the risks vs. benefits, and provide informed consent, as these treatments require further study.
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