Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long-term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee.

The human meniscus: A review of anatomy, function, injury, and advances in treatment

The oral route is a popular and convenient means of drug delivery. However, despite its advantages, it also has challenges. Many drugs are not suitable for oral delivery due to: first pass metabolism; less than ideal properties; and side-effects of treatment. Additionally, oral delivery relies heavily on patient compliance. Implantable drug delivery devices are an alternative system that can achieve effective delivery with lower drug concentrations, and as a result, minimise side-effects whilst increasing patient compliance. This article gives an overview of classification of these drug delivery devices; the mechanism of drug release; the materials used for manufacture; the various methods of manufacture; and examples of clinical applications of implantable drug delivery devices.

/pdf/implantable-polymeric-drug-delivery-devices-classification-4mn43hrymj.pdf

Implantable Polymeric Drug Delivery Devices: Classification, Manufacture, Materials, and Clinical Applications

A method of preparing a knee joint for a prosthesis in a patient includes mating a patient-specific three-dimensional curved inner surface of a femoral alignment guide onto a corresponding three-dimensional femoral joint surface of the patient. The patient-specific three-dimensional curved inner surface is preoperatively configured from medical scans of the knee joint of the patient. First and second holes are drilled into an anterior portion of the femoral joint surface through corresponding first and second guiding apertures of the femoral alignment guide.

Patient Specific Knee Alignment Guide And Associated Method

An orthopedic implant manufacturing method. The method includes preparing a pre-operative surgical plan for a specific patient, the surgical plan including a three-dimensional image of a patient's joint indicating at least one resection plane, communicating the surgical plan to a surgeon of the patient, and receiving approval of the surgical plan and the resection plane by the surgeon. The method also includes providing automated osteophyte/protrusion removal control for surgeon manipulation, receiving a modified three-dimensional image of a patient's joint indicating an osteophyte/protrusion removal and a recommendation for a corresponding selected orthopedic implant from the surgeon, and requesting manufacture of the selected orthopedic implant.

Method And Apparatus For Manufacturing An Implant

A patient-specific guiding system for guiding an instrument relative to a portion of an anatomical feature of a patient. The patient-specific guiding system includes a patient-specific guide. The guide includes a first portion having a first patient-specific inner surface that conforms to a first surface of the anatomical feature and an outer surface opposite the first patient-specific inner surface. The first portion also includes a guide surface for use in guiding the instrument relative to the anatomical feature. The guide also includes a second portion having a second patient-specific inner surface that conforms to a second surface of the anatomical feature and an outer surface opposite the second patient-specific inner surface. The second portion is removably connected to the first portion.

Patient Specific Alignment Guide With Cutting Surface and Laser Indicator

A prosthetic device for use as an artificial meniscus is disclosed. The prosthetic device restores shock absorption, stability, and function to the knee joint after removal of the damaged natural meniscus. In some embodiments, the prosthetic device includes an anti-migration feature. The anti-migration feature is a bridge for engagement with a femur notch in some instances. Generally, the anti-migration feature allows the artificial meniscus to be implanted into the patient's knee and maintain its position within the knee without penetrating the adjacent bone. The bridge is reinforced with fibers in some instances.

Meniscus prosthetic devices with anti-migration features

Devices, apparatus, and systems for replacing at least some of the functionality of the natural hip joint and associated methods of implantation are disclosed. In one aspect a prosthetic acetabular cup system is provided. The system includes a metal shell comprising an outer surface for securely engaging a prepared portion of an acetabulum and an opposing inner surface. In some instances, portions of the inner and outer surfaces define an anchoring section that is deformable between an insertion configuration—where the anchoring section projects inwardly from the inner surface—and an anchoring configuration—where the anchoring section projects outwardly from the outer surface to define an anchoring protrusion for engaging the prepared portion of the acetabulum. In some embodiments, the system also includes a pliable articulating component having an outer surface including at least one engagement feature sized and shaped to engage with the metal shell. The pliable articulating component includes an inner surface for articulatingly receiving a femoral head.

Acetabular Prosthetic Devices and Associated Methods

Meniscus prosthetic devices (100,370) are disclosed. The meniscus prosthetic devices are configured to replace the functions of a healthy natural meniscus. Methods of manufacturing (460), selecting (202), and implanting (340/350) prosthetic devices for use as a replacement meniscus are also disclosed. The methods of manufacturing the prosthetic devices include injection molding polymers with reinforcing fibers in some instances. The selection methods include a pre- implantation selection method and a during-implantation selection method in some instances. The methods of implanting meniscus prosthetic devices are utilized for replacing a damaged meniscus in some instances. Collectively, the meniscus prosthetic devices and associated methods are utilized for treating patients with damaged menisci.

Meniscus prosthetic devices and associated methods

The medial meniscus plays an important role in the knee joint [1]. Meniscus dysfunction due to tear is a common knee injury which leads to degenerative arthritis, attributed primarily to the changes in knee load distribution [2]. Clearly, there is a substantial need to protect the articular cartilage by either repairing or replacing the menisci. A “floating” Polycarbonate-Urethane (PCU) meniscal implant (Fig. 1a) is proposed as a solution for restoring the function of the missing meniscus and for the reduction of pain, through improved tibial and femoral pressure distribution. The implant is composed of PCU embedded with polyethylene reinforcement fibers (“Dyneema®”, DSM), and its design is based on the geometry of the articulating surfaces of the femur and tibia. Our goal was to develop an optimal meniscal implant design (in terms of composition and geometry), whose contact pressure with the tibial plateau (TP) would be similar to that of the natural meniscus and be able resist mechanical failure of any of its components. We hereby present one aspect of the implant bench-tests, finite element (FE) analyses of the implant in the medial knee under physiological relevant loading conditions.Copyright © 2009 by ASME

Design of a Polycarbonate-Urethane Meniscal Implant: Finite Element Approach

Meniscus replacement still represents an unsolved problem in orthopedics. Allograft meniscus implantation has been suggested to restore contact pressures following meniscectomy. However, graft availability, infection, and size matching still limit its use. A synthetic meniscal substitute could have significant advantages for meniscal replacement, as it could be available at the time of surgery in a substantial number of sizes and shapes to accommodate most patients. In the current study we present an optimization method for meniscal implant design and employ in the development of artificial polycarbonate-urethane (PCU) meniscus implant in an ovine model. The construction of the gross implant structure was based on 3D interpolation of MRI scans of the native sheep meniscus in-situ. PCU-based samples based on this design were produced for testing. 35 ovine knee joints were tested. An experimental evaluation of the implants’ biomechanical performances was conducted by measuring pressure distributions on the tibial plateau (TP) during loading. Subsequently, a pressure score of 0 to 100% was calculated. The score reflects on the magnitude of peak pressure and contact area coverage with respect to the natural meniscus. Implant design was reevaluated following changes to the initial implant configuration, e.g., modification of implant geometry, adding reinforcement material, and the applying of different fixation forces during implantation. The effect of these changes on pressure distribution was assessed by additional compression tests. The initial all-PCU implant showed limited ability to distribute pressure, The pressure score of 37% calculated for this case reflects on the small contact area (151mm2) subject to relatively high contact pressures (>1.85MPa). The implant’s ability to distribute pressure improved significantly when circumferential reinforcement fibers were added. Applying a pretension force of 20N during fixation, improved pressure distribution and increased the contact area (273mm2). A small region of focal pressure concentration still existed in this case, but the pressure score increased markedly to 77%. Finally, it was found that optimal pressure distribution (87%) can be attained when a force of 30 to 50N is applied. In this configuration, peak pressures and coverage area (1.65MPa and 310mm2) were similar to those of the natural meniscus (1.61MPa and 373 mm2, respectively). We conclude that peripheral reinforcement of the implant (similar to the natural meniscus microstructure), in addition to pretension of 30 to 50N can significantly improve TP pressure distributions. The results are in agreement with other studies, reported on pressure distribution improvement due to reinforcement and/or pretension. We believe that the current device can be used in future as a practical solution for patients suffering from severe meniscal injury.

Design optimization of a polycarbonate-urethane meniscal implant in the sheep knee

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