Repair Of Meniscus Injury With Periosteum And Fibrin Glue

Object: To research effect of auto graft periosteum and fibrin glue on the healing of meniscus injury in avascular portion.Methods: Meniscus injury in avascular portion were performed on both knees of 36 New Zealand white rabbits which been divided to three groups at random. After the rabbits had been anaesthetized with intravenous Nembutal (26ml/kg), an anteromedial incision was done on the medial side of patellar ligament of both knee to open the skin along the medial superior border of patella to tibia tuberosity. The meniscus hock was used to expose the anterior horn and somatic part of medial meniscus as well as the cartilage surface of femoral condyle. Sickle-type knife were used to produce full-thickness laceration. Thirty-six adult rabbit were prepare into the injuryed model in avascular portion of meniscus (0.7×0.3)cm with full-thickness laceration. Select 12 of the 36 rabbits as A group,12 of the rabbits as B group, and 12 of the rabbits as C group. In A group periosteum and fibrin glue were infused in laceration;in B group,fibrin glue was infused in laceration; and C group no any filler was applied for management. Twelve rabbits were sacrificed in the 3rd ,6th and 12th weeks after operation. All menisci were collected in each group each time for gross morphological observation. All the meniscus samples were place in gormaldehyde solution for few days. Afterwards,with dehydration, paraffin soaking and embedding of sample, HE staining was given for optic microscopic examination.Results: Gross observation: It was observed that among 36 rabbits in three groups, there was no case of incision infection and hydrarthrosis on the surgical knee joints and no adhesion between meniscus and cartilage of articular fade. In blank control group (C group), all of meniscus wounds were not healed and no tissue filler was visible. In other two groups, all of meniscus injuries had been filled up with tissue. The healed tissue was colored deeper compared with that before operation and its surface was sunk interiorly slightly; additionally , the healed tissue adhered tightly to the adjacent meniscus tissue.Histological examination:In blank control group(C group),3 to 12 weeks after operation, no any split was observed to heal among the menisci and there were no chondrocyte proliferation presented on the border of splits.In B group, 3 weeks after operation, it was visible microscopically that meniscus defect was filled with fibrin and few fibroblastic cells were observed occasionally . 6 weeks after operation, it was apparent that the defect-covered tissue was similar to fibrous tissue and fibroblastic cells are visible in scatter around the matrix. Twelve weeks after operation , it was visible that all of the defects had been filled up with collagenous fibril-like tissue and there were many fibroblastic cells that closely adhered to the adjacent tissue .In A group, three weeks after operation, it was apparent that the entire defect area was filled with pale red tissue completely and a large amount of fibroblastic cells and collagenous fibrils were visible , chondrocytes were survived in reticular structure of fibrin. Six weeks after operation, it was apparent that the defect was filled up with collagenous fibrils and chondrocutes, the cell volume and bigger karyon. Twelve weeks after operation, the entire defect was filled up with fibrous cartilage-like tissue and cartilage cavities and capsule were apparent. But there was still difference between the repaired tissue and adjacent normal meniscus tissue,and chondrocytes were arranged in cell the collagenous arrangement in normal cartilage.Conclusion: Fibrin glue has the effect of improve the healing of injury meniscus, autograft periosteum and fibrin glue not only healing the injury meniscus but also periosteum can transform to cartilage cells.