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Table 2 Regenerative treatment options for meniscal lesions

From: Role of mesenchymal stem cells in meniscal repair

Treatment Pro/Cons
Augmentation of meniscal suture and meniscus reconstruction by intraarticular microfracturing + Easy to perform
+ Adhesion of stem cells at lesion site
- Uncertain effect
- Low concentration of stem cells at defect site
Augmentation of meniscal suture or meniscus cell-free reconstruction (e.g. Actifit) by locally applied growth factors (e.g. PRP) + Application directly at meniscal lesion site
+ High concentration at lesion site
+ Support of intrinsic healing potential
+ One-step-procedure
- Preparation time
- Short term effect at lesion site
- Uncertain local effect
Augmentation of meniscal suture by locally applied MSCs (e.g. bone marrow derived) + High potential differentiation
+ Application directly at meniscal lesion site
+ Support of meniscus regeneration
+ Use of autologous cells
+ Potentially one-step-procedure
- Preparation time
- Regulatory burden
- Missing knowledge of repair mechanisms
Intraarticular injection of MSCs/growth factors + Adhesion at lesion site
+ Easy to perform
- Uncertain effect
- Low concentration of stem cells at lesion site
- Harvesting and preparation prior to application
- Side effects in the knee joint beside the defect site
Intravascular injection of MSCs + Adhesion at lesion site
- Uncertain effect
- Low concentration of stem cells at lesion site
- Harvesting and preparation prior to application
- Side effects in other areas besides the defect
- No clinical experience
Implantation of MSC loaded carrier/scaffold at meniscal defect site + Potential for treatment of meniscal critical size defects
+ Application directly at meniscal defect site
+ Option for pre-differentiation of MSC/carrier construct
+ Use of autologous cells
- High costs
- Missing knowledge of repair mechanisms
- Necessity of cell expansion prior to implantation/two-step-procedure
- No clinical experience