Use of porous polyurethanes for meniscal reconstruction and meniscal prostheses.

In the past, porous materials made of an aromatic polyurethane (PU) were successfully used to meniscal reconstruction in dogs. Since aromatic PUs yield very toxic fragments upon degradation, a linear PU was synthesized by curing a poly(epsilon-caprolactone) and 1,4-trans-cyclohexane diisocyanate based prepolymer with cyclohexanedimethanol. Porous materials of this polymer were also implanted for meniscal reconstruction. The results were comparable with the most successful implant series so far. Additionally, a porous meniscal prosthesis was developed to replace a total meniscus. Due to the very high shear stresses to which the prosthesis would be exposed, the stress hysteresis phenomenon linear PUs are known to exhibit could be of great consequence. Therefore an aliphatic PU network, synthesized by cross-linking poly(epsilon-caprolactone) and 1,4-trans-cyclohexane diisocyanate with glycerol, was used. Dislocation caused by tearing out of the sutures was found to be a problem because the tear resistance of the material was relatively low. In this study the tearing problem has been partly circumvented by using a complex suturing technique. Meniscal prostheses turned out to induce fibrocartilage upon implantation, and degeneration of articular cartilage was less severe than after meniscectomy.

[1]  A. Pennings,et al.  Experimental meniscal lesions reconstructed with a carbon fiber-polyurethane-poly(L-lactide) graft. , 1986, Clinical orthopaedics and related research.

[2]  D. Lyman.  Polyurethanes. I. The solution polymerization of diisocyanates with ethylene glycol , 1960 .

[3]  R. Bos,et al.  Degradation of and tissue reaction to biodegradable poly(L-lactide) for use as internal fixation of fractures: a study in rats. , 1991, Biomaterials.

[4]  J. W. Dieter,et al.  Aliphatic polyurethane elastomers with high performance properties , 1987 .

[5]  K. Dehaven.  Decision-making factors in the treatment of meniscus lesions. , 1990, Clinical orthopaedics and related research.

[6]  A. Pennings,et al.  Porous polymer implant for repair of meniscal lesions: a preliminary study in dogs. , 1991, Biomaterials.

[7]  R. Veth,et al.  Meniscal repair by fibrocartilage? An experimental study in the dog , 1992, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  Alan N. Gent,et al.  Threshold fracture energies for elastomers , 1975 .

[9]  J. J. Niebauer,et al.  The Healing of Semilunar Cartilages , 1936 .

[10]  A. Gent,et al.  Tear Strength of Elastomers under Threshold Conditions , 1983 .

[11]  M Szycher,et al.  Biostability of Polyurethane Elastomers: A Critical Review , 1988, Journal of biomaterials applications.

[12]  M. Asano,et al.  Synthesis of low-molecular-weight copoly(l-lactic acid/ɛ-caprolactone) by direct copolycondensation in the absence of catalysts, and enzymatic degradation of the polymers , 1990 .

[13]  T. Taylor,et al.  Effect of postoperative immobilisation on the regrowth of the knee joint semilunar cartilage: An experimental study , 1983, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  D. Bluemke,et al.  Annealing-induced morphological changes in segmented elastomers , 1981 .

[15]  J. H. de Groot,et al.  Use of porous biodegradable polymer implants in meniscus reconstruction. 2) Biological evaluation of porous biodegradable polymer implants in menisci , 1990 .

[16]  A. Bhowmick.  Tear strength of elastomers over a range of rates, temperatures and crosslinking: tearing energy spectra , 1986 .

[17]  J. Aubert,et al.  Low-density, microcellular polystyrene foams , 1985 .

[18]  G. D. den Heeten,et al.  An experimental study of reconstructive procedures in lesions of the meniscus. Use of synovial flaps and carbon fiber implants for artificially made lesions in the meniscus of the rabbit. , 1983, Clinical orthopaedics and related research.

[19]  T. Fairbank.  Knee joint changes after meniscectomy. , 1948, The Journal of bone and joint surgery. British volume.

[20]  N. Schneider,et al.  Infrared Studies of Hydrogen Bonding in Toluene Diisocyanate Based Polyurethanes , 1975 .

[21]  J. Pascault,et al.  Phase segregation kinetics in segmented linear polyurethanes: Relations between equilibrium time and chain mobility and between equilibrium degree of segregation and interaction parameter , 1984 .

[22]  D. Grijpma,et al.  (CO)POLYMERS OF L-LACTIDE .1. SYNTHESIS, THERMAL-PROPERTIES AND HYDROLYTIC DEGRADATION , 1994 .

[23]  S. Cooper,et al.  Structure‐property relationships in polycaprolactone‐polyurethanes , 1983 .

[24]  F. N. Ghadially,et al.  Experimental methods of repairing injured menisci. , 1986, The Journal of bone and joint surgery. British volume.

[25]  W. Knauss,et al.  The Fracture Energy and Some Mechanical Properties of a Polyurethane Elastomer , 1971 .

[26]  R. Warren,et al.  Meniscal replacement using a cryopreserved allograft. An experimental study in the dog. , 1990, Clinical orthopaedics and related research.

[27]  A. Pennings,et al.  Use of porous biodegradable polymer implants in meniscus reconstruction. 1) Preparation of porous biodegradable polyurethanes for the reconstruction of meniscus lesions , 1990 .

[28]  V C Mow,et al.  Material properties of the normal medial bovine meniscus , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[29]  J. Steadman,et al.  Future directions. Collagen-based prostheses for meniscal regeneration. , 1990, Clinical orthopaedics and related research.

[30]  R. Bonart.  X-ray investigations concerning the physical structure of cross-linking in segmented urethane elastomers , 1968 .

[31]  P Ghosh,et al.  The knee joint meniscus , 1987 .

[32]  N. Schneider,et al.  Temperature Dependence of Hydrogen Bonding in Toluene Diisocyanate Based Polyurethanes , 1977 .

[33]  J. Klompmaker.  Porous polymers for repair and replacement of the knee joint meniscus and articular cartilage , 1992 .

[34]  S. Cooper,et al.  Morphology and properties of short segment block copolymers , 1980 .

[35]  A. Thomas,et al.  Rupture of Rubber. III. Determination of Tear Properties , 1955 .