John Autrey Feagin Jr.
Associate Professor Emeritus of Surgery
Damage to the menisci of the knee is the most common serious injury of the knee joint in military, athletic, and occupational settings. Because of the critical role the menisci play in the stabilization and load-transmission characteristics of the knee joint, damage to the menisci often results in progressive damage and degeneration of the other joint tissues. Therefore, an urgent need exists for improved methods of surgical repair. In response to this need, we have designed a research plan to investigate the capacity of surgical grafting procedures to functionally restore the damaged meniscus. Our primary hypothesis is that autogenous tissue grafts have the capability to regenerate mechanical properties similar to those of normal meniscus and to prevent the joint degeneration commonly associated with meniscal damage. To address this general hypothesis, we will pursue the following three sub-hypotheses and three specific aims:
Hypothesis 1: Following either partial or total meniscectomy of the medial meniscus, the articular cartilage and lateral meniscus suffer degenerative changes in the mechanical properties which are characteristic of changes observed with osteoarthritis. We believe that with even partial loss of meniscal integrity, the normal stabilizing and protective function of the meniscus is disrupted. With continued use of the joint, we believe that these alterations will result in a decrease in both the tensile and compressive moduli of the articular cartilage and the lateral meniscus, as well as an increase in tissue permeability.
Specific Aim 1: Using previously developed techniques, we will determine the changes in the intrinsic tensile and compressive properties of the articular cartilage and lateral meniscus following an untreated partial or total meniscectomy of the medial meniscus in a canine model.
Hypothesis 2: An autogenous tissue graft surgically introduced into a partial or total defect or total meniscectomy of the medial meniscus has the capacity to regenerate mechanical properties and ultrastructure similar to those of natural meniscal tissue. In order for a repair procedure to adequately restore the functional capabilities of the meniscus, we believe that the intrinsic elastic and viscoelastic mechanical properties of the repair tissue must be similar to those of the natural meniscus. Based on our preliminary histologic and ultrastructural studies, we believe that iliotibial band grafts have this capability.
Specific Aim 2: Biomechanical tests and histologic analysis will be used to determine the intrinsic mechanical properties and ultrastructure of the autogenous iliotibial band grafts six months following repair.
Hypothesis 3: The repair of a partial or total meniscal defect with an autogenous graft prevents degenerative changes in the mechanical properties of the soft tissue of the joint (articular cartilage, lateral meniscus). A critical test of the efficacy of autogenous grafts in meniscal repair is to determine how well the repair procedures prevent the joint degeneration which arises from an untreated defect.
Specific Aim 3: Biomechanical testing and histologic analysis will be used to determine the changes in the mechanical properties and ultrastructure of articular cartilage and lateral meniscus following segmental replacement of a partial mensicectomy or replacement of a total meniscectomy using autogenous tissue grafts.
We believe that meniscal replacement with autogenous tissue of a segmental meniscal defect will protect the articular cartilage and preserve the health and normal function of the knee joint. The ability to repair meniscal defects with autogenous tissue grafts will make a major and lasting contribution to treating a common but disabling knee problem in both the VA and military populations. These studies will prove valuable in the development of reliable and reproducible surgical techniques for meniscal repair and transplantation.
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