251
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Huang YC, Chen CY, Lin KC, Renn JH, Tarng YW, Hsu CJ, Chang WN, Yang SW. Comparing morbidities of bone graft harvesting from the anterior iliac crest and proximal tibia: a retrospective study. J Orthop Surg Res 2018; 13:115. [PMID: 29769090 PMCID: PMC5956943 DOI: 10.1186/s13018-018-0820-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/26/2018] [Indexed: 01/17/2023] Open
Abstract
Background The anterior iliac crest (AIC) and proximal tibia (PT) are common donor sites for autologous bone graft harvesting. We compared pain levels at these harvest sites on 1 day, 5 days, 2 weeks, 4 weeks, and 8 weeks post-harvest. Methods We retrospectively reviewed 18 patients undergoing autologous bone grafting surgery at a level I trauma center between June 2013 and October 2014. Ten grafts were harvested from the AIC group and eight from the PT group. A standard visual analog scale (VAS) was used to rate pain at the harvest sites on postoperative day (POD) 1, 5, 14, 28, and 56 and at the recipient site on POD 1. Results There were no statistically significant differences between both groups in age (p = 0.474), gender (p = 1.00), incidence of harvest site morbidity (p = 1.00), and average VAS at the recipient site on POD 1 (p = 0.471). VAS at the harvest site on POD 1, 5, and 14 confirmed statistically that pain was more severe in the AIC group than in the PT group (p < 0.001). However, no significant difference was observed on POD 28 and 56 between both groups. Pain was significantly less on POD 1 in the PT group at the harvest site than at the recipient site (p < 0.001). Conclusions The PT is a suitable harvest site, producing statistically less pain for at least two postoperative weeks than the AIC. Besides, patients report less postoperative pain at the PT harvest site than at the recipient site.
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Affiliation(s)
- Ying-Cheng Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Jenn-Huei Renn
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Yih-Wen Tarng
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Chien-Jen Hsu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Wei-Ning Chang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Shan-Wei Yang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China.
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252
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Abstract
Recurrent anterior shoulder instability is associated with glenohumeral bone loss. Glenoid deficiency compromises the concavity-compression mechanism. Medial Hill-Sachs lesions can result in an off-track humeral position. Anterior glenoid reconstruction or augmentation prevents recurrence by addressing the pathomechanics. In Bristow and Latarjet procedures, the coracoid process is harvested for conjoint tendon transfer, capsular reinforcement, and glenoid rim restoration. Complications and the nonanatomic nature of the procedure have spurred research on graft sources. The iliac crest is preferred for autogenous structural grafts. Tricortical, bicortical, and J-bone grafts have shown promising results despite the historical association of Eden-Hybinette procedures with early degenerative joint disease. Allogeneic osteochondral grafts may minimize the risk of arthropathy and donor site morbidity. Tibial plafond and glenoid allografts more closely match the native glenoid geometry and restore the articular chondral environment, compared with conventional grafts. Graft availability, cost, risk of disease transmission, and low chondrocyte viability have slowed the acceptance of osteochondral allografts.
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253
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Chen Y, Kent D, Bermingham M, Dehghan-Manshadi A, Wang G, Wen C, Dargusch M. Manufacturing of graded titanium scaffolds using a novel space holder technique. Bioact Mater 2018; 2:248-252. [PMID: 29744433 PMCID: PMC5935515 DOI: 10.1016/j.bioactmat.2017.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 12/29/2022] Open
Abstract
To optimize both the mechanical and biological properties of titanium for biomedical implants, a highly flexible powder metallurgy approach is proposed to generate porous scaffolds with graded porosities and pore sizes. Sugar pellets acting as space holders were compacted with titanium powder and then removed by dissolution in water before sintering. The morphology, pore structure, porosity and pore interconnectivity were observed by optical microscopy and SEM. The results show that the porous titanium has porosity levels and pore size gradients consistent with their design with gradual and smooth transitions at the interfaces between regions of differing porosities and/or pore sizes. Meanwhile, the porous titanium has high interconnectivity between pores and highly spherical pore shapes. In this article we show that this powder metallurgy processing technique, employing the novel sugar pellets as space-holders, can generate porous titanium foams with well-controlled graded porosities and pore sizes. This method has excellent potential for producing porous titanium structures for hard tissue engineering applications. A new fabrication strategy for production of graded porous titanium scaffolds for skeletal implant applications is proposed. The synthetic titanium scaffolds were fabricated using a novel space holder technique. The scaffolds are produced with highly spherical pore shapes from space holder. The pores manufactured are with well-controlled sizes and high interconnectivity.
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Affiliation(s)
- Yunhui Chen
- Queensland Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, St. Lucia, 4072, Australia
| | - Damon Kent
- Queensland Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, St. Lucia, 4072, Australia.,School of Science and Engineering, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia.,ARC Research Hub for Advanced Manufacturing of Medical Devices, Australia
| | - Michael Bermingham
- Queensland Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, St. Lucia, 4072, Australia.,ARC Research Hub for Advanced Manufacturing of Medical Devices, Australia
| | - Ali Dehghan-Manshadi
- Queensland Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, St. Lucia, 4072, Australia
| | - Gui Wang
- Queensland Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, St. Lucia, 4072, Australia
| | - Cuie Wen
- School of Engineering, RMIT University, Melbourne, 3001, Australia
| | - Matthew Dargusch
- Queensland Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, St. Lucia, 4072, Australia.,ARC Research Hub for Advanced Manufacturing of Medical Devices, Australia
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254
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Three-Dimensional Architecture and Mechanical Properties of Bovine Bone Mixed with Autologous Platelet Liquid, Blood, or Physiological Water: An In Vitro Study. Int J Mol Sci 2018; 19:ijms19041230. [PMID: 29670035 PMCID: PMC5979420 DOI: 10.3390/ijms19041230] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 01/04/2023] Open
Abstract
In recent years, several techniques and material options have been investigated and developed for bone defect repair and regeneration. The progress in studies of composite graft materials and autologous platelet-derived growth factors for bone regeneration in dentistry and their biological and biomechanical properties has improved clinical strategies and results. The aim of this study was to evaluate the three-dimensional architecture and mechanical properties of three different combinations of composite bovine graft, adding autologous platelet liquid (APL), blood, or physiological water. One experimental group for each combination of biomaterials was created. In particular, in Group I, the bovine graft was mixed with APL; in Group II, it was mixed with blood, and in Group III, the biomaterial graft was combined with physiological water. Then, the composite biomaterials were evaluated by scanning electron microscopy (SEM), and a compression-loading test was conducted. The evaluation showed a statistical significance (p < 0.01) of the elastic regime of deformation resistance, in which the combination of APL with bone graft resulted in an 875% increase in the mechanical resistance. The protocol of APL mixed with bovine bone graft produced a composite sticky graft block that was capable of increasing the mechanical properties in order to improve its clinical use in the treatment of the maxillary bone defects.
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255
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Effect of Concentrated Growth Factor (CGF) on the Promotion of Osteogenesis in Bone Marrow Stromal Cells (BMSC) in vivo. Sci Rep 2018; 8:5876. [PMID: 29651154 PMCID: PMC5897572 DOI: 10.1038/s41598-018-24364-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 03/27/2018] [Indexed: 12/17/2022] Open
Abstract
The therapeutic method traditionally used in bone defect reconstruction is autologous bone grafting. The most common problems affecting this type of repair approach are bone absorption and donor trauma. The approach taken in this study overcomes these problems. Bone marrow stromal cells (BMSCs) provided the crucial seed cells. Fibrin biological scaffolds were formed by combining the BMSCs with concentrated growth factor (CGF). BMSCs were isolated from Wistar rat femurs; CGF was prepared from rat heart blood. Five repair groups were created for comparative purposes: (A) CGF + BMSCs; (B) CGF; (C) collagen + BMSCs; (D) collagen; (E) blank. After three months, the rats were sacrificed, and histopathology and three-dimensional CT images produced. Bone regeneration was significantly higher in the (A) CGF + BMSC group; osteogenesis was lower in the (B) CGF and (C) collagen + BMSC groups, at very similar levels; the (D) collagen and (E) blank groups scored the lowest results. Our research suggests that combining CGF with BMSCs leads to the formation of fibrin scaffolds that have a powerful effect on osteogenesis as well as a subsidiary angiogenic effect. SEM images of the CGF scaffolds cultured with BMSCs confirmed good CGF biocompatibility. The superior osteoinductive activity of the CGF + BMSC combination makes it an excellent biomaterial for bone regeneration.
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256
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Kawecki F, Clafshenkel WP, Fortin M, Auger FA, Fradette J. Biomimetic Tissue-Engineered Bone Substitutes for Maxillofacial and Craniofacial Repair: The Potential of Cell Sheet Technologies. Adv Healthc Mater 2018; 7:e1700919. [PMID: 29280323 DOI: 10.1002/adhm.201700919] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/02/2017] [Indexed: 12/21/2022]
Abstract
Maxillofacial defects are complex lesions stemming from various etiologies: accidental, congenital, pathological, or surgical. A bone graft may be required when the normal regenerative capacity of the bone is exceeded or insufficient. Surgeons have many options available for bone grafting including the "gold standard" autologous bone graft. However, this approach is not without drawbacks such as the morbidity associated with harvesting bone from a donor site, pain, infection, or a poor quantity and quality of bone in some patient populations. This review discusses the various bone graft substitutes used for maxillofacial and craniofacial repair: allografts, xenografts, synthetic biomaterials, and tissue-engineered substitutes. A brief overview of bone tissue engineering evolution including the use of mesenchymal stem cells is exposed, highlighting the first clinical applications of adipose-derived stem/stromal cells in craniofacial reconstruction. The importance of prevascularization strategies for bone tissue engineering is also discussed, with an emphasis on recent work describing substitutes produced using cell sheet-based technologies, including the use of thermo-responsive plates and the self-assembly approach of tissue engineering. Indeed, considering their entirely cell-based design, these natural bone-like substitutes have the potential to closely mimic the osteogenicity, osteoconductivity, osteoinduction, and osseointegration properties of autogenous bone for maxillofacial and craniofacial reconstruction.
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Affiliation(s)
- Fabien Kawecki
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX Division of Regenerative Medicine CHU de Québec Research Center‐Université Laval Québec QC G1J 1Z4 Canada
- Department of Surgery Faculty of Medicine Université Laval Québec QC G1V 0A6 Canada
| | - William P. Clafshenkel
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX Division of Regenerative Medicine CHU de Québec Research Center‐Université Laval Québec QC G1J 1Z4 Canada
- Department of Surgery Faculty of Medicine Université Laval Québec QC G1V 0A6 Canada
| | - Michel Fortin
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX Division of Regenerative Medicine CHU de Québec Research Center‐Université Laval Québec QC G1J 1Z4 Canada
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Université Laval Québec QC G1V 0A6 Canada
| | - François A. Auger
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX Division of Regenerative Medicine CHU de Québec Research Center‐Université Laval Québec QC G1J 1Z4 Canada
- Department of Surgery Faculty of Medicine Université Laval Québec QC G1V 0A6 Canada
| | - Julie Fradette
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX Division of Regenerative Medicine CHU de Québec Research Center‐Université Laval Québec QC G1J 1Z4 Canada
- Department of Surgery Faculty of Medicine Université Laval Québec QC G1V 0A6 Canada
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257
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Comparison of the bone regeneration ability between stem cells from human exfoliated deciduous teeth, human dental pulp stem cells and human bone marrow mesenchymal stem cells. Biochem Biophys Res Commun 2018; 497:876-882. [DOI: 10.1016/j.bbrc.2018.02.156] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
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258
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A pilot study: Alternative biomaterials in critical sized bone defect treatment. Injury 2018; 49:523-531. [PMID: 29153382 DOI: 10.1016/j.injury.2017.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Critical-sized bone defects are a significant challenge with limited effective reconstructive options. The Masquelet Technique (MT) offers a solution to help restore form and function. Although this technique has produced promising results; a clear mechanism has not been determined. Theories include that the induced membrane has osteogenic potential or the membrane acts as a physical barrier to prevent fibrous tissue ingrowth. We hypothesize the induced membrane acts primarily as a physical barrier and that a synthetic non-biological membrane will allow a comparable amount of bone volume in the defect site. METHODS Ten New Zealand rabbit forelimbs (n=10) were divided into three study groups. A critical sized defect of 3.5cm in the ulna was created. In the control group, a traditional MT was performed (n=4). The experimental arm varied by replacement of the PMMA with a non-porous (n=3) or porous (150um) (n=3) polytetrafluoroethylene (PTFE) membrane filled with allograft. Micro-CT analysis was done to compare bone volume to tissue volume ratios (BV/TV). Defect sections were examined histologically with alkaline phosphatase (ALP), tartrate-resistant acid phosphatase (TRAP) and von kossa (VK) staining. RESULTS MicroCT analysis comparing BV/TV between the control and experimental arms showed no difference. BV/TV of the MT was 7.77%±2.34 compared to porous 9.12%±3.66 and nonporous 9.76%±1.57 PTFE membranes (p1=0.761, p2=0.572, respectively). Histological sections from both samples stained for ALP and TRAP displayed osteoblastic and osteoclastic activity. There was a higher amount of ALP and TRAP positively stained cells near the native bone ends in comparison to the center of the defect, in both sample types. CONCLUSION AND SIGNIFICANCE Replacing the induced membrane from the MT with a synthetic PTFE membrane illustrated that the membrane acts primarily as a functional barrier. Compared to the induced membrane, the PTFE membrane was able to display similar osteointegrative properties. These results allow for future optimization of the technique with the potential to further streamline towards a single stage procedure.
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259
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A Novel Method to Calculate the Volume of Alveolar Cleft Defect Before Surgery. J Craniofac Surg 2018; 29:342-346. [DOI: 10.1097/scs.0000000000004181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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260
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Cui Y, Zhu T, Li A, Liu B, Cui Z, Qiao Y, Tian Y, Qiu D. Porous Particle-Reinforced Bioactive Gelatin Scaffold for Large Segmental Bone Defect Repairing. ACS APPLIED MATERIALS & INTERFACES 2018; 10:6956-6964. [PMID: 29411600 DOI: 10.1021/acsami.7b19010] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Large segmental bone defect repairing remains a big challenge in clinics, and synthetic bone grafts suitable for this purpose are still highly demanded. In this article, hydrophilic composite scaffolds (bioactive hollow particle (BHP)-gel scaffold) composed of bioactive hollow nanoparticles and cross-linked gelatin have been developed. The bioactive nanoparticles have a porous structure as well as high specific surface area; thus, they interact strongly with gelatin to overcome the swelling problem that a hydrophilic polymer scaffold will usually face. With this combination, these BHP-gel scaffolds showed porous structure and mechanical properties similar to those of the cancellous bone. They also showed excellent bioactivity and cell growth promotion performance in vitro. The best of them, namely, 10BHP-gel scaffold, was evaluated in vivo on a rat femur model, where it was found that the 5 mm segmental bone defect almost healed with new bone tissue formed in 12 weeks and the scaffold itself degraded at the same time. Thus, 10BHP-gel scaffold may become a potential bone graft for large segmental bone defect healing in the future.
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Affiliation(s)
- Yang Cui
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, China
- University of Chinese Academy of Sciences , Beijing 100190, China
| | - Tengjiao Zhu
- Orthopedic Department, Peking University International Hospital , Beijing 102206, China
| | - Ailing Li
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, China
| | - Bingchuan Liu
- Orthopedic Department, Peking University Third Hospital , Beijing 100191, China
| | - Zhiyong Cui
- Orthopedic Department, Peking University Third Hospital , Beijing 100191, China
| | - Yan Qiao
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, China
| | - Yun Tian
- Orthopedic Department, Peking University Third Hospital , Beijing 100191, China
| | - Dong Qiu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190, China
- University of Chinese Academy of Sciences , Beijing 100190, China
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261
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Risk factors for post-operative complications after procedures for autologous bone augmentation from different donor sites. J Craniomaxillofac Surg 2018; 46:312-322. [DOI: 10.1016/j.jcms.2017.11.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/09/2017] [Accepted: 11/14/2017] [Indexed: 11/20/2022] Open
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262
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Chen T, Li J, Córdova LA, Liu B, Mouraret S, Sun Q, Salmon B, Helms J. A WNT protein therapeutic improves the bone-forming capacity of autografts from aged animals. Sci Rep 2018; 8:119. [PMID: 29311710 PMCID: PMC5758817 DOI: 10.1038/s41598-017-18375-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/04/2017] [Indexed: 02/05/2023] Open
Abstract
Autografts tend to be unreliable in older patients. Some of these age-related skeletal changes appear to be attributable to a decline in endogenous WNT signaling. We used a functional in vivo transplantation assay to demonstrate that the bone-forming capacity of an autograft can be traced back to a Wnt-responsive cell population associated with the mineralized bone matrix fraction of a bone graft. Micro-CT imaging, flow cytometry and quantitative analyses demonstrate that this mineralized fraction declines with age, along with a waning in endogenous Wnt signaling; together these factors contribute to the age-related deterioration in autograft efficacy. Using a lipid formulation to stabilize the hydrophobic WNT3A protein, we demonstrate that osteogenic capacity can be restored by incubating the bone graft ex vivo with WNT3A. Compared to control bone grafts, WNT-treated bone grafts give rise to three times more bone. These preclinical results establish a pivotal role for WNT signaling in the age-related decline of autologous bone grafting efficacy, and demonstrate a means to restore that efficacy via local, transient amplification of endogenous Wnt signaling.
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Affiliation(s)
- Tao Chen
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 400000, China.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Jingtao Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.,State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610007, China
| | - Luis A Córdova
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Bo Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.,Ankasa Regenerative Therapeutics, Inc. 329 Oyster Point Blvd. Suite 3306, South San Francisco, CA, 94080, USA
| | - Sylvain Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.,Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis, Diderot University, U.F.R. of Odontology, Paris, France
| | - Qiang Sun
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.,Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Benjamin Salmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.,Paris Descartes - Sorbonne Paris Cite University, Dental School, EA2496, Montrouge, France and Dental Medicine Department, Bretonneau Hospital, HUPNVS, AP-HP, Paris, France
| | - Jill Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA. .,Ankasa Regenerative Therapeutics, Inc. 329 Oyster Point Blvd. Suite 3306, South San Francisco, CA, 94080, USA.
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263
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Muzaffar AR, Warren A, Baker L. Use of the On-Q Pain Pump in Alveolar Bone Grafting: Effect on Hospit Length of Stay. Cleft Palate Craniofac J 2018; 53:e23-7. [DOI: 10.1597/14-174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Alveolar bone grafting (ABG) with iliac crest bone graft can be associated with significant pain at the donor site. The On-Q pain pump has been shown to be efficacious in treating postsurgical pain. The aim of this study was to compare the length of postoperative hospital stay in patients undergoing ABG who received the On-Q pain pump at the iliac crest donor site (On-Q+) with that of patients who did not receive the On-Q pain pump (On-Q-). Design A retrospective, cohort study, approved by institutional review board, was performed. Thirty-one consecutive patients in the On-Q- group were compared with 38 consecutive patients in the On-Q– group. The two cohorts were assessed for length of stay. Statistical analysis was performed using the Fisher exact probability test. Setting Tertiary care academic medical center. Patients Sixty-nine patients with cleft lip and/or cleft palate (CL/P) undergoing secondary ABG with iliac crest bone graft were operated on between May 1993 and January 2014. Main Outcome Measure Length of postoperative hospital stay. Result Mean length of stay in the On-Q– patients was 0.52 days versus 0.37 days for the On-Q– patients. This difference between the two cohorts was not statistically significant (P = .234). Conclusion Although there is a trend toward a shorter length of stay in our patients who received the On-Q pump, this finding was not statistically significant. Given the expense and additional burden of care associated with the device, we have become more selective in its utilization.
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264
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Pacifici A, Laino L, Gargari M, Guzzo F, Velandia Luz A, Polimeni A, Pacifici L. Decellularized Hydrogels in Bone Tissue Engineering: A Topical Review. Int J Med Sci 2018; 15:492-497. [PMID: 29559838 PMCID: PMC5859772 DOI: 10.7150/ijms.22789] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/02/2018] [Indexed: 12/23/2022] Open
Abstract
Nowadays, autograft and allograft techniques represent the main solution to improve bone repair. Unfortunately, autograft technique is expensive, invasive and subject to infections and hematoma, frequently affecting both donor sites and surgical sites. A recent advance in tissue engineering is the fabrication of cell-laden hydrogels with custom-made geometry, depending on the clinical case. The use of ECM (Extra-Cellular Matrix)-derived Hydrogels from bone tissue is the new opportunity to obtain good results in bone regeneration. Several micro-engineering techniques and approaches are available to fabricate different cell gradients and zonal structures in hydrogels design, in combination with the advancement in biomaterials selection. In this review, we analyse the stereolithografy, the Bio-patterning, the 3D bioprinting and 3D assembly, the Laser-Induced Forward Transfer Bioprinting (LIFT), the Micro-extrusion bioprinting, the promising Electrospinning technology, the Microfluidics and the Micromolding. Several mechanical properties are taken into account for bone regeneration scaffolds. However, each typology of scaffold presents some advantages and some concerns. The research on biomaterials is the most promising for bone tissue engineering: the new biomimetic materials will allow us to obtain optimal results in the next clinical application of basic research.
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Affiliation(s)
- Andrea Pacifici
- Department of Oral and Maxillofacial Sciences La Sapienza University of Rome, Italy
| | - Luigi Laino
- Multidisciplinary department of surgical and dental specialties. University of Campania Luigi Vanvitelli
| | - Marco Gargari
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Federico Guzzo
- Department of Dentistry "Fra G.B. Orsenigo", Ospedale San Pietro FBF, Rome, Italy
| | - Andrea Velandia Luz
- AgEstimation Project, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Luciano Pacifici
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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265
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Influence of Chromium-Cobalt-Molybdenum Alloy (ASTM F75) on Bone Ingrowth in an Experimental Animal Model. J Funct Biomater 2017; 9:jfb9010002. [PMID: 29278372 PMCID: PMC5872088 DOI: 10.3390/jfb9010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022] Open
Abstract
Cr-Co-Mo (ASTM F75) alloy has been used in the medical environment, but its use as a rigid barrier membrane for supporting bone augmentation therapies has not been extensively investigated. In the present study, Cr-Co-Mo membranes of different heights were placed in New Zealand white, male rabbit tibiae to assess the quality and volume of new bone formation, without the use of additional factors. Animals were euthanized at 20, 30, 40, and 60 days. Bone formation was observed in all of the cases, although the tibiae implanted with the standard membranes reached an augmentation of bone volume that agreed with the density values over the timecourse. In all cases, plasmatic exudate was found under the membrane and in contact with the new bone. Histological analysis indicated the presence of a large number of chondroblasts adjacent to the inner membrane surface in the first stages, and osteoblasts and osteocytes were observed under them. The bone formation was appositional. The Cr-Co-Mo alloy provides a scaffold with an adequate microenvironment for vertical bone volume augmentation, and the physical dimensions and disposition of the membrane itself influence the new bone formation.
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266
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Patient-specific Instrument-assisted Structural Glenoid Bone Grafting in Reverse Shoulder Arthroplasty. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2017. [DOI: 10.1097/bte.0000000000000123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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267
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Nwankwo EC, Grimes JS. Persistence of bone voids after calcaneal bone-graft harvest. SAGE Open Med Case Rep 2017; 5:2050313X17740511. [PMID: 29152301 PMCID: PMC5680936 DOI: 10.1177/2050313x17740511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 10/11/2017] [Indexed: 11/26/2022] Open
Abstract
Objectives: The complications associated with iliac crest bone-graft harvest have resulted in the development of alternative harvest sites. Lower extremity alternative sites that have been reported for foot and ankle procedures include greater trochanter, proximal tibia, distal tibia, and calcaneus. These sites have been studied in terms of complications, postoperative pain, and quality of the harvested bone. The long-term effect of the harvest on the bone of the calcaneus has not been reported. Methods: Case report on incidental CT imaging 4 years after bone graft harvest from the calcaneus. Results: This case demonstrates the failure of the calcaneal trabecular bone to regenerate after harvesting cancellous bone graft for foot fusion procedure. Conclusions: The calcaneal graft site should not be used for a repeat bone-graft harvest without advanced imaging to confirm reconstitution of the harvest bed.
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Affiliation(s)
- Eugene C Nwankwo
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jerry S Grimes
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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268
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O'Connor SM, Wobker SE, Cardona DM, Eward W, Esther RJ, Dodd LG. Iatrogenic lesions of soft tissue and bone. Semin Diagn Pathol 2017; 35:208-217. [PMID: 29110897 DOI: 10.1053/j.semdp.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S M O'Connor
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - S E Wobker
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - D M Cardona
- Department of Pathology, Duke University, Durham, NC, United States
| | - W Eward
- Division of Oncology, Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - R J Esther
- Department of Orthopaedic Surgery, University of North Carolina Chapel Hill, United States
| | - L G Dodd
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States.
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269
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Ghadakzadeh S, Hamdy R, Tabrizian M. Efficient in vitro delivery of Noggin siRNA enhances osteoblastogenesis. Heliyon 2017; 3:e00450. [PMID: 29167826 PMCID: PMC5686427 DOI: 10.1016/j.heliyon.2017.e00450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/20/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022] Open
Abstract
Several types of serious bone defects would not heal without invasive clinical intervention. One approach to such defects is to enhance the capacity of bone-formation cells. Exogenous bone morphogenetic proteins (BMP) have been utilized to positively regulate matrix mineralization and osteoblastogenesis, however, numerous adverse effects are associated with this approach. Noggin, a potent antagonist of BMPs, is an ideal candidate to target and decrease the need for supraphysiological doses of BMPs. In the current research we report a novel siRNA-mediated gene knock-down strategy to down-regulate Noggin. We utilized a lipid nanoparticle (LNP) delivery strategy in pre-osteoblastic rat cells. In vitro LNP-siRNA treatment caused inconsequential cell toxicity and transfection was achieved in over 85% of cells. Noggin siRNA treatment successfully down-regulated cellular Noggin protein levels and enhanced BMP signal activity which in turn resulted in significantly increased osteoblast differentiation and extracellular matrix mineralization evidenced by histological assessments. Gene expression analysis showed that targeting Noggin specifically in bone cells would not lead to a compensatory effect from other BMP negative regulators such as Gremlin and Chordin. The results from this study support the notion that novel therapeutics targeting Noggin have the clinically relevant potential to enhance bone formation without the need for toxic doses of exogenous BMPs. Such treatments will undeniably provide safe and economical treatments for individuals whose poor bone repair results in permanent morbidity and disability.
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Affiliation(s)
- S. Ghadakzadeh
- Experimental Surgery, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - R.C. Hamdy
- Experimental Surgery, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University, Montreal, Canada
| | - M. Tabrizian
- Department of Biomedical Engineering, McGill University, Montreal, Canada
- Faculty of Dentistry, McGill University, Montreal, Canada
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270
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Xie H, Ji Y, Tian Q, Wang X, Zhang N, Zhang Y, Xu J, Wang N, Yan J. Autogenous bone particle/titanium fiber composites for bone regeneration in a rabbit radius critical-size defect model. Connect Tissue Res 2017; 58:553-561. [PMID: 28095112 DOI: 10.1080/03008207.2017.1281259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the effects of autogenous bone particle/titanium fiber composites on repairing segmental bone defects in rabbits. MATERIALS AND METHODS A model of bilateral radial bone defect was established in 36 New Zealand white rabbits which were randomly divided into 3 groups according to filling materials used for bilaterally defect treatment: in group C, 9 animal bone defect areas were prepared into simple bilateral radius bone defect (empty sham) as the control group; 27 rabbits were used in groups ABP and ABP-Ti. In group ABP, left defects were simply implanted with autogenous bone particles; meanwhile, group ABP-Ti animals had right defects implanted with autogenous bone particle/titanium fiber composites. Animals were sacrificed at 4, 8, and 12 weeks, respectively, after operation. RESULTS Micro-CT showed that group C could not complete bone regeneration. Bone volume to tissue volume values in group ABP-Ti were better than group ABP. From histology and histomorphometry Groups ABP and ABP-Ti achieved bone repair, the bone formation of group ABP-Ti was better. The mechanical strength of group ABP-Ti was superior to that of other groups. CONCLUSIONS These results confirmed the effectiveness of autologous bone particle/titanium fiber composites for promoting bone regeneration and mechanical strength.
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Affiliation(s)
- Huanxin Xie
- a Department of Orthopaedic Surgery , the Second Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Ye Ji
- a Department of Orthopaedic Surgery , the Second Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Qi Tian
- b Department of Stomatology, Zhaochunyu Dental Clinic , Harbin , China
| | - Xintao Wang
- a Department of Orthopaedic Surgery , the Second Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Nan Zhang
- c Department of Orthopaedic Surgery, the Second Affiliated Hospital of Qiqihar Medical College , Qiqihar , China
| | - Yicai Zhang
- d Department of Orthopaedic Surgery, Harbin the First Hospital , Harbin , China
| | - Jun Xu
- a Department of Orthopaedic Surgery , the Second Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Nanxiang Wang
- a Department of Orthopaedic Surgery , the Second Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Jinglong Yan
- a Department of Orthopaedic Surgery , the Second Affiliated Hospital of Harbin Medical University , Harbin , China
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271
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Bone Marrow Mononuclear Cells Combined with Beta-Tricalcium Phosphate Granules for Alveolar Cleft Repair: A 12-Month Clinical Study. Sci Rep 2017; 7:13773. [PMID: 29062005 PMCID: PMC5653813 DOI: 10.1038/s41598-017-12602-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/04/2017] [Indexed: 11/08/2022] Open
Abstract
Alveolar cleft is the most common congenital bone defect. Autologous iliac crest bone graft (ICBG) is the most widely adopted procedure for alveolar cleft repair, but the condition is associated with door-site morbidities. For the first time, this study used bone marrow mononuclear cells (BMMNCs) combined with beta-tricalcium phosphate (β-TCP) granules to repair alveolar bone defect. The effectiveness of this technique was compared with autologous ICBG after 12 months of follow-up. The bone formation volume was quantitatively evaluated by three-dimensional computed tomography and computer aided engineering technology. BMMNCs/β-TCP granule grafting was radiographically equivalent to ICBG in alveolar cleft repair. Although considerable resorption was observed up to 6 months after surgery, no significant differences were noted in the Chelsea score and bone formation volume between groups. These finding indicate that BMMNCs/β-TCP grafting is a safe and effective approach for alveolar bone regeneration.
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272
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Three-Dimensional Cone Beam Computed Tomography Volumetric Outcomes of rhBMP-2/Demineralized Bone Matrix versus Iliac Crest Bone Graft for Alveolar Cleft Reconstruction. Plast Reconstr Surg 2017; 140:767-774. [PMID: 28953728 DOI: 10.1097/prs.0000000000003686] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies indicate that recombinant human bone morphogenetic protein-2 (rhBMP-2) in a demineralized bone matrix scaffold is a comparable alternative to iliac bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved bone stock when rhBMP-2/demineralized bone matrix (DBM) scaffold is used but lack the capacity to evaluate bone growth in three dimensions. This study uses cone beam computed tomography to provide the first clinical evaluation of volumetric and density comparisons between these two treatment modalities. METHODS A prospective study was conducted with 31 patients and 36 repairs of the alveolar cleft over a 2-year period. Twenty-one repairs used rhBMP-2/DBM scaffold and 14 repairs used iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months to evaluate bone fill; cone beam computed tomographic images were obtained at 6 to 9 months to compare volumetric and density data. RESULTS At 3 months, postoperative occlusal radiographs demonstrated that 67 percent of patients receiving rhBMP-2/DBM scaffold had complete bone fill of the alveolus, versus 56 percent of patients in the autologous group. In contrast, cone beam computed tomographic data showed 31.6 percent (95 percent CI, 24.2 to 38.5 percent) fill in the rhBMP-2 group compared with 32.5 percent (95 percent CI, 22.1 to 42.9 percent) in the autologous population. Density analysis demonstrated identical average values between the groups (1.38 g/cc). CONCLUSIONS These data demonstrate comparable bone regrowth and density values following secondary alveolar cleft repair using rhBMP-2/DBM scaffold versus autologous iliac bone graft. Cone beam computed tomography provides a more nuanced understanding of true bone regeneration within the alveolar cleft that may contribute to the information provided by occlusal radiographs alone. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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273
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Cansiz E, Sitilci TA, Uzun A, Isler SC. Reconstruction of atrophic maxilla by anterior iliac crest bone grafting via neuroaxial blockade technique: a case report. J Istanb Univ Fac Dent 2017; 51:46-51. [PMID: 28955586 PMCID: PMC5573495 DOI: 10.17096/jiufd.68600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/08/2016] [Indexed: 11/21/2022] Open
Abstract
Anterior iliac crest bone grafting is a well-established modality in the treatment of alveolar bone deficiencies. However, this procedure may also have considerable
postoperative morbidity which is mostly related to general anesthesia. Postoperative pain-related complications can be managed by neuroaxial blockade techniques which
provide adequate surgical analgesia and reduce postoperative pain. This clinical report describes the reconstruction of a severely atrophic maxilla with anterior iliac
crest bone grafting using combined spinal epidural anesthesia. Neuroaxial blockade techniques may be a useful alternative to eliminate general anesthesia related
challenges of anterior iliac crest bone grafting procedures.
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Affiliation(s)
- Erol Cansiz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Tolga A Sitilci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Aysenur Uzun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
| | - Sabri Cemil Isler
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University Turkey
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274
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Comparative Effectiveness of Bone Grafting Using Xenograft Freeze-Dried Cortical Bovine, Allograft Freeze-Dried Cortical New Zealand White Rabbit, Xenograft Hydroxyapatite Bovine, and Xenograft Demineralized Bone Matrix Bovine in Bone Defect of Femoral Diaphysis of White Rabbit: Experimental Study In Vivo. Int J Biomater 2017; 2017:7571523. [PMID: 29093738 PMCID: PMC5637838 DOI: 10.1155/2017/7571523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 11/17/2022] Open
Abstract
Autogenous bone graft is gold standard in treating bone defects, but it might have difficulty in corporation and rejection reaction. This study is to compare the effectiveness among freeze-dried xenograft, freeze-dried allograft, hydroxyapatite xenograft, and demineralized bone matrix xenograft as bone graft to fill bone defect in femoral diaphysis of white rabbit. Thirty male New Zealand white rabbits were distributed into five groups. Bone defect was filled correspondingly with xenograft freeze-dried cortical bovine, allograft freeze-dried cortical New Zealand white rabbit, xenograft hydroxyapatite bovine, and xenograft demineralized bone matrix bovine. No graft was used in control group. VEGF, osteoblast, and woven bone were higher in allograft freeze-dried cortical New Zealand white rabbit (mean 5.6625 (p < 0.05)) and xenograft demineralized bone matrix bovine (mean 5.2475 (p < 0.05)) with calcification of woven bone was already seen in week 2 in the latter group. There was a decrease of woven bone (mean 4.685 (p < 0.05)) fibrous tissue (mean 41.07 (p < 0.05)) in xenograft demineralized bone matrix bovine. The Immunoglobulin-G was elevated in control and all study groups but not significantly (p = 0.07855). Bone healing process in xenograft demineralized bone matrix bovine is more effective than in xenograft hydroxyapatite bovine, allograft freeze-dried New Zealand white rabbit, xenograft freeze-dried cortical bovine, and control.
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275
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Stimulation of 3D osteogenesis by mesenchymal stem cells using a nanovibrational bioreactor. Nat Biomed Eng 2017; 1:758-770. [DOI: 10.1038/s41551-017-0127-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 07/31/2017] [Indexed: 12/18/2022]
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276
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Fang X, Lei L, Jiang T, Chen Y, Kang Y. Injectable thermosensitive alginate/β-tricalcium phosphate/aspirin hydrogels for bone augmentation. J Biomed Mater Res B Appl Biomater 2017; 106:1739-1751. [PMID: 28888067 DOI: 10.1002/jbm.b.33982] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Xiaoqian Fang
- Department of Prosthodontics School and Hospital of Stomatology Peking University; Beijing 100081 China
- Fifth Clinical Division School and Hospital of Stomatology Peking University; Beijing 100020 China
| | - Lei Lei
- Department of Prosthodontics School and Hospital of Stomatology Peking University; Beijing 100081 China
| | - Ting Jiang
- Department of Prosthodontics School and Hospital of Stomatology Peking University; Beijing 100081 China
- National Engineering Laboratory for Digital and Material Technology of Stomatology; Beijing Key Laboratory of Digital Stomatology; Beijing 100081 China
| | - Ying Chen
- Department of Prosthodontics School and Hospital of Stomatology Peking University; Beijing 100081 China
| | - Yunqing Kang
- Department of Ocean and Mechanical Engineering; Florida Atlantic University; Boca Raton Florida 33431
- Department of Biomedical Science; Florida Atlantic University; Boca Raton Florida 33431
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277
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Li Y, Yang L, Zheng Z, Li Z, Deng T, Ren W, Wu C, Guo L. Bio-Oss ® modified by calcitonin gene-related peptide promotes osteogenesis in vitro. Exp Ther Med 2017; 14:4001-4008. [PMID: 29067095 PMCID: PMC5647716 DOI: 10.3892/etm.2017.5048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/31/2017] [Indexed: 12/16/2022] Open
Abstract
Bio-Oss® and α-calcitonin gene-related peptide (CGRP) are involved in osteogenesis. However, it has remained to be assessed how α-CGRP affects the effect of Bio-Oss. In the present study, primary osteoblasts were incubated with α-CGRP, Bio-Oss, α-GGRP-Bio-Oss or mimic-α-CGRP. The proliferation rate, mineralization nodules, alkaline phosphatase (ALP) activity and the expression of osteogenic genes were measured by a Cell Counting Kit-8 assay, Alizarin Red-S staining, ALP activity detection and reverse-transcription quantitative PCR as well as western blot analysis, respectively. The proliferation rate, ALP activity and the number of mineralization nodules were significantly increased in the α-CGRP-modified Bio-Oss group compared to that in the Bio-Oss group. The mRNA and protein levels of osteocalcin, Runt-related transcription factor-2 and ALP were significantly upregulated in the α-CGRP-Bio-Oss group compared with those in the Bio-Oss group. Furthermore, the effect of mimic-α-CGRP on osteogenesis was reduced as it carried a mutation. In conclusion, the present study was the first to demonstrate that Bio-Oss modified with CGRP contributed to osteogenesis and may provide a novel formulation applied in the clinic for restoration of large bone defects.
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Affiliation(s)
- Yuanjing Li
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Lan Yang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Zhichao Zheng
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Zhengmao Li
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Tian Deng
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Wen Ren
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Caijuan Wu
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
| | - Lvhua Guo
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510140, P.R. China
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278
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A Comparative Analysis of Recombinant Human Bone Morphogenetic Protein-2 with a Demineralized Bone Matrix versus Iliac Crest Bone Graft for Secondary Alveolar Bone Grafts in Patients with Cleft Lip and Palate. Plast Reconstr Surg 2017; 140:318e-325e. [DOI: 10.1097/prs.0000000000003519] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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279
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Bhowmick A, Banerjee SL, Pramanik N, Jana P, Mitra T, Gnanamani A, Das M, Kundu PP. Organically modified clay supported chitosan/hydroxyapatite-zinc oxide nanocomposites with enhanced mechanical and biological properties for the application in bone tissue engineering. Int J Biol Macromol 2017; 106:11-19. [PMID: 28774805 DOI: 10.1016/j.ijbiomac.2017.07.168] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 05/06/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Abstract
The objective of this study is to design biomimetic organically modified montmorillonite clay (OMMT) supported chitosan/hydroxyapatite-zinc oxide (CTS/HAP-ZnO) nanocomposites (ZnCMH I-III) with improved mechanical and biological properties compared to previously reported CTS/OMMT/HAP composite. Fourier transform infrared spectroscopy, powder X-ray diffraction, scanning electron microscopy and transmission electron microscopy were used to analyze the composition and surface morphology of the prepared nanocomposites. Strong antibacterial properties against both Gram-positive and Gram-negative bacterial strains were established for ZnCMH I-III. pH and blood compatibility study revealed that ZnCMH I-III should be nontoxic to the human body. Cytocompatibility of these nanocomposites with human osteoblastic MG-63 cells was also established. Experimental findings suggest that addition of 5wt% of OMMT into CTS/HAP-ZnO (ZnCMH I) gives the best mechanical strength and water absorption capacity. Addition of 0.1wt% of ZnO nanoparticles into CTS-OMMT-HAP significantly enhanced the tensile strengths of ZnCMH I-III compared to previously reported CTS-OMMT-HAP composite. In absence of OMMT, control sample (ZnCH) also showed reduced tensile strength, antibacterial effect and cytocompatibility with osteoblastic cell compared to ZnCMH I. Considering all of the above-mentioned studies, it can be proposed that ZnCMH I nanocomposite has a great potential to be applied in bone tissue engineering.
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Affiliation(s)
- Arundhati Bhowmick
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India
| | - Sovan Lal Banerjee
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India
| | - Nilkamal Pramanik
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India
| | - Piyali Jana
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India
| | - Tapas Mitra
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India
| | - Arumugam Gnanamani
- Microbiology Division, CSIR-Central Leather Research Institute, Adyar, Chennai, 600020, Tamil Nadu, India
| | - Manas Das
- Department of Chemical Engineering, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India
| | - Patit Paban Kundu
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata, 700009, India; Department of Chemical Engineering, Indian Institute of Technology, Roorkee, 247667, India.
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280
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Liang C, Lin X, Wang SL, Guo LH, Wang XY, Li J. Osteogenic potential of three different autogenous bone particles harvested during implant surgery. Oral Dis 2017. [PMID: 28644543 DOI: 10.1111/odi.12704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim was to compare the osteoblast activity and osteogenic potential of autogenous bone particles harvested using three different techniques and determine the most advantageous method of collecting autogenous bone particles. SUBJECTS AND METHODS Bone particles were harvested from 20 patients during dental implant surgery using bone scraping, low-speed drilling and bone trap filtering. After the osteoblasts were cultured, cell proliferation, migration, mineralization, transcription of osteogenesis-related genes, secretion of osteogenesis-related proteins and osteoinductive protein content in the bone particle matrix were evaluated. RESULTS Osteoblast activity and osteogenic potential were higher in bone samples harvested by scraper or low-speed drilling than in samples harvested by bone trap filter. Although these parameters were slightly lower in the low-speed drilling group than in the scraper group, significant differences were found only in bone Gla protein levels. However, the levels of osteoinductive proteins in the bone particle matrix were significantly higher in the low-speed drilling group than in the scraper group. CONCLUSIONS Low-speed drilling is a recommendable and effective technique for collecting autogenous bone particles. In implant operations, low-speed drilling can be considered the first-line option, and if the quantity of harvested bone is insufficient, bone shavings obtained by the scraper may be considered.
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Affiliation(s)
- C Liang
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - X Lin
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - S-L Wang
- Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - L-H Guo
- Department of Stomatology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - X-Y Wang
- Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - J Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
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281
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Putzer D, Ammann CG, Coraça-Huber D, Lechner R, Schmölz W, Nogler M. The Influence of Liquids on the Mechanical Properties of Allografts in Bone Impaction Grafting. Biopreserv Biobank 2017; 15:410-416. [PMID: 28686464 DOI: 10.1089/bio.2017.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Allografts are used to compensate for bone defects resulting from revision surgery, tumor surgery, and reconstructive bone surgery. Although it is well known that the reduction of fat content of allografts increases mechanical properties, the content of liquids with a known grain size distribution has not been assessed so far. The aim of the study was to compare the mechanical properties of dried allografts (DA) with allografts mixed with a saline solution (ASS) and with allografts mixed with blood (AB) having a similar grain size distribution. Fresh-frozen morselized bone chips were cleaned chemically, sieved, and reassembled in specific portions with a known grain size distribution. A uniaxial compression was used to assess the yield limit, initial density, density at yield limit, and flowability of the three groups before and after compaction with a fall hammer apparatus. No statistically significant difference could be found for the yield limit between DA and ASS (p = 0.339) and between ASS and AB (p = 0.554). DA showed a statistically significant higher yield limit than AB (p = 0.022). Excluding the effect of the grain size distribution on the mechanical properties, it was shown that allografts have a lower yield limit when lipids are present. The liquid content of allografts seems to play an inferior role as no statistically significant difference could be found between DA and ASS. It is suggested, in accordance with other studies, to chemically clean allografts before implantation to reduce the contamination risk and the fat content.
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Affiliation(s)
- David Putzer
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Christoph Gert Ammann
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Débora Coraça-Huber
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Ricarda Lechner
- 2 Department of Orthopedic Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Werner Schmölz
- 3 Department of Trauma Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Michael Nogler
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
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282
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Smith A, Kortebein S, Eid A, Boughter J, Cary N, Brooks J, Sebelik M. Comparing Cancellous Bone Volume of the Manubrium to Iliac Crest in Fresh Cadavers. Otolaryngol Head Neck Surg 2017; 157:36-41. [PMID: 28669310 DOI: 10.1177/0194599817692961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The iliac crest is the gold standard for cancellous bone grafting. This site is distant from head and neck reconstruction and may lead to significant postoperative morbidity. We propose an alternative harvest site within the head and neck with potentially less mobility deficits, the manubrium. Study Design Fresh-frozen cadaveric study. Setting Gross anatomy laboratory. Subjects and Methods Access to 18 cadavers was granted from the Medical Education and Research Institute in Memphis, Tennessee. The anterior iliac crests were exposed and H-type osteotomies performed. The manubrium was accessed through a substernal notch incision and a cortical window created through the anterior manubrium. Cancellous bone was harvested from these sites. Cadaveric demographics and noncompressed and compressed volumes were recorded with statistical comparisons. Results The population was predominantly male (12/18) with a mean age of 69.6 (95% confidence interval [CI], 64.0-75.3) years. The mean body mass index was 22.9 (95% CI, 18.8-27.1) kg/m2 with no sex propensity. Uncompressed volumes did not vary, ranging from 6.4 to 7.5 mL. Compressed volumes (mL) for the right iliac crest (4.3; 95% CI, 3.0-5.6), left iliac crest (3.5; 95% CI, 2.7-4.2), and manubrium (2.4; 95% CI, 1.8-3.0) varied (1-way analysis of variance: F(2, 51) = 4.63; P < .02). Furthermore, there was correlation between compressed volumes taken from either area ( r = 0.58; P < .02). Conclusions The manubrium can be used for cancellous bone grafting. This site affords a proximity to the head and neck rather than the distant iliac crest but with slightly lower yields. Potential applications include reconstructing small mandibular defects, mandible nonunion, or alveolar bone grafting.
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Affiliation(s)
- Aaron Smith
- 1 Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sarah Kortebein
- 1 Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anas Eid
- 1 Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - John Boughter
- 4 University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nathan Cary
- 2 Department of Oral and Maxillofacial Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeffrey Brooks
- 2 Department of Oral and Maxillofacial Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Merry Sebelik
- 1 Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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283
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Abstract
Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures. This article reviews orthobiologics and their applications in pediatric sports medicine.
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Affiliation(s)
- Christopher C Bray
- Pediatric Orthopaedic Surgery and Adolescent Sports Medicine, Department of Orthopaedic Surgery, Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA; University of South Carolina School of Medicine - Greenville, Greenville, SC, USA.
| | - Clark M Walker
- Department of Orthopaedic Surgery, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA
| | - David D Spence
- Department of Orthopaedic Surgery, University of Tennessee - Campbell Clinic, 1400 South Germantown Road, Germantown, Memphis, TN 38138, USA
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284
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Bajestan MN, Rajan A, Edwards SP, Aronovich S, Cevidanes LHS, Polymeri A, Travan S, Kaigler D. Stem cell therapy for reconstruction of alveolar cleft and trauma defects in adults: A randomized controlled, clinical trial. Clin Implant Dent Relat Res 2017; 19:793-801. [PMID: 28656723 DOI: 10.1111/cid.12506] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone. PURPOSE To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma. MATERIALS AND METHODS Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading. RESULTS The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft. CONCLUSION The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.
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Affiliation(s)
- Mona N Bajestan
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Archana Rajan
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Sean P Edwards
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Angeliki Polymeri
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Suncica Travan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Darnell Kaigler
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan
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285
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Efficacy comparison of Accell Evo3 and Grafton demineralized bone matrix putties against autologous bone in a rat posterolateral spine fusion model. Spine J 2017; 17:855-862. [PMID: 28126356 DOI: 10.1016/j.spinee.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/23/2016] [Accepted: 01/19/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal fusion procedures are intended to stabilize the spinal column for a multitude of disorders including abnormal curvature, traumatic instability, degenerative instability, and damage from infections or tumors. As an aid in the bone healing response, bone graft materials are used to bridge joints for arthrodesis and promote unions in pseudoarthrosis. Currently, the gold standard for stabilizing fusion masses in spinal procedures involves using the osteogenic, osteoinductive, and osteoconductive properties of autologous iliac crest corticocancellous bone. However, considerable morbidity is associated with harvesting the autologous graft. Donor site complications including infection, large hematomas, and pain have been reported at rates as high as 50% (Boden and Jeffrey, 1995). Biologically, the rate of bone repair dictates the rate at which the fusion mass will unite under autologous graft conditions. PURPOSE The purpose of this study is to compare the quality and rate of fusion between Accell Evo3 and Grafton demineralized bone matrix (DBM), with the gold standard iliac crest bone graft (ICBG) as the control, in athymic rat posterolateral fusion. STUDY DESIGN This study was a randomized, controlled study in a laboratory setting at the Hospital for Special Surgery in New York City. Blinded observations were made, which created an assessment of outcomes for successful fusions between each method. PATIENT SAMPLE Forty-eight (48) athymic rats were used in this study and underwent posterolateral lumbar fusion. They were assessed at either 3 weeks or 9 weeks to see the rate and efficacy of fusion. OUTCOME MEASURES Outcome measures will be the efficacy of the different bone grafts and their success rates of fusion in the rats. METHODS A comparison of the quality and rate of fusion between Accell Evo3® (DBM A) and Grafton (DBM B), with the gold standard iliac crest bone graft (ICBG) as the control, was performed using the established posterolateral intertransverse process on an athymic rat model. Materials were evaluated for fusion by several criteria, including manual palpation, standard and high-resolution radiographic imaging, micro-computed topography, and histologic analysis. Forty-eight (48) athymic rats received a bilateral intertransverse process fusion, using either bone from the iliac crest (control group), Accell Evo3, or Grafton. Twelve (12) rats (four from each group) were sacrificed at 3 weeks postoperatively, whereas the remaining thirty-six (36) were sacrificed at 9 weeks postoperatively. Three blinded observers examined the spines after the rats were euthanized, and they blindly assessed each rat for fusion success. RESULTS Manual palpation of the three different groups at 3 weeks postoperatively found successful fusion in 1 of 4 (25%) of the autologous bone graft (ABG) group and 4 of 4 (100%) of both DBM A and B groups. Manual palpation of the remaining animals that were sacrificed at 9 weeks postoperatively showed successful fusion in 4 of 12 (33%) of the ABG group, 8 of 12 (66%) of the DBM A group, and 12 of 12 (100%) of the DBM B group. Radiography found that 9 of 16 (56%) of the ABG group and 16 of 16 (100%) of both DBM Putty A and B groups had fused. Histologic analysis of the ABG group demonstrated less mature and less organized osteoid at both 3 and 9 weeks than the DBM Putty A and B groups. Nondestructive mechanical testing demonstrated increased stiffness in 4-point bending of both DBM A and B compared with ABG. CONCLUSIONS Both DBM-treated groups achieved a significantly higher rate of fusion than the ABG-treated group at 9 weeks in this model. Successful fusion was also demonstrated in the DBM-treated groups at 3 weeks.
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286
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Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a "gold standard"? A consecutive review of 279 patients with 456 clinical procedures. Int J Implant Dent 2017; 3:23. [PMID: 28573552 PMCID: PMC5453915 DOI: 10.1186/s40729-017-0084-4] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/22/2017] [Indexed: 01/25/2023] Open
Abstract
Background This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts. Methods A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the years of 2009 until 2011 with autologous bone transplantation prior to secondary implant insertion. Intraoral donor sites (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, and anterior sinus wall) and extraoral donor site (iliac crest) were used. A total of 279 patients underwent after a healing period of 3–5 months routinely computer tomography scans followed by virtual implant planning. The implants were inserted using guided oral implantation as described by Naziri et al. All records of all the consecutive patients were reviewed according to patient age, history of periodontitis, smoking status, jaw area and dental situation, augmentation method, intra- and postoperative surgical complications, and surgeon’s qualifications. Evaluated was the augmentation surgical outcome regarding bone graft loss and early implant loss postoperatively at the time of prosthodontic restauration as well a follow-up period of 2 years after loading. Results A total of 279 patients underwent 456 autologous augmentation procedures in 546 edentulous areas. One hundred thirteen crista zygomatico-alveolaris grafts, 104 ramus mandible grafts, 11 symphysis grafts, 116 grafts from the anterior superior iliac crest, and 112 sinus lift augmentations with bone scrapes from the anterior facial wall had been performed. There was no drop out or loss of follow-up of any case that had been treated in our clinical center in this 3-year period. Four hundred thirty-six (95.6%) of the bone grafts healed successfully, and 20 grafts (4.4%) in 20 patients had been lost. Fourteen out of 20 patients with total graft failure were secondarily re-augmented, and six patients wished no further harvesting procedure. In the six patients, a partial graft resorption was detected at the time of implantation and additional simultaneous augmentation during implant insertion was necessary. No long-term nerve injury occurred. Five hundred twenty-five out of 546 initially planned implants in 259 patients could be inserted into successfully augmented areas, whereas 21 implants in 20 patients due to graft loss could not be inserted. A final rehabilitation as preplanned with dental implants was possible in 273 of the 279 patients. The early implant failure rate was 0.38% concerning two out of the 525 inserted implants which had to be removed before the prosthodontic restoration. Two implants after iliac crest augmentation were lost within a period of 2 years after loading, concerning a total implant survival rate after 2 years of occlusal loading rate of 99.6% after autologous bone augmentation prior to implant insertion. Conclusions This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standard” in alveolar ridge augmentation prior to oral implantation.
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Affiliation(s)
- Andreas Sakkas
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - Frank Wilde
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Marcus Heufelder
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty of Leipzig University, Leipzig, Germany
| | - Alexander Schramm
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.,Department of Oral and Plastic Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany
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287
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Buser Z, Drapeau S, Stappenbeck F, Pereira RC, Parhami F, Wang JC. Effect of Oxy133, an osteogenic oxysterol, on new bone formation in rat two-level posterolateral fusion model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2763-2772. [PMID: 28547574 DOI: 10.1007/s00586-017-5149-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 05/10/2017] [Accepted: 05/18/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of our study was to determine the effect of Oxy133 and rhBMP2 on fusion rates and new bone formation in a rat posterolateral fusion (PLF) model. Furthermore, we examined whether Oxy133 could inhibit the adipogenesis that is often present in rhBMP2-induced fusions. METHODS Sixty-four male Lewis rats underwent two levels PLF (L3-L5). All animals were randomly divided into eight groups based on the test compound that they received: control (DMSO), low-dose rhBMP2 (0.5 µg), high-dose rhBMP2 (5 µg), low-dose Oxy133 (5 mg), high-dose Oxy133 (20 mg), low rhBMP2 + high Oxy133, high rhBMP2 + high Oxy133, and low rhBMP2 + low Oxy133. Fusion rates were assessed 8 weeks after surgery with manual palpation and plain radiographs. Bone parameters were measured using microCT. Histology was used to evaluate adipogenesis. RESULTS No fusion was observed in the control group. Based on the manual palpation, 100% fusion was observed in all other groups except in the low-dose rhBMP2 group (69%). At 8 weeks based on X-rays, 100% fusion was observed in the following groups: high-dose rhBMP2, low-dose Oxy133, and low rhBMP2 + low Oxy133. In the other groups, the fusion rates were between 95 and 97%, except for the low rhBMP2 group (72%). We observed similar values in BV/TV ratio at L3-4 when Oxy133 groups were compared to rhBMP2 groups alone (44.62% in high-dose Oxy133 vs. 41.47% in high-dose rhBMP2 and 47.18% in low-dose Oxy133 vs. 54.98% in low-dose rhBMP2). Trabecular thickness was slightly lower in Oxy133 groups compared to rhBMP2 when comparing low- and high-dose groups from each group (118.44 µm for high-dose Oxy133 vs. 122.39 µm for high-dose rhBMP2 and 123.51 µm for low-dose Oxy133 vs. 135.74 µm for low-dose rhBMP2). At the same time, trabecular separation was lower in Oxy133 groups compared to rhBMP2 groups. Similar trends in bone parameters were observed at the L4-5 levels. Fusion masses with low- and high-dose Oxy133 had significantly less adipocytes than rhBMP2 groups that showed robust adipocyte formation. CONCLUSION In our study, both low-dose and high-dose Oxy133 produced solid fusions with bone densities similar or higher than in the BMP2 groups. High-dose Oxy133 group had significantly less adipocytes than high- or low-dose rhBMP2 groups. Furthermore, high-dose Oxy133 was able to significantly inhibit high-dose BMP2-induced adipogenesis when combined together. Consistent with the previous reports, our preliminary findings suggest that Oxy133 has a significant potential as an alternative to rhBMP2 in spine fusion.
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Affiliation(s)
- Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, Elaine Stevely Hoffman Medical Research Center, University of Southern California, HMR 710, 2011 Zonal Ave., Los Angeles, CA, 90033, USA.
| | - Susan Drapeau
- Vericel Corporation, Cambridge, MA, USA.,Medtronic, Minneapolis, MN, USA
| | | | - Renata C Pereira
- Department of Pediatric Nephrology, University of California Los Angeles, Los Angeles, CA, USA
| | - Farhad Parhami
- Department of Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, Elaine Stevely Hoffman Medical Research Center, University of Southern California, HMR 710, 2011 Zonal Ave., Los Angeles, CA, 90033, USA
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288
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Rancy SK, Malliaris SD, Wolfe SW. Tibial Bone Grafting for Wrist Reconstruction. J Wrist Surg 2017; 6:158-162. [PMID: 28428919 PMCID: PMC5397308 DOI: 10.1055/s-0036-1585583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
Background Iliac crest bone graft harvesting is routinely performed for upper extremity orthopedic procedures despite high complication rates associated with sensory nerve injury, hematoma, chronic pain, and fracture. Description of Technique Cancellous bone graft is harvested from the proximal tibia using a medial approach, minimizing donor site morbidity. Patients and Methods A retrospective review was undertaken of 14 patients who underwent cancellous proximal tibia bone graft harvesting to augment healing of wrist reconstruction, with 2 months minimum follow-up. We report donor limb tourniquet time, time to union, visual analog scale (VAS) pain score, and complications. Patients were also contacted by phone to administer a retrospective questionnaire and record experiences with the harvesting technique. Results Average donor site VAS for the immediate postoperative period was 7.4. Average tourniquet time was 28 minutes. Average time to union of the recipient site was 45 days. One patient experienced delayed union after corrective osteotomy, attributed to osteoporosis. Two patients underwent hardware removal from the operative wrist, unrelated to bone graft harvesting. One patient with a history of chronic neuropathy and foot drop developed dysesthesia and allodynia about the ipsilateral ankle, but was asymptomatic at the proximal tibia donor site; ankle symptoms resolved 3 weeks postoperatively. No patient reported any residual donor site difficulties 24.2 months postoperatively. Conclusion In consideration of the minimal complication rate, favorable clinical parameters, and excellent patient tolerance, we advocate proximal tibia bone graft harvesting as opposed to iliac crest harvesting for wrist reconstruction when a moderate amount of autogenous cancellous graft is needed. Level of Evidence IV.
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Affiliation(s)
- Schneider K. Rancy
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Stephanie D. Malliaris
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
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289
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Volumetric Analysis of Alveolar Bone Defect Using Three-Dimensional-Printed Models Versus Computer-Aided Engineering. J Craniofac Surg 2017; 28:383-386. [DOI: 10.1097/scs.0000000000003301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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290
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Sun H, Lu PP, Zhou PH, Sun SW, Zhang HT, Liu YJ, Yang X, Shen XF, Yang HL. Recombinant human platelet-derived growth factor-BB versus autologous bone graft in foot and ankle fusion: A systematic review and meta-analysis. Foot Ankle Surg 2017; 23:32-39. [PMID: 28159040 DOI: 10.1016/j.fas.2016.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 02/04/2023]
Abstract
Today, autogenous bone graft (ABG) is still considered as the gold standard for joint fusion. Recombinant human platelet-derived growth factor-BB (rhPDGF-BB) which is of chemotactic and mitogenic to mesenchymal stem cells and possesses outstanding osteogenetic potentials has been used for ankle and foot fusion in recent years. The goal of this article is to evaluate the safety and efficacy of rhPDGF-BB versus ABG in foot and ankle fusion. The PubMed MEDLINE, EMBASE, Web of Science, and Cochrane Library were systematic searched. Finally, three randomized controlled trials (RCTs) with 634 patients were enrolled in this study. Results of radiologic effectiveness which included CT and radiographic union rates revealed that there was no significant difference between rhPDGF-BB approach and ABG approach. Analysis of clinical results held the same outcomes expect that ABG group was superior in long-term Short Form-12 physical component scores. The pooled results also demonstrated that rhPDGF-BB was as safe as ABG in foot and ankle surgery. However, autograft harvesting procedure has some drawbacks such as donor-site pain and morbidity, additional operation time, blood loss, and scarring, which can be overcome by rhPDGF-BB. Thus, rhPDGF-BB is a viable alternative to autograft in foot and ankle fusion surgery. Yet, more high-quality RCTs with long-term follow-up are still required to make the final conclusion.
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Affiliation(s)
- Han Sun
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Pei-Pei Lu
- Nursing College, Liaoning Medical University, No. 40, Section 3, Songpo Road, Guta District of Jinzhou City, Liaoning Province, 121001, China.
| | - Ping-Hui Zhou
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Si-Wei Sun
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Hong-Tao Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Yi-Jie Liu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Xu Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Xiao-Feng Shen
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
| | - Hui-Lin Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 188 Shizi Street Gusu District of Suzhou City, Jiangsu Province, 215006, China.
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291
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Miguita L, Mantesso A, Pannuti CM, Deboni MCZ. Can stem cells enhance bone formation in the human edentulous alveolar ridge? A systematic review and meta-analysis. Cell Tissue Bank 2017; 18:217-228. [PMID: 28233169 DOI: 10.1007/s10561-017-9612-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/16/2017] [Indexed: 12/22/2022]
Abstract
Several non-biological materials are currently being used to increase the alveolar bone volume to support dental implants. Recently, stem cell therapy has emerged as a promising biological substitute or adjuvant to enhance bone healing. In order to determine if stem cell therapy has enough clinical evidence to bone ridge augmentation in humans, a systematic review and meta-analysis were conducted. Two independent investigators searched the Entrez PubMed, SCOPUS and Web of Science databases for eligible randomized clinical trials that describe stem cell therapies for alveolar bone formation. The included studies were evaluated for risk of bias. A random-effects meta-analysis model was used to evaluate the percentage of bone formation in the selected studies. Heterogeneity was evaluated using the Cochrane Chi 2 and I 2. Nine eligible trials were included. These studies presented an overall unclear risk of bias. A comparison between the lower heterogeneity studies and the long term observational outcomes showed a slight tendency to enhance bone formation. High heterogeneity between the included studies was observed. The lack of outcome standardization made a wide-ranging comparison difficult. The application of stem cells in oral surgery and implantology appears to be promising although more standardized study designs, increased samples and long-term observations are needed to strength the clinical evidence that stem cell therapy is effective for alveolar bone formation.
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Affiliation(s)
- Lucyene Miguita
- Department of Oral Medicine, Discipline of Oral Pathology, Dental School, University of São Paulo (FOUSP), Av Professor Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Andrea Mantesso
- Department of Oral Medicine, Discipline of Oral Pathology, Dental School, University of São Paulo (FOUSP), Av Professor Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Claudio Mendes Pannuti
- Department of Oral Medicine, Discipline of Periodontology, Dental School, University of São Paulo (FOUSP), Av Professor Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Maria Cristina Zindel Deboni
- Department of Oral and Maxillofacial Surgery, Discipline of Oral Surgery, Dental School, University of São Paulo (FOUSP), Av Professor Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP, 05508-000, Brazil.
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292
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Wang Y, Fang X, Wang C, Ding C, Lin H, Liu A, Wang L, Cao Y. Exogenous PTHrP Repairs the Damaged Fracture Healing of PTHrP+/- Mice and Accelerates Fracture Healing of Wild Mice. Int J Mol Sci 2017; 18:ijms18020337. [PMID: 28178186 PMCID: PMC5343872 DOI: 10.3390/ijms18020337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
Bone fracture healing is a complicated physiological regenerative process initiated in response to injury and is similar to bone development. To demonstrate whether an exogenous supply of parathyroid hormone–related protein (PTHrP) helps in bone fracture healing, closed mid-diaphyseal femur fractures were created and stabilized with intramedullary pins in eight-week-old wild-type (WT) PTHrP+/+ and PTHrP+/− mice. After administering PTHrP for two weeks, callus tissue properties were analyzed at one, two, and four weeks post-fracture (PF) by various methods. Bone formation–related genes and protein expression levels were evaluated by real-time reverse transcriptase–polymerase chain reaction and Western blots. At two weeks PF, mineral density of callus, bony callus areas, mRNA levels of alkaline phosphatase (ALP), type I collagen, Runt-related transcription factor 2 (Runx-2), and protein levels of Runx-2 and insulin-like growth factor-1 decreased in PTHrP+/− mice compared with WT mice. At four weeks PF, total collagen-positive bony callus areas, osteoblast number, ALP-positive areas, and type I collagen-positive areas all decreased in PTHrP+/− mice. At both two and four weeks PF, tartrate-resistant acid phosphatase–positive osteoclast number and surface decreased a little in PTHrP+/− mice. The study indicates that exogenous PTHrP provided by subcutaneous injection could redress impaired bone fracture healing, leading to mutation of activated PTHrP by influencing callus areas, endochondral bone formation, osteoblastic bone formation, and bone turnover.
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Affiliation(s)
- Yinhe Wang
- Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Xin Fang
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden.
| | - Chun Wang
- Department of Geriatrics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Congzhu Ding
- Department of Geriatrics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Hua Lin
- Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Anlong Liu
- Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Lei Wang
- Department of Oral & Maxillofacial-Head & Neck Oncology, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China.
| | - Yang Cao
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden.
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro 70182, Sweden.
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293
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Han SH, Lee HJ, Hong IT, Kim U, Lee SJ. Non-structural cancellous bone graft and headless compression screw fixation for treatment of scaphoid waist non-union. Orthop Traumatol Surg Res 2017; 103:89-93. [PMID: 27939913 DOI: 10.1016/j.otsr.2016.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 08/23/2016] [Accepted: 10/06/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Scaphoid fracture commonly occurs around the mid-third of the scaphoid, and non-union of this fracture has several treatment options. The authors performed autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist non-union. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. METHODS Medical records and radiographs of 30 patients who underwent cancellous bone graft and headless compression screw fixation for non-union of scaphoid waist fracture were retrospectively reviewed. There were 28 men and 2 women, with a mean age of 32.8 years (range: 21-63). The mean time to surgery was 10 months (range: 3-25) and mean follow-up was 37.5 months (range: 15-52). The authors analyzed bony union, lateral intrascaphoid angle, scapholunate angle, radiolunate angle and scaphoid length on radiographs and evaluated the Modified Mayo wrist score (MMWS) as a functional outcome. RESULTS Bony union was achieved in all cases. The lateral intrascaphoid angle improved from 40° to 32° (P<0.001). The scapholunate angle also improved from 61° to 56° (P=0.009). The radiolunate angle decreased from 8° to 4° (P=0.048) and scaphoid length increased from 22mm to 26mm (P<0.001) postoperatively. Wrist motion and MMWS improved significantly at last follow-up. However, there were no significant differences between scaphoid deformity correction angle and pre- to post-operative difference in MMWS. CONCLUSIONS Non-structural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack-Lichtman type II non-union in the mid-third of the scaphoid. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- S H Han
- Department of orthopaedic surgery, CHA Bundang medical center, school of medicine, CHA university, 463-712 Seong-nam, Republic of Korea.
| | - H J Lee
- Department of orthopaedic surgery, CHA Bundang medical center, school of medicine, CHA university, 463-712 Seong-nam, Republic of Korea
| | - I T Hong
- Department of orthopaedic surgery, CHA Bundang medical center, school of medicine, CHA university, 463-712 Seong-nam, Republic of Korea
| | - U Kim
- Department of orthopaedic surgery, CHA Bundang medical center, school of medicine, CHA university, 463-712 Seong-nam, Republic of Korea
| | - S J Lee
- Department of orthopaedic surgery, CHA Bundang medical center, school of medicine, CHA university, 463-712 Seong-nam, Republic of Korea
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294
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Abstract
Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.
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Affiliation(s)
- Milind Madhav Chaudhary
- Director, Orthopaedic Surgery, Centre for Ilizarov Techniques, Chaudhary Hospital, Akola, Maharashtra, India,Address for correspondence: Dr. Milind Madhav Chaudhary, Chaudhary Hospital, Akola - 444 001, Maharashtra, India. E-mail:
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295
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Kajiwara D, Ikoma T. Collagen and Hydroxyapatite Composite Membranes as Drug-Carrying Support for Biomedical Applications. ACTA ACUST UNITED AC 2017. [DOI: 10.1557/adv.2017.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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296
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First report on treating spontaneous infectious spondylodiscitis of lumbar spine with posterior debridement, posterior instrumentation and an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin: a case report. J Med Case Rep 2016; 10:349. [PMID: 27955704 PMCID: PMC5153911 DOI: 10.1186/s13256-016-1125-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022] Open
Abstract
Background Spontaneous infectious spondylodiscitis is a rare, but serious disease with the risk of progressive neurological impairment. The surgical approach to spontaneous infectious spondylodiscitis is in most cases an anterior debridement and fusion, often in staged surgeries. Here we report a case of single-stage posterior debridement and posterior instrumented fusion in combination with an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin. Case presentation A 59-year-old Caucasian man presented with a 6-week history of lumbar pain without sensory or motor disorders of his lower extremities. A magnetic resonance imaging scan of his lumbar spine in T2-weighted sequences showed a high signal of the intervertebral disc L4/L5 and in T1-weighted sequences an epidural abscess at the posterior wall of L4. Additional computed tomography imaging revealed osteolytic destruction of the base plate of L4 and the upper plate of L5. Antibiotic therapy was started with intravenous ciprofloxacin and clindamycin. We performed a posterior debridement via a minimally invasive approach, a posterior percutaneous stabilization using transpedicular screw-rod instrumentation and filled the intervertebral space with an injectable calcium sulfate/hydroxyapatite composite which elutes a high concentration of gentamicin. The patient’s lower back pain improved quickly after surgery and no recurrence of infection has been noticed during the 1-year follow-up. Computed tomography at 11 months shows complete bony fusion of L4 and L5. Conclusions An injectable calcium sulfate/hydroxyapatite composite releasing a high level of gentamicin can support the surgical treatment of spondylodiscitis in combination with posterior debridement and transpedicular screw-rod instrumentation.
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297
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McAlister JE, Hyer CF, Black TE. Distraction First Metatarsophalangeal Arthrodesis With Tricortical Calcaneus Autograft: Technique Tips. Foot Ankle Spec 2016; 9:522-526. [PMID: 27613811 DOI: 10.1177/1938640016668029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
UNLABELLED First metatarsophalangeal joint arthritis can stem from a biomechanical imbalance as in hallux abducto valgus, metabolic arthritidies such as rheumatoid or gout, and even in posttraumatic cases. Advanced arthritis in the foot and ankle can often become debilitating. Surgical intervention is often necessary. Revision of failed first metatarsophalangeal joint arthroplasty is often in the setting of bony erosion and lysis, cystic changes, and loss of bone stock. In this article, we describe first metatarsophalangeal distraction arthrodesis technique using tricortical calcaneus autograft with the aim of simplifying donor site graft harvesting and decreasing donor site morbidity while attaining successful osseous union. LEVELS OF EVIDENCE Level V.
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Affiliation(s)
- Jeffrey E McAlister
- CORE Institute. Phoenix, Arizona (JEM).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH).,Grant Medical Center, Columbus, Ohio (TEB)
| | - Christopher F Hyer
- CORE Institute. Phoenix, Arizona (JEM).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH).,Grant Medical Center, Columbus, Ohio (TEB)
| | - Trevor E Black
- CORE Institute. Phoenix, Arizona (JEM).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH).,Grant Medical Center, Columbus, Ohio (TEB)
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298
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Abstract
Bone graft is a common adjunct procedure in orthopedic surgery used for fusions, fracture repair, and the reconstruction of skeletal defects in the foot and ankle. Autologous graft, or autograft, involves the transport of bone from a donor site to another location in the same patient. It is considered by many to be the gold standard of bone grafting, as it is provides all biologic factors required for functional graft. Further, autograft is 100% histocompatible with no risk of disease transmission.
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299
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Tanikake Y, Akahane M, Furukawa A, Tohma Y, Inagaki Y, Kira T, Tanaka Y. Calcium Concentration in Culture Medium as a Nondestructive and Rapid Marker of Osteogenesis. Cell Transplant 2016; 26:1067-1076. [PMID: 27983908 DOI: 10.3727/096368916x694166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Artificial bones made of β-tricalcium phosphate (β-TCP) combined with bone marrow-derived mesenchymal stromal cells (BM-MSCs) are used for effective reconstruction of bone defects caused by genetic defects, traumatic injury, or surgical resection of bone tumors. However, the selection of constructs with high osteogenic potential before implantation is challenging. The purpose of this study was to determine whether the calcium concentration in BM-MSC culture medium can be used as a nondestructive and simple osteogenic marker for selecting tissue-engineered grafts constructed using β-TCP and BM-MSCs. We prepared three cell passages of BM-MSCs derived from three 7-week-old, male Fischer 344 rats; the cells were cultured in osteoinductive medium in the presence of β-TCP for 15 days. The medium was replaced with fresh medium on day 1 in culture and subsequently changed every 48 h; it was collected for measurement of osteocalcin secretion and calcium concentration by enzyme-linked immunosorbent assay and X-ray fluorescence spectrometry, respectively. After cultivation, the constructs were implanted subcutaneously into the backs of recipient rats. Four weeks after implantation, the alkaline phosphatase (ALP) activity and osteocalcin content of the constructs were measured. A strong inverse correlation was observed between the calcium concentration in the medium and the ALP activity and osteocalcin content of the constructs, with Pearson's correlation coefficients of 0.92 and 0.90, respectively. These results indicate that tissue-engineered bone with high osteogenic ability can be selected before implantation based on low calcium content of the culture medium, resulting in successful bone formation after implantation. This nondestructive, simple method shows great promise for assessing the osteogenic ability of tissue-engineered bone.
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300
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Azi ML, Aprato A, Santi I, Kfuri M, Masse A, Joeris A. Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016; 17:465. [PMID: 27829447 PMCID: PMC5103502 DOI: 10.1186/s12891-016-1312-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022] Open
Abstract
Background This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques. Methods The PubMed and the Cochrane Library databases were searched using the terms: ‘fracture’ AND (‘bone loss’ OR ‘defect’ OR ‘defects’) AND ‘bone graft’, restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates. Results Out of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87–95 %) while union rate after additional procedures raised to 98 % (95 % CI 96–99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001). Conclusion The results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1312-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matheus Lemos Azi
- Manoel Victorino Hospital, Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil.
| | - Alessandro Aprato
- Department of Orthopaedic Surgery, San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole n.10, 10043, Turin, Italy
| | - Irene Santi
- AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600, Dübendorf, Switzerland
| | - Mauricio Kfuri
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus - Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Av. Bandeirantes 3900, 14048-900, Ribeirão Preto, São Paulo, Brazil.,Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, Missouri, USA
| | - Alessandro Masse
- Department of Orthopaedic Surgery, San Luigi Hospital of Orbassano, University of Turin, Regione Gonzole n.10, 10043, Turin, Italy
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600, Dübendorf, Switzerland
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