1
|
Della Valle A, Compagnoni R, Puglia F, Priano D, Menon A, Teani L, La Maida GA, De Feo T, Sacchi M, Ambrogi F, Cicatelli A, Randelli PS. Allografts use in orthopedic surgery: trend change over the past 11 years from a regional tissue bank. Cell Tissue Bank 2024; 25:713-720. [PMID: 38386210 DOI: 10.1007/s10561-024-10134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
Allografts are the second most transplanted tissue in medicine after blood and are now increasingly used for both primary and revision surgery. Allografts have the advantages of lower donor site morbidity, availability of multiple grafts, and shorter operative time. The Banks represents the bridge between Donor and Recipient and guarantees the quality and safety of the distributed allografts Given the increasing interest in these tissues, a retrospective analysis of data collected from the Regional Musculoskeletal Tissue Bank registry over an 11-year period (2009-2019) was conducted. The statistical analyses used were the Shapiro-Wilk normality test and a Poisson regression model. From January 2009 to December 2019, a total of 14,199 musculoskeletal tissues stored in the Regional Musculoskeletal Tissue Bank were provided for surgical allograft procedures. In 2009, the number of allografts performed was 925; this figure has steadily increased to 1599 in 2019. Epiphyses were taken as the reference tissue with an almost constant trend over the period, while a significant increase was denoted for extensor mechanism allograft, ligaments, tendons and long bone corticals (p < 0.001), processed bone tissues had no change in trend (p = 0.841). There was also a gradual decrease in the rate of microbiological positivity, as determined by bacteriological and serological tests performed on the collected tissues. This phenomenon is due to improved sampling techniques and the training of a dedicated team. Thus, we have seen how the use of allografts in orthopedic surgery has increased over the past 11 years, uniformly in terms of tissue type, except for the noticeable increase in ligamentous tissue.
Collapse
Affiliation(s)
- Andrea Della Valle
- Banca del Tessuto Muscolo-Scheletrico Regione Lombardia, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- U.O.C. Patologie Vertebrali e Scoliosi, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Via Della Commenda 10, 20122, Milan, Italy
| | - Francesco Puglia
- U.O.C. Ortopedia e Traumatologia Pediatrica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Daniele Priano
- U.O.C. Ortopedia e Traumatologia Pediatrica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Scuola Di Specializzazione in Statistica Sanitaria E Biometria, Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Lorenzo Teani
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Giovanni Andrea La Maida
- U.O.C. Patologie Vertebrali e Scoliosi, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Tullia De Feo
- S.C. Trapianti Lombardia- NITp, IRCCS Fondazione Ca'Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Marco Sacchi
- AREU, Coordinamento Regionale Trapianti, DG Welfare - Regione Lombardia, Piazza Città Di Lombardia 1, 20124, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology ''G.A. Maccaro,'' Università Degli Studi di Milano, Milan, Italy
| | - Alfonso Cicatelli
- U.O.C. Patologie Vertebrali e Scoliosi, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| |
Collapse
|
2
|
Gursoy S, Bessa F, Dandu N, Khan ZA, Huddleston HP, Williams BT, Vadhera AS, Clapp IM, Malloy P, Shewman EF, Nho SJ, Chahla J. Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction. Am J Sports Med 2024; 52:1753-1764. [PMID: 38761016 DOI: 10.1177/03635465241251824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
BACKGROUND The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. PURPOSE To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. STUDY DESIGN Descriptive laboratory study. METHODS A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. RESULTS The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. CONCLUSION The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. CLINICAL RELEVANCE This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest.
Collapse
Affiliation(s)
- Safa Gursoy
- Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Felipe Bessa
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Hailey P Huddleston
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brady T Williams
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ian M Clapp
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth F Shewman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
3
|
Panda D, Nayak S. Stem Cell-Based Tissue Engineering Approaches for Diabetic Foot Ulcer: a Review from Mechanism to Clinical Trial. Stem Cell Rev Rep 2024; 20:88-123. [PMID: 37867186 DOI: 10.1007/s12015-023-10640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Diabetic foot ulcer (DFU) is a complication from incomplete or prolonged wound healing, at times requires amputation, putting substantial health and socioeconomic burden. Wound healing is a dynamic overlapping process that can be regulated by arrays of molecular factors showing redundancy in function. However, dysregulation in the mechanism of angiogenesis, extra cellular matrix (ECM) formation and immune modulation are the major causes for impair wound healing in hyperglycaemic patients. Despite development of wound care research, there is a lack of well-accepted targeted therapy with multidisciplinary approach for DFU treatment. Stem cell therapy holds a promising outcome both in preclinical and clinical trials because of its ability to promote healing via regeneration and specialized tissue differentiation. Among different types of stem cells, regenerative potential of mesenchymal stem cell (MSC) is well demonstrated in both experimental and clinical trial. Still there is a huge knowledge gap among medical practitioners for deciding the best stem cell source, administration route, and safety. This review strengthens the fact that why stem cell therapy is a promising candidate to treat DFU and cited multiple tissue engineering and biomaterial-based approaches for delivering stem cells and their aftermath paracrine events. Based on the pre-clinical and clinical studies, the review tried to come up with optimum stem cell source and delivery route for the treatment of DFU. At last, the review glances on possible direction to enhance therapeutics strategy for the same, including different approaches like: phytocompounds, exosomes, scaffold geometry, cell preconditioning and licensing etc.
Collapse
Affiliation(s)
- Debarchan Panda
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Sunita Nayak
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India.
| |
Collapse
|
4
|
Smith L, Jakubiec A, Biant L, Tawy G. The biomechanical and functional outcomes of autologous chondrocyte implantation for articular cartilage defects of the knee: A systematic review. Knee 2023; 44:31-42. [PMID: 37516029 DOI: 10.1016/j.knee.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/07/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Autologous chondrocyte implantation (ACI) is primarily performed in active, young patients to treat knee pain and functional limitations resulting from articular cartilage injury. Nevertheless, the functional outcomes of ACI remain poorly understood. This systematic review aimed to evaluate the biomechanical and functional outcomes of ACI. METHODS Ovid MEDLINE, Embase, and Web of Science were systematically searched using the terms 'Knee OR Knee joint AND Autologous chondrocyte implantation OR ACI'. Inclusion and exclusion criteria were used to screen publications by title, abstract, and full text. Study quality and bias were assessed by two reviewers. Means and standard deviations of all collected variables were calculated and presented in the review. PROSPERO ID CRD42021238768. RESULTS Nineteen articles including 20 ACI cohorts were included. In general, the average range of motion (ROM) improved with clinical (>5°) and statistical significance (p < 0.05) postoperatively: 130.5 ± 14.8° to 136.1 ± 10.2°. Knee strength significantly improved within the first two postoperative years but remained poorer than control groups at final follow-up. No statistical differences were found between ACI and control groups in their ability to perform functional activities like the 6-minute walk test. CONCLUSION Knee range of motion generally improved following ACI. Although, some studies reported that knee strengths remained significantly poorer than healthy controls, particularly >2-years postoperatively, implying that longer-term strength training may benefit patients.However, the volume of research and current level of evidence remain low, thus further research is required to better understand the impact of ACI on knee function and guide future rehabilitative protocols.
Collapse
Affiliation(s)
- Lauren Smith
- Division of Medical Education, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Alexander Jakubiec
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Leela Biant
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Orthopaedics, Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gwenllian Tawy
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
| |
Collapse
|
5
|
Farago D, Kozma B, Kiss RM. Categorize the existing clamps used for tensile test of human graft- a systematic review. BMC Musculoskelet Disord 2022; 23:707. [PMID: 35879684 PMCID: PMC9316330 DOI: 10.1186/s12891-022-05650-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The use of tendon allografts for orthopedic repair has gained wide acceptance in recent years, most notably in anterior cruciate tendon reconstruction. Multiple studies support the use of tendon allografts and the benefits of its use are well accepted and understood. One of the important criteria of the use of tendon allografts is statistically similar histological and biomechanical properties to autographs. The aim of this systematic literature review is to investigate and categorize existing clamps used in the determination of the biomechanical properties of tendons such as maximum load, maximum strength, modulus of elasticity, ultimate strain, and stiffness. A variety of clamps for use during the endurance test of tendons were categorized according to the temperature used during the measurement. The clamps are divided into three groups: room temperature, cooled and heated clamps. The second goal of our review is to overview of clamps on the following aspects: name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters, and summarize in Table 3, as a comprehensive catalogue. Methods This systematic review was carried out in keeping with the PRISMA 2020 E&E and the PRISMA-S guidelines and checklists. A search was conducted for publications dating between 1991 and February 28th 2022 through three electronic databases (Web of Science, Scopus, and PubMed). We used Critical Appraisal Skills Program checklist to check the quality of included articles. Results The database search and additional sources resulted in 1725 records. 1635 records eliminated during the screening for various reasons (case report, other languages, book chapter, unavailable text/conference abstract, unrelated topic). The number of articles used in the final synthesis was 90. A variety of clamps for use during the endurance test of tendons were identified and categorized according to the temperature used during the measurement. Based on this, the clamps are divided into three groups: room temperature, cooled or heated clamps. Conclusions On the basis of the systematic literature review, mechanical parameters determined by usage with cooled clamps proved to be more reliable than with those at room temperature and with heated clamps. The collected information from the articles included name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters given in Table 3. summarized. The main advantage of the cooled clamps is that there is no limit to the type and length of the tendon. This study provides an overview of clamps and does not represent the modernity of any method. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05650-w.
Collapse
Affiliation(s)
- Denes Farago
- Cooperation Research Center for Biomechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary. .,Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Blanka Kozma
- Department of Biomedical Engineering, SUNY University at Buffalo, Buffalo, USA
| | - Rita Maria Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
| |
Collapse
|
6
|
Rabiu AR, Mart JPS, Reichert ILH, Ahluwalia R. The King's Sliding Hindfoot Osteotomy for the Treatment of Talus Body Defects-Results of a New Technique in Tibiotalocalcaneal Arthrodesis. J Foot Ankle Surg 2021; 60:1301-1307. [PMID: 34362653 DOI: 10.1053/j.jfas.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
Bone loss after avascular necrosis of the talus secondary to acute traumatic or chronic pathologies often requires surgical reconstruction. This study reports the early results of a sliding oblique hindfoot osteotomy for salvage procedures combined with tibiotalar arthrodesis to achieve a well-aligned, painless, plantigrade foot. All patients presenting to our institution with severe talus body defects requiring corrective surgery between January 2016 and August 2020 were included. An oblique osteotomy of the diseased talus was performed to correct anterior talus subluxation and prevent excessive loss of height at the tibiotalar apposition and to correct varus-valgus deformity. A retrograde hindfoot nail was used for intramedullary tibiotalocalcaneal arthrodesis. Patients were prospectively followed. Primary outcomes included assessment of mobility and union at 6 months. Secondary outcomes included 30-day postoperative complications, patient satisfaction and change in American Orthopaedic Foot & Ankle Society (AOFAS) score at 1-year postoperation. Nine patients underwent this procedure with a mean follow-up of 18 months (4-36 months). Average age was 66 (58-81) years. Mean body mass index was 33.7 (22-38) kg/m2. All patients went on to fusion and were ambulating at 6 months (n = 8). At 1 year, the mean improvement in AOFAS was 28.9 points (p < .05) (n = 7) and all patients were satisfied with the outcome of their treatment. This technique represents an alternative to conventional hindfoot salvage techniques showing predictable outcomes in complex hindfoot deformity with talar body collapse and anterior subluxation. Further quantitative studies are needed to define if this technique minimizes limb shortening/limb-length discrepancies when compared to traditional horizontal cuts.
Collapse
Affiliation(s)
- Abdul-Rasheed Rabiu
- Surgical Registrar, Department of Orthopaedics, King's College Hospital, King's College NHS Trust London, London, United Kingdom
| | - Jean-Pierre St Mart
- Surgical Registrar, Department of Orthopaedics, King's College Hospital, King's College NHS Trust London, London, United Kingdom
| | - Ines L H Reichert
- Consultant Trauma & Orthopaedic Surgeon, Department of Orthopaedics, King's College Hospital, King's College NHS Trust London, London, United Kingdom
| | - Raju Ahluwalia
- Consultant Foot and Ankle Surgeon, Department of Orthopaedics, King's College Hospital, King's College NHS Trust London, London, United Kingdom.
| |
Collapse
|
7
|
Leite CBG, Montechi JMN, Camanho GL, Gobbi RG, Angelini FJ. Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions. J Knee Surg 2021; 36:475-482. [PMID: 34610641 DOI: 10.1055/s-0041-1736195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Postoperative infections after allograft implantation is a major concern in knee ligament reconstructions considering the theoretical risk of disease transmission and its potential severity. Here, we aimed to evaluate the postoperative infection rate after knee ligament reconstructions using aseptically processed allografts, and provide an overview of the allografts use in an academic tertiary hospital. A retrospective study was performed evaluating patients who underwent knee ligament reconstructions using aseptically processed allografts, including primary and revision surgeries, from 2005 to 2018. Demographic data, including the type of knee injury and trauma energy, and postoperative data were collected focusing on postoperative infections. Regarding these infected cases, further analyses were performed considering the presenting signs and symptoms, the isolated microorganism identified in culture, the time between graft implantation and diagnosis of infection (defined as acute, subacute, and late), and the need for graft removal. A total of 180 cases of ligament reconstructions were included. The mean follow-up was 8.2 (range: 2.1-15.6) years and the mean age at surgery was 34.1 (± 11.1) years. A total of 262 allografts were implanted in those 180 cases, 93 (35.5%) as bone plug allografts and 169 (64.5%) as soft tissue allografts. Common surgical indications included multiligament reconstruction (57.2%) and primary anterior cruciate ligament (ACL) reconstruction (15%). Seven cases (3.9%) presented postoperative infections. Knee pain (100%) and swelling (100%) were the most prevalent symptoms. Two cases (28.6%) presented sinus tract. Allografts were removed in two cases, the same cases that presented draining sinus (p = 0.04). High-energy trauma was the only statistically associated factor for infection (p = 0.04). No significant association between infection and the type of allograft (p > 0.99) or sex (p = 0.35) were observed. Four cases (57.1%) had monomicrobial staphylococcal infections. Based on that, the allograft-related infection rate was 1.7% (the remaining three infected cases). Nonirradiated, aseptically processed allografts have a low postoperative infection rate in knee ligament reconstructions, being a safe alternative for surgeries that require additional source, increased variety, and quantity of grafts.
Collapse
Affiliation(s)
- Chilan B G Leite
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - João M N Montechi
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Gilberto L Camanho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Riccardo G Gobbi
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Fabio J Angelini
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
8
|
Comparison of Outcome of Bone Autograft and Allograft in Union of Long Bone Fractures. ACTA MEDICA BULGARICA 2021. [DOI: 10.2478/amb-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and Purpose
There are few studies addressing the rate of application of bone allograft and its use; hence, the present study aimed to compare the clinical outcomes of using bone allograft and autograft in patients with long bone fracture.
Method
In this clinical trial study, all patients who underwent bone graft surgery with the diagnosed long bone fractures of upper and lower limbs at Shahid Beheshti Hospital were included in the research. Patients were divided into two groups, autograft and allograft, according to type of treatment. They were evaluated for their union, complications, and range of motion.
Results
In the present study, 124 people were studied. Among them, 100 patients were eligible and included in the study. The allograft and autograft groups did not have any statistical significant differences in terms of age, sex, location, causes of fracture, and surgical methods. Results of the present research on patients in terms of fracture site indicated that there was no significant relationship between the two groups in rate of union (P = 0.18). Allograft and autograft had no difference in terms of complications. Studied range of motion indicated that patients were not different in terms of their ranges of motion.
Conclusion
Based on findings of the present study, allograft could be a suitable substitute for the autograft. The two graft methods were similar in terms of complications, union, and ranges of motion.
Collapse
|
9
|
Juels CA, So E, Seidenstricker C, Holmes J, Scott RT. A Comparison of Outcomes of Revision Surgical Options for the Treatment of Failed Bulk Talar Allograft Transfer: A Systematic Review. J Foot Ankle Surg 2021; 59:1265-1271. [PMID: 32972848 DOI: 10.1053/j.jfas.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/27/2020] [Accepted: 07/14/2020] [Indexed: 02/03/2023]
Abstract
Talar bulk osteochondral allograft transplantation is a useful treatment strategy for large, uncontained osteochondral lesions of talus. Complications and high revision rates from osteochondral talar allograft transfer can be common. Talar graft failure is a devastating complication that results from failure of allograft incorporation within the host bone and subsequent resorption and sometimes subsidence can occur. Treatment options and outcomes for graft failure have rarely been reported. The purpose of this study is to evaluate treatment options and their outcomes for treating talar allograft failure. A systematic review was completed to find all reports of salvage treatments for talar graft failure and outcomes of these reports were analyzed. Eleven studies involving a total of 522 ankles, in 520 patients, met the inclusion criteria. The allograft failure rate was 11.5% in these studies with a reoperation rate of 18.9%. With limited reports, satisfactory outcomes for treatment of graft failure with ankle arthrodesis were 77.3%, 50% for revision allograft procedures, and 50% for total ankle arthroplasty. Considering the large failure rate and reoperation rate for bulk talar allograft transplantations, superior revision, and salvage options are needed. More prospective cohort studies focusing on consistent and standard outcome measures are needed to further assess revision options for failed talar allograft procedures.
Collapse
Affiliation(s)
- Christopher A Juels
- Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ.
| | - Eric So
- Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ
| | | | | | - Ryan T Scott
- Director, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ
| |
Collapse
|
10
|
Different sterilization and disinfection methods used for human tendons - a systematic review using mechanical properties to evaluate tendon allografts. BMC Musculoskelet Disord 2021; 22:404. [PMID: 33941147 PMCID: PMC8091719 DOI: 10.1186/s12891-021-04296-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background It is important to know the biomechanical properties of an allograft. This is because when looking to do a transplant of a tendon, the tendon must have very similar biomechanical properties to the original tendon. To use tendon allografts, it is critical to properly sterilize the tendon before implantation. In past decades, several sterilization procedures have been used. This study aimed to systematically evaluate the existing literature to compare the values of failure load/ultimate strength and Young’s modulus of elasticity of different sterilization methods on commonly used tendon allografts. Five major scientific literature databases (Web of Science, Science Direct, Scopus, PLOS ONE, Hindawi) and additional sources were used. Results Studies used had to show a particular sterilization method. Studies were identified to meet the following inclusion criteria: is a controlled laboratory study, gamma irradiation (dose reported), and other sterilization methods. Search for publications dated between 1991 and March 31st, 2020. The database search and additional sources resulted in 284 records. Two hundred thirty records eliminated during the screening for various reasons. The number of articles used in the final synthesis was 54. Conclusions Identified sterilization methods (gamma irradiation, ethylene oxid, supercritical carbon dioxide (SCCO2), BioCleanse, Electron Beam) are offered as a catalog of potential methods. As a result of the broadness of the present research, it provides an overview of sterilization methods and their effect on the mechanical properties (failure load and Young’s modulus of elasticity) of tendons. It does not stand for the state-of-the-art of any single process. Based on a systematic literature review, we recommend freezing and gamma irradiation or electron beam at 14.8–28.5 kGy. These methods are effective at keeping or improving the mechanical properties, while fully sterilizing the inside and the outside of the tendon. Other sterilization method (ethylene oxide, supercritical carbon dioxide (SCCO2), BioCleanse) deteriorated the mechanical properties. These methods are not recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04296-4.
Collapse
|
11
|
Herrlinger F, Schulz T, Pruß A, Schulz E. Validation of Microbiological Testing of Tissue Preparations with Different Incubation Temperatures. Transfus Med Hemother 2021; 48:23-31. [PMID: 33708049 PMCID: PMC7923897 DOI: 10.1159/000513646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The European Pharmacopoeia (Ph. Eur.) provides principles for microbiological testing of tissue preparations. According to the Ph. Eur., tests should be performed at different temperatures for detection of aerobic bacteria and fungi (20–25°C) vs. anaerobic bacteria (30–35°C). Semiautomated systems using blood culture bottles are already widely used and they are adequate for growth detection. Resin-containing bottles and the addition of penicillinase permit testing of culture media containing antibiotics. Materials and Methods At 3 temperatures (21, 30, and 35°C) cornea culture media with and without dextran (CM II and CM I) and thermal disinfected femoral head medium (FH) were spiked with the 6 reference strains recommended by the Ph. Eur. (additionally: Enterococcus faecalis, Staphylococcus epidermidis, and Cutibacterium acnes). Microbial growth was monitored with the BACTECTM FX unit or visually at 21°C. Results Growth for all strains was detected with each medium at all 3 temperatures, except for C. acnes at 21°C (all media) and 30°C with FH. C. acnes had the highest times to detection, requiring test durations of 14 days. Microbial growth was faster at 30 and 35°C compared to 21°C. Conclusion The requirements according to the Ph. Eur. for a successful method suitability test could be fulfilled for the semiautomated blood culture bottle system with the BACTECTM FX unit for the media and microorganisms used. In the presented validation study 35°C was shown to be the incubation temperature with the fastest growth, of the majority of the test strains used, and complete detection within 14 days.
Collapse
Affiliation(s)
- Frithjof Herrlinger
- University Tissue Bank, Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tino Schulz
- University Tissue Bank, Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Pruß
- University Tissue Bank, Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Schulz
- University Tissue Bank, Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
12
|
Bessa FS, Williams BT, Polce EM, Neto M, Garcia FL, Leporace G, Metsavaht L, Chahla J. Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review. Front Surg 2020; 7:61. [PMID: 33195381 PMCID: PMC7596302 DOI: 10.3389/fsurg.2020.00061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background: The acetabular labrum plays a major role in hip function and stability. The gold standard treatment for labral tears is labral repair, but in cases where tissue is not amenable to repair, reconstruction has been demonstrated to provide superior outcomes compared to debridement. Many types of grafts have been used for reconstruction with good to excellent outcomes. Autograft options include iliotibial band (ITB), semitendinosus, and indirect head of the rectus femoris tendon, while allografts have included fascia lata and gracilis tendon allografts. Questions/Purposes: As allografts are not always readily available and have some inherent disadvantages, the aims of this systematic review were to assess (1) indications for labral reconstruction and (2) summarize outcomes, complications, and reoperation rates after arthroscopic labral reconstruction with autografts. Methods: A systematic review of the literature was performed using six databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar) to identify studies reporting outcomes for arthroscopic labral reconstruction utilizing autografts, with a minimum follow-up of 1 year. Study design, patient demographics, autograft choice, complications, donor site morbidity, reoperation rates, conversion to arthroplasty, and patient reported outcomes were extracted and reported. Results: Seven studies were identified for inclusion with a total of 402 patients (173 females, age range 16–72, follow-up range 12–120 months). The most commonly reported functional outcome score was the modified Harris Hip Score (mHHS), which was reported in six of seven studies. Preoperative mHHS ranged from 56 to 67.3 and improved postoperatively to a range of 81.4–97.8. Conversion to total hip arthroplasty and reoperation rates ranged from 0 to 13.2% and 0 to 11%, respectively. The most common indication for labral reconstruction was an irreparable labrum. Autografts utilized included ITB, hamstring tendons, indirect head of rectus femoris, and capsular tissue. Conclusions: Arthroscopic autograft reconstruction of the acetabular labrum results in significant improvement in the short- and mid-term patient reported outcomes, for properly selected patients presenting with pain and functional limitation in the hip due to an irreparable labral injury.
Collapse
Affiliation(s)
- Felipe S Bessa
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil.,Division of Young Adult Hip Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Brady T Williams
- Division of Young Adult Hip Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Evan M Polce
- Division of Young Adult Hip Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Mansueto Neto
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil.,Physioterapy Research Group, Bahia Federal University, Salvador, Brazil
| | - Flávio L Garcia
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil.,Division of Young Adult Hip Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States.,Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Gustavo Leporace
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil.,Imaging Diagnostic Department, São Paulo Federal University, São Paulo, Brazil
| | - Leonardo Metsavaht
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil.,Imaging Diagnostic Department, São Paulo Federal University, São Paulo, Brazil
| | - Jorge Chahla
- Division of Young Adult Hip Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| |
Collapse
|
13
|
Saiyed A, Datta D. A Middle-Aged Woman With Hematochezia, Hypotension, and Leg Cramps. Chest 2020; 158:e21-e24. [PMID: 32654734 DOI: 10.1016/j.chest.2020.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
CASE PRESENTATION A 57-year-old woman with a history of mantle cell lymphoma presented to the ED with complaints of vomiting, bleeding per rectum, and leg cramps, that started 6 h prior to her arrival. She had received chemotherapy a week prior. Her leg cramps were not associated with pain or swelling of the legs; she also denied any trauma to the legs. She did complain of mild lower abdominal pain at presentation. Review of systems was negative for fever, chills, diarrhea, chest pain, and dizziness. She denied using alcohol or nonsteroidal anti-inflammatory drugs. The patient was tachycardic with a systolic BP (SBP) of 85 mm Hg and was administered 1-L normal saline, with improvement in her SBP to 90 mm Hg. The hematocrit level was 24%, the WBC count was 0.3 × 109/L, and the platelet count was 6 × 109/L in the ED. On arrival in the ICU, she was noted to have an SBP of 70 mm Hg. Resuscitation with IV fluids was initiated, followed by transfusion of packed RBCs and platelets, based on the blood counts. Despite aggressive fluid resuscitation and improvement in her hemoglobin, the patient remained persistently hypotensive. The diagnosis of underlying septic shock because of neutropenia was considered; the patient was started on vasopressors and empirical broad-spectrum antibiotics, with improvement in her BP. After this, the patient was sent to radiology for a CT scan of the abdomen and pelvis with contrast to evaluate for mesenteric infarction, enteric or colonic bleeding, and the need for arterial embolization.
Collapse
Affiliation(s)
- Alifaiz Saiyed
- Department of Internal Medicine, University of CT Health Center, Farmington, CT
| | - Debapriya Datta
- Division of Pulmonary & Critical Care Medicine, University of CT Health Center, Farmington, CT.
| |
Collapse
|
14
|
Juels CA, So E, Seidenstricker C, Holmes J, Scott RT. Complications of En Bloc Osteochondral Talar Allografts and Treatment of Failures: Literature Review and Case Report. J Foot Ankle Surg 2020; 59:149-155. [PMID: 31753570 DOI: 10.1053/j.jfas.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/20/2019] [Indexed: 02/03/2023]
Abstract
Reoperation rates and complication rates can be high for patients receiving an osteochondral talar allograft transplant. Complications can include graft failure, delamination of the graft, arthrofibrosis, advancing osteoarthritis, nonunion of malleolar osteotomies, and partial or complete osteonecrosis of the talus. Graft failure refers to failure of graft incorporation with subsequent necrosis and subsidence. Treatment options for talar graft failure are limited, and outcomes for these treatments have rarely been reported. We present a review of the published data on the complications and treatments for failed talar allograft transplantation. A case report is presented on a young woman who experienced graft failure and osteonecrosis of her talar allograft transplant. Because of the size of the present osteonecrosis, an ankle arthrodesis was performed as the initial revision procedure. Talar necrosis was removed and revascularized from the ankle fusion with solid fusion was confirmed with computed tomography. Symptomatic adjacent joint pain quickly developed in the hindfoot after the ankle fusion, and 12 months later an ankle fusion conversion to total ankle arthroplasty was performed. The patient has returned to normal activity with significant reduction in pain at most recent follow-up visit. This patient was followed for 7 years from initial osteochondral talar allograft transplantation and for 2 years from conversion of ankle fusion to total ankle arthroplasty. It is important to understand the techniques, indications, and outcomes for the various revision options for talar allograft failure. This case report illustrates how multiple revision options can be used to provide the best outcome for the patient.
Collapse
Affiliation(s)
- Christopher A Juels
- Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ.
| | - Eric So
- Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ
| | | | | | - Ryan T Scott
- Director, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ
| |
Collapse
|
15
|
Das M, Mayilsamy K, Mohapatra SS, Mohapatra S. Mesenchymal stem cell therapy for the treatment of traumatic brain injury: progress and prospects. Rev Neurosci 2020; 30:839-855. [PMID: 31203262 DOI: 10.1515/revneuro-2019-0002] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/05/2019] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of injury-related mortality and morbidity in the USA and around the world. The survivors may suffer from cognitive and memory deficits, vision and hearing loss, movement disorders, and different psychological problems. The primary insult causes neuronal damage and activates astrocytes and microglia which evokes immune responses causing further damage to the brain. Clinical trials of drugs to recover the neuronal loss are not very successful. Regenerative approaches for TBI using mesenchymal stem cells (MSCs) seem promising. Results of preclinical research have shown that transplantation of MSCs reduced secondary neurodegeneration and neuroinflammation, promoted neurogenesis and angiogenesis, and improved functional outcome in the experimental animals. The functional improvement is not necessarily related to cell engraftment; rather, immunomodulation by molecular factors secreted by MSCs is responsible for the beneficial effects of this therapy. However, MSC therapy has a few drawbacks including tumor formation, which can be avoided by the use of MSC-derived exosomes. This review has focused on the research works published in the field of regenerative therapy using MSCs after TBI and its future direction.
Collapse
Affiliation(s)
- Mahasweta Das
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA.,Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Karthick Mayilsamy
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA.,Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Shyam S Mohapatra
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA.,Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Subhra Mohapatra
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA.,Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| |
Collapse
|
16
|
Perumal R, Valleri DP, Gessesse MT, Jayaramaraju D, Rajasekaran S. Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:435-440. [DOI: 10.1007/s00590-019-02584-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
|
17
|
Ribeiro VST, Kraft L, Suss PH, Cieslinski J, Wollmann LC, Tuon FF. Anaerobic bioburden in transport solution of human cardiovascular tissues. J Microbiol Methods 2019; 166:105723. [PMID: 31526821 DOI: 10.1016/j.mimet.2019.105723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Abstract
Although reports of infections caused by anaerobes after tissue transplantation are uncommon, contamination of allografts may result in substantial complications. Anaerobic incubation and testing of organ transport solution (TS) are not routine. The aim of this study was to determine the bioburden of strict anaerobic bacteria and oxygen tension of heart-TS. Forty TS from different donors were evaluated cultured using membrane filtration (MF), direct inoculation on broth and automated blood culture bottle (ABCB). Bacterial identification was performed by MALDI-TOF. The transport conditions were simulated to verify the bacterial recovery. A sterile bag fulfilled with 250 ml-1 of sterile saline was spiked with 100 CFU ml-1 of Clostridium perfringens and the fluid recovered 0 h, 1 h, 2 h, 6 h, 12 h, 24 h and 48 h for culture and oxygen measurement. Strict anaerobic bacteria were not isolated in heart-TS. The recovery of C.perfringens spiked in heart-TS was 100% using automated blood culture bottles. MF method detected >100 CFU only after 6 h of spiking. The manual culture was not able to recover C.perfringens after the process. The percentage of O2 measures varied from 77.6 to 87.9%. MF or ABCB are better than direct inoculation for recovery of anaerobes from heart-TS. Although all samples from heart donors were negative for anaerobes (probably due to low incidence of contamination), C.perfringens were all recovered in the simulated transport condition.
Collapse
Affiliation(s)
- Victoria Stadler Tasca Ribeiro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná 80215-901, Brazil
| | - Letícia Kraft
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná 80215-901, Brazil
| | - Paula Hansen Suss
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná 80215-901, Brazil
| | - Juliette Cieslinski
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná 80215-901, Brazil
| | | | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná 80215-901, Brazil; Human Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná 80215-901, Brazil.
| |
Collapse
|
18
|
Cells, soluble factors and matrix harmonically play the concert of allograft integration. Knee Surg Sports Traumatol Arthrosc 2019; 27:1717-1725. [PMID: 30291395 DOI: 10.1007/s00167-018-5182-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/20/2018] [Indexed: 01/05/2023]
Abstract
Implantation of allograft tissues has massively grown over the last years, especially in the fields related to sports medicine. Beside the fact that often no autograft option exists, autograft related disadvantages as donor-site morbidity and prolonged operative time are drastically reduced with allograft tissues. Despite the well documented clinical success for bone allograft procedures, advances in tissue engineering raised the interest in meniscus, osteochondral and ligament/tendon allografts. Notably, their overall success rates are constantly higher than 80%, making them a valuable treatment option in orthopaedics, especially in knee surgery. Complications reported for allografting procedures are a small risk of disease transmission, immunologic rejection, and decreased biologic incorporation together with nonunion at the graft-host juncture and, rarely, massive allograft resorption. Although allografting is a successful procedure, improved techniques and biological knowledge to limit these pitfalls and maximize graft incorporation are needed. A basic understanding of the biologic processes that affect the donor-host interactions and eventual incorporation and remodelling of various allograft tissues is a fundamental prerequisite for their successful clinical use. Further, the importance of the interaction of immunologic factors with the biologic processes involved in allograft incorporation has yet to be fully dissected. Finally, new tissue engineering techniques and use of adjunctive growth factors, cell based and focused gene therapies may improve the quality and uniformity of clinical outcomes. The aim of this review is to shed light on the biology of meniscus, osteochondral and ligament/tendon allograft incorporation and how collection and storage techniques may affect graft stability and embodiment.Level of evidence V.
Collapse
|
19
|
Pereira H, Fatih Cengiz I, Gomes S, Espregueira-Mendes J, Ripoll PL, Monllau JC, Reis RL, Oliveira JM. Meniscal allograft transplants and new scaffolding techniques. EFORT Open Rev 2019; 4:279-295. [PMID: 31210969 PMCID: PMC6549113 DOI: 10.1302/2058-5241.4.180103] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical management of meniscal injuries has changed radically in recent years. We have moved from the model of systematic tissue removal (meniscectomy) to understanding the need to preserve the tissue.Based on the increased knowledge of the basic science of meniscal functions and their role in joint homeostasis, meniscus preservation and/or repair, whenever indicated and possible, are currently the guidelines for management.However, when repair is no longer possible or when facing the fact of the previous partial, subtotal or total loss of the meniscus, meniscus replacement has proved its clinical value. Nevertheless, meniscectomy remains amongst the most frequent orthopaedic procedures.Meniscus replacement is currently possible by means of meniscal allograft transplantation (MAT) which provides replacement of the whole meniscus with or without bone plugs/slots. Partial replacement has been achieved by means of meniscal scaffolds (mainly collagen or polyurethane-based). Despite the favourable clinical outcomes, it is still debatable whether MAT is capable of preventing progression to osteoarthritis. Moreover, current scaffolds have shown some fundamental limitations, such as the fact that the newly formed tissue may be different from the native fibrocartilage of the meniscus.Regenerative tissue engineering strategies have been used in an attempt to provide a new generation of meniscal implants, either for partial or total replacement. The goal is to provide biomaterials (acellular or cell-seeded constructs) which provide the biomechanical properties but also the biological features to replace the loss of native tissue. Moreover, these approaches include possibilities for patient-specific implants of correct size and shape, as well as advanced strategies combining cells, bioactive agents, hydrogels or gene therapy.Herein, the clinical evidence and tips concerning MAT, currently available meniscus scaffolds and future perspectives are discussed. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180103.
Collapse
Affiliation(s)
- Hélder Pereira
- Orthopedic Department of Póvoa de Varzim - Vila do Conde Hospital Centre, Vila do Conde, Portugal
- Ripoll y De Prado Sports Clinic, Murcia-Madrid, FIFA Medical Centre of Excellence, Madrid, Spain
- International Centre of Sports Traumatology of the Ave, Vila do Conde, Portugal
- 3Bs Research Group, I3Bs, Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ibrahim Fatih Cengiz
- 3Bs Research Group, I3Bs, Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sérgio Gomes
- International Centre of Sports Traumatology of the Ave, Vila do Conde, Portugal
| | - João Espregueira-Mendes
- 3Bs Research Group, I3Bs, Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
- Orthopedic Department, University of Minho, Braga, Portugal
| | - Pedro L. Ripoll
- Ripoll y De Prado Sports Clinic, Murcia-Madrid, FIFA Medical Centre of Excellence, Madrid, Spain
| | - Joan C. Monllau
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rui L. Reis
- 3Bs Research Group, I3Bs, Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal
| | - J. Miguel Oliveira
- 3Bs Research Group, I3Bs, Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Barco, Guimarães, Portugal
- ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal
| |
Collapse
|
20
|
Italian consensus statement for the use of allografts in ACL reconstructive surgery. Knee Surg Sports Traumatol Arthrosc 2019; 27:1873-1881. [PMID: 29860601 DOI: 10.1007/s00167-018-5003-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Graft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the "Allografts for Anterior Cruciate Ligament Reconstruction" consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making. METHODS In March 2017, a formal consensus process was developed using a modified Delphi technique method, involving a steering group (9 participants), a rating group (28 participants) and a peer-review group (31 participants). Nine statements were generated and then debated during a SIGASCOT consensus meeting. A manuscript has been then developed to report methodology and results of the consensus process and finally approved by all steering group members. RESULTS A different level of consensus has been reached among the topics selected. Strong agreement has been reported in considering harvesting, treatment and conservation methods relevant for clinical results, and in considering biological integration longer in allograft compared to autograft. Relative agreement has been reported in using allograft as the first-line graft for revision ACL-R, in considering biological integration a crucial aspect for rehabilitation protocol set-up, and in recommending a delayed return to sport when using allograft. Relative disagreement has been reported in using allograft as the first-line graft for primary ACL-R in patients over 50, and in not considering clinical results of allograft superior to autograft. Strong disagreement has been reported in using allograft as the first-line graft for primary ACL-R and for skeletally immature patients. CONCLUSIONS Results of this consensus do not represent a guideline for surgeons, but could be used as starting point for an international discussion on use of allografts in ACL-R. LEVEL OF EVIDENCE IV, consensus of experts.
Collapse
|
21
|
Hulet C, Sonnery-Cottet B, Stevenson C, Samuelsson K, Laver L, Zdanowicz U, Stufkens S, Curado J, Verdonk P, Spalding T. The use of allograft tendons in primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:1754-1770. [PMID: 30830297 DOI: 10.1007/s00167-019-05440-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. METHODS The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. RESULTS Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. CONCLUSION When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. LEVELS OF EVIDENCE III.
Collapse
Affiliation(s)
- Christophe Hulet
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Ciara Stevenson
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Kristian Samuelsson
- Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lior Laver
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Urszula Zdanowicz
- Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA, 15219-3110, USA
| | - Sjoerd Stufkens
- Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jonathan Curado
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Peter Verdonk
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK.
| |
Collapse
|
22
|
Zahra S, Galea G, Jashari R, Petit P, de By TMMH. Validation of microbiological testing in cardiovascular tissue establishments: results of a second international quality-round trial. Eur J Clin Microbiol Infect Dis 2019; 38:1481-1490. [DOI: 10.1007/s10096-019-03576-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
|
23
|
Abstract
The number of individuals affected by acute kidney injury (AKI) and chronic kidney disease (CKD) is constantly rising. In light of the limited availability of treatment options and their relative inefficacy, cell based therapeutic modalities have been studied. However, not many efforts are put into safety evaluation of such applications. The aim of this study was to review the existing published literature on adverse events reported in studies with genetically modified cells for treatment of kidney disease. A systematic review was conducted by searching PubMed and EMBASE for relevant articles published until June 2018. The search results were screened and relevant articles selected using pre-defined criteria, by two researchers independently. After initial screening of 6894 abstracts, a total number of 97 preclinical studies was finally included for full assessment. Of these, 61 (63%) presented an inappropriate study design for the evaluation of safety parameters. Only 4 studies (4%) had the optimal study design, while 32 (33%) showed sub-optimal study design with either direct or indirect evidence of adverse events. The high heterogeneity of studies included regarding cell type and number, genetic modification, administration route, and kidney disease model applied, combined with the consistent lack of appropriate control groups, makes a reliable safety evaluation of kidney cell-based therapies impossible. Only a limited number of relevant studies included looked into essential safety-related outcomes, such as inflammatory (48%), tumorigenic and teratogenic potential (12%), cell biodistribution (82%), microbiological safety with respect to microorganism contamination and latent viruses' reactivation (1%), as well as overall well-being and animal survival (19%). In conclusion, for benign cell-based therapies, well-designed pre-clinical studies, including all control groups required and good manufacturing processes securing safety, need to be done early in development. Preferably, this should be performed side by side with efficacy evaluation and according to the official guidelines of leading health organizations.
Collapse
|
24
|
No association between positive intraoperative allograft cultures and infection rates after reconstructive knee ligament surgery. Knee 2018; 25:1129-1133. [PMID: 30414787 DOI: 10.1016/j.knee.2018.08.012] [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] [Received: 02/21/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several reports of severe infections associated with allograft tissue in knee reconstructive surgery have led many surgeons to consider routine intraoperative culture of allograft tissue before implantation. Thus, the purpose of this study was to determine the prevalence of positive soft tissue allograft cultures in reconstructive knee surgery, and evaluate its association with surgical site infection. METHODS Retrospective study of 202 patients who underwent knee reconstructive ligament surgeries, including revisions, between January 2013 and July 2017. Intraoperative culture results were obtained and the report of a surgical site infection during follow-up was recorded. Patients without cultures were excluded. A priori power analysis was performed. The association between positive culture results and development of surgical site infection was evaluated using Fisher's Exact test (P < 0.05). RESULTS A total of 300 allografts were implanted in 202 patients. Mean average follow-up was 32.9 ± 12.5 (range 13 to 57.9) months. Sixteen patients had positive intraoperative allograft cultures (7.9%). The most frequently isolated organism was Bacillus species (six cultures); none of these patients presented with clinical signs of infection. Nine patients developed surgical site infections and were treated with oral antibiotics, and one patient developed septic arthritis that required surgical debridement of the implanted graft; all of these patients had a negative soft tissue allograft culture. No significant association was found between a positive culture and surgical site infection (P = 0.43). CONCLUSION There was no apparent association between positive intraoperative irradiated soft tissue allograft cultures and surgical site infection in reconstructive knee surgery.
Collapse
|
25
|
Montagner G, Trojan D, Cogliati E, Manea F, Vantini A, Paolin A. Stability analysis of the antibiotic cocktail used by Treviso Tissue Bank Foundation for tissues decontamination. Cell Tissue Bank 2018; 19:721-726. [PMID: 30206741 DOI: 10.1007/s10561-018-9725-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023]
Abstract
Although careful donor selection reduces tissue contamination, close microbiological control of harvested allografts remains a key task of tissue banks. To guarantee the safety of human tissues for allograft transplantation, a decontamination regimen must be adopted which, as recommended by European guidelines, is active against the majority of microorganisms isolated in tissues. Antibiotic decontamination methods differ from one tissue bank to another in terms of antimicrobial agents, temperature and length of exposure. After identifying the most effective antibiotics against the bacterial strains most commonly isolated in allografts, Treviso Tissue Bank Foundation demonstrated the efficacy of an antibiotic cocktail for tissue decontamination containing Gentamicin, Vancomycin and Meropenem. The aim of this study was to analyse the degradation kinetics of the three antibiotics according to preparation method and use. The results show that only Meropenem is unstable at + 4 °C, while Gentamicin and Vancomycin are valid for over 10 days. We thus established to add Meropenem before the start of the tissue decontamination phase.
Collapse
|
26
|
Zhang N, Ma L, Liu X, Jiang X, Yu Z, Zhao D, Zhang L, Zhang C, Huang F. In vitro and in vivo evaluation of xenogeneic bone putty with the carrier of hydrogel derived from demineralized bone matrix. Cell Tissue Bank 2018; 19:591-601. [PMID: 29974309 DOI: 10.1007/s10561-018-9708-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
The demineralized bone matrix (DBM) putty is a traditional bone graft utilized to facilitate the repair and reconstruction of bone. Recent studies indicated the DBM putties with the various carriers were different in bone repairing ability. In order to prepare a kind of DBM putty with a good biocompatibility and bioactivity, the DBM gel was processed from the DBM and the feasibility as a carrier for the DBM putty was evaluated. After the bovine DBM gel was prepared, the BMPs content as well as the ability to promote osteogenic differentiation of MC3T3-E1 cells in vitro were investigated. Then the DBM putty was prepared and filled into the rat calvarial defect model to evaluate the bone repairing ability by micro-CT and histology. The result showed there was 2.953 ± 0.054 ng BMP contained in per gram of the DBM gel. And the ALP production of MC3T3-E1 cells in the DBM gels group increased with prolonged culturing, the mineralized nodules formed in MC3T3-E1 cells on 14th day after co-culture. The putty prepared by DBM gel was easy to handle without loss of DBM particles at room temperature. In the rat calvarial bone defect experiment, histological observation showed more mature bone formed in the DBM putty group than that in the type I collagen group at 12 weeks, which indicated the bone putty prepared by DBM gel exhibited a better bone repair capability.
Collapse
Affiliation(s)
- Naili Zhang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Lina Ma
- Department of Diagnostics, School of Medicine, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Xiaowei Liu
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Xiaorui Jiang
- Department of Hand and Foot Surgery, Yuhuangding Hospital, 20 Yuhuangding East Road, Zhifu, Yantai, 264000, China
| | - Zhenhai Yu
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Dongmei Zhao
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Luping Zhang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Chunlei Zhang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Fei Huang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China.
| |
Collapse
|
27
|
Mirabet V, Melero A, Ocete MD, Bompou D, Torrecillas M, Carreras JJ, Valero I, Marqués AI, Medina R, Larrea LR, Arbona C, Garrigues TM, Gimeno C. Effect of freezing and storage temperature on stability and antimicrobial activity of an antibiotic mixture used for decontamination of tissue allografts. Cell Tissue Bank 2018; 19:489-497. [DOI: 10.1007/s10561-018-9693-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/17/2018] [Indexed: 01/05/2023]
|
28
|
Moriguchi Y, Lee DS, Chijimatsu R, Thamina K, Masuda K, Itsuki D, Yoshikawa H, Hamaguchi S, Myoui A. Impact of non-thermal plasma surface modification on porous calcium hydroxyapatite ceramics for bone regeneration. PLoS One 2018. [PMID: 29538457 PMCID: PMC5851618 DOI: 10.1371/journal.pone.0194303] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In the physiochemical sciences, plasma is used to describe an ionized gas. Previous studies have implicated plasma surface treatment in the enhancement of hydrophilicity of implanted musculoskeletal reconstructive materials. Hydroxyapatite (HA) ceramics, widely used in bone tissue regeneration, have made great advancements to skeletal surgery. In the present study, we investigate the impact of low-pressure plasma on the interconnected porous calcium hydroxyapatite (IP-CHA) both in vitro and in vivo. Our results indicate that dielectric barrier discharge (DBD) plasma, when used with oxygen, can augment the hydrophilicity of non-porous HA surfaces and the osteoconductivity of the IP-CHA disc via increased water penetration of inner porous structures, as demonstrated through microfocus computed tomography (μCT) assay. In vivo implantation of plasma-treated IP-CHA displayed superior bone ingrowth than untreated IP-CHA. Though plasma-treated IP-CHA did not alter osteoblast cell proliferation, it accelerated osteogenic differentiation of seeded marrow mesenchymal stem cells. In vitro X-ray photoelectron spectroscopy (XPS) revealed that this plasma treatment increases levels of oxygen, rather than nitrogen, on the plasma-treated IP-CHA surface. These findings suggest that plasma treatment, an easy and simple processing, can significantly improve the osteoconductive potential of commonly used artificial bones such as IP-CHA. Further optimization of plasma treatment and longer-term follow-up of in vivo application are required toward its clinical application.
Collapse
Affiliation(s)
- Yu Moriguchi
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Dae-Sung Lee
- Center for Atomic and Molecular Technologies, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
| | - Ryota Chijimatsu
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Khair Thamina
- Department of Neurological Surgery, Weill Cornell Medical College, NY, NY, United States of America
| | - Kazuto Masuda
- Center for Atomic and Molecular Technologies, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
| | - Dai Itsuki
- Center for Atomic and Molecular Technologies, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Hamaguchi
- Center for Atomic and Molecular Technologies, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
| | - Akira Myoui
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Medical Center for Translational Research, Osaka University Hospital, Suita, Osaka, Japan
- * E-mail:
| |
Collapse
|
29
|
Yu A, Prentice HA, Burfeind WE, Funahashi T, Maletis GB. Risk of Infection After Allograft Anterior Cruciate Ligament Reconstruction: Are Nonprocessed Allografts More Likely to Get Infected? A Cohort Study of Over 10,000 Allografts. Am J Sports Med 2018; 46:846-851. [PMID: 29298084 DOI: 10.1177/0363546517745876] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Allograft tissue is frequently used in anterior cruciate ligament reconstruction (ACLR). It is often irradiated and/or chemically processed to decrease the risk of disease transmission, but some tissue is aseptically harvested without further processing. Irradiated and chemically processed allograft tissue appears to have a higher risk of revision, but whether this processing decreases the risk of infection is not clear. PURPOSE To determine the incidence of deep surgical site infection after ACLR with allograft in a large community-based sample and to evaluate the association of allograft processing and the risk of deep infection. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors conducted a cohort study using the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry. Primary isolated unilateral ACLR with allograft were identified from February 1, 2005 to September 30, 2015. Ninety-day postoperative deep infections were identified via an electronic screening algorithm and then validated through chart review. Logistic regression was used to evaluate the likelihood of 90-day postoperative deep infection per allograft processing method: processed (graft treated chemically and/or irradiated) or nonprocessed (graft not irradiated or chemically processed). RESULTS Of 10,190 allograft cases, 8425 (82.7%) received a processed allograft, and 1765 (17.3%) received a nonprocessed allograft. There were 15 (0.15%) deep infections during the study period: 4 (26.7%) coagulase-negative Staphylococcus, 4 (26.7%) methicillin-sensitive Staphylococcus aureus, 1 (6.7%) Peptostreptococcus micros, and 6 (40.0%) with no growth. There was no difference in the likelihood for 90-day deep infection for processed versus nonprocessed allografts (odds ratio = 1.36, 95% CI = 0.31-6.04). CONCLUSION The overall incidence of deep infection after ACLR with allograft tissue was very low (0.15%), suggesting that the methods currently employed by tissue banks to minimize the risk of infection are effective. In this cohort, no difference in the likelihood of infection between processed and nonprocessed allografts could be identified.
Collapse
Affiliation(s)
- Anthony Yu
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, California, USA
| | - Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - William E Burfeind
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Tadashi Funahashi
- Department of Orthopaedics, Southern California Permanente Medical Group, Irvine, California, USA
| | - Gregory B Maletis
- Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, California, USA
| |
Collapse
|
30
|
Keizer MNJ, Hoogeslag RAG, van Raay JJAM, Otten E, Brouwer RW. Superior return to sports rate after patellar tendon autograft over patellar tendon allograft in revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28624854 DOI: 10.1007/s00167-017-4612-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE After revision anterior cruciate ligament reconstruction (ACLR), the rate of return to the pre-injury type of sport (RTS type) is low and graft choice might be an important factor. The aim of this study was to determine whether there is a difference in outcome after revision ACLR using a patellar tendon allograft compared to an ipsilateral patellar tendon autograft. It was hypothesized that the rate of RTS type using an ipsilateral patellar tendon autograft will be superior to using patellar tendon allograft. METHODS The design is a retrospective cohort study. Inclusion criteria were patients who underwent revision ACLR with a minimum follow-up of 1 year after revision using a patellar allograft or ipsilateral autograft. Primary study parameter was rate of RTS type. Secondary study parameters were RTS level, subscores of the KOOS, the IKDCsubjective, the Tegner score and reasons for no RTS. RESULTS Eighty-two patients participated in this study (36 allografts and 46 autografts). In patients with a minimum follow-up of 1 year, rate of RTS type was 51.4% for the patellar tendon allograft and 62.8% for the patellar tendon autograft group (n.s.). In patients with a minimum follow-up rate of 2 years, rate of RTS type was 43.3 versus 75.0%, respectively (p = 0.027). No differences in secondary study parameters were found. In patients with a minimum follow-up of 1 year, rate of RTS type was significantly higher (p = 0.025) for patients without anxiety compared to patients who were anxious to perform certain movements. CONCLUSION After a minimum follow-up of 2 years, rate of RTS type is in favour of using an ipsilateral patellar tendon autograft when compared to using a patellar tendon allograft in patients undergoing revision ACLR; after a minimum follow-up of 1 year, no significant difference was found. In revision ACLR, the results of this study might influence graft choice in favour of autologous graft when the use of an allograft or autograft patellar tendon is considered. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Michèle N J Keizer
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Jos J A M van Raay
- Department of Orthopaedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Egbert Otten
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands.
| |
Collapse
|
31
|
Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction. Infect Control Hosp Epidemiol 2018; 37:827-33. [PMID: 27340734 DOI: 10.1017/ice.2016.65] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.
Collapse
|
32
|
Kikuchi K, Masuda T, Fujiwara N, Kuji A, Miura H, Jung HS, Harada H, Otsu K. Craniofacial Bone Regeneration using iPS Cell-Derived Neural Crest Like Cells. J HARD TISSUE BIOL 2018. [DOI: 10.2485/jhtb.27.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kazuko Kikuchi
- Division of Pediatric and Special Care Dentistry, Department of Oral Health Science, School of Dentistry, Iwate Medical University
- Division of Developmental Biology and Regenerative Medicine, Department of Anatomy, Iwate Medical University
| | - Tomoyuki Masuda
- Division of Developmental Biology and Regenerative Medicine, Department of Anatomy, Iwate Medical University
| | - Naoki Fujiwara
- Division of Developmental Biology and Regenerative Medicine, Department of Anatomy, Iwate Medical University
| | - Akiyoshi Kuji
- Division of Pediatric and Special Care Dentistry, Department of Oral Health Science, School of Dentistry, Iwate Medical University
| | - Hiroyuki Miura
- Division of Dental Education, Department of Oral Medicine, School of Dentistry, Iwate Medical University
| | - Han-Sung Jung
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Oral Science Research Center, BK21 PLUS Project, Yonsei University College of Dentistry
- Oral Biosciences, Faculty of Dentistry, The University of Hong Kong
| | - Hidemitsu Harada
- Division of Developmental Biology and Regenerative Medicine, Department of Anatomy, Iwate Medical University
| | - Keishi Otsu
- Division of Developmental Biology and Regenerative Medicine, Department of Anatomy, Iwate Medical University
| |
Collapse
|
33
|
Abstract
Bone banks are responsible for the collection, production, testing, packaging, storage and delivery of osseous grafts. In compliance with legal and quality requirements, it is their main task to ensure the biological properties and the microbiological safety of the transplants as well. German legal requirements for bone banking are explained and current standards with respect to donor selection, laboratory tests and tissue processing, as well as labeling are discussed. Production and preparation procedures should include a validated microbiological inactivation method that largely preserves the biological properties of the tissue.
Collapse
Affiliation(s)
- A Pruß
- Universitätsgewebebank, Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - U Kalus
- Universitätsgewebebank, Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| |
Collapse
|
34
|
|
35
|
Leow-Dyke SF, Rooney P, Kearney JN. The efficacy and sterilisation of human decellularised dermal allografts with combinations of cupric ions and hydrogen peroxide. Cell Tissue Bank 2017; 18:561-572. [PMID: 28952000 DOI: 10.1007/s10561-017-9660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
Decellularised tissue allografts have been used in reconstructive surgical applications and transplantation for many years. Some of the current methods of sterilisation have a detrimental effect on the tissue graft structure and function. The anti-microbial activity of cupric ions and hydrogen peroxide (H2O2) are well known however their combined application is not currently utilised as a decontamination agent in the tissue banking world sector. The aim of this study was to determine the combined concentrations of copper chloride (CuCl2) and H2O2 that have the optimal bactericidal and sporicidal activity on decellularised (dCELL) human dermis. The first part of this study established the decimal reduction time (D-value) of CuCl2 (0.1 mg/L and 1 mg/L) together with H2O2 (0.01, 0.1, 0.5 and 1%) for Staphylococcus epidermidis, Escherichia coli and Bacillus subtilis spores. The second part of this study identified the most effective CuCl2 and H2O2 concentration that decontaminated dCELL human dermis inoculated with these pathogens. Of all the concentrations tested, 0.1 mg/L CuCl2 in combination with 1% H2O2 had the shortest D-value; S. epidermidis D = 3.15 min, E. coli D = 2.62 min and B. subtilis spores D = 18.05 min. However when adsorbed onto dCELL dermis, S. epidermidis and E. coli were more susceptible to 1 mg/L CuCl2 together with 0.5% H2O2. These studies show promise of CuCl2-H2O2 formulations as potential sterilants for decellularised dermal allografts.
Collapse
Affiliation(s)
- S F Leow-Dyke
- NHS Blood and Transplant, Tissue Services R&D, Liverpool, UK. .,Public Health England, Manchester Medical Microbiology Partnership, Manchester, UK.
| | - P Rooney
- NHS Blood and Transplant, Tissue Services R&D, Liverpool, UK
| | - J N Kearney
- NHS Blood and Transplant, Tissue Services R&D, Liverpool, UK
| |
Collapse
|
36
|
Denaro V, Longo UG, Salvatore G, Candela V, Maffulli N. Subcutaneous emphysema of the leg after hardware removal and bone allografting for infected non-union of the distal femur. BMC Musculoskelet Disord 2017; 18:351. [PMID: 28810893 PMCID: PMC5558669 DOI: 10.1186/s12891-017-1706-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/02/2017] [Indexed: 11/12/2022] Open
Abstract
Background Infected non-unions of the supracondylar region of the femur are uncommon. Even though hardware removal is a common procedure, it may lead to complications, including neurovascular injury, refracture, worsening pain or recurrence of deformity. Case presentation We report on a male who developed subcutaneous emphysema of the leg after hardware removal and bone allografting for an infected non-union of the distal femur. He was managed by debridement of the surgical wound, antibiotic therapy, multiple fasciotomies, and application of a VAC (vacuum-assisted closure) system. Conclusions Although subcutaneous emphysema of the leg after hardware removal and bone allografting for infected non-union of the distal femur is extremely rare, the potential life treating complications and their potential impact on the functional status of the patient have to be taken into consideration when counseling patients about this procedure. Even when it is not possible to identify a bacterial pathogen responsible for the subcutaneous emphysema of the leg, prompt intervention may save the limb of the patient.
Collapse
Affiliation(s)
- Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.,University of Salerno School of Medicine, Salerno, Italy
| |
Collapse
|
37
|
Schmidt S, Schulte A, Schwarz S, Hofmann N, Tietz S, Boergel M, Sixt SU. Fresh osteochondral allografts-procurement and tissue donation in Europe. Injury 2017; 48:1296-1301. [PMID: 28551055 DOI: 10.1016/j.injury.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fresh osteochondral allografts are a well-established treatment for large, full-thickness cartilage defects. The clinical outcome for carefully selected patients is very favorable, especially for the young and active and graft survival up to 25 years has been described in the literature. Furthermore, a high patient satisfaction rate has been reported, but the biggest obstacle to overcome is the availability of tissue for transplantation. Large fresh bone allografts for cartilage damage repair only can be harvested from organ donors following organ removal or cadaveric donors, preferably in the setting of an operation room to minimize possible contamination of the tissue. Apart from the logistic challenges this entails, an experienced recovery team is needed. Furthermore, the public as well as medical staff is much less aware of the possibility and requirements of tissue donation than organ donation and families of deceased are rarely approached for bone and cartilage donation. This review aims to highlight the current situation of organ and tissue donation in Europe with special focus on the processing of bones and possible safety and quality concerns. We analyze what may prevent consent and what might be done to improve the situation of tissue donation.
Collapse
Affiliation(s)
- S Schmidt
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany.
| | - A Schulte
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - S Schwarz
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - N Hofmann
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - S Tietz
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - M Boergel
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - S U Sixt
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany; Clinic for Anesthesiology, University Hospital of Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| |
Collapse
|
38
|
Ali Akbari Ghavimi S, Tata RR, Greenwald AJ, Allen BN, Grant DA, Grant SA, Lee MW, Ulery BD. Controlled Ion Release from Novel Polyester/Ceramic Composites Enhances Osteoinductivity. AAPS JOURNAL 2017; 19:1029-1044. [DOI: 10.1208/s12248-017-0072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/28/2017] [Indexed: 02/01/2023]
|
39
|
Colaço HB, Lord BR, Back DL, Davies AJ, Amis AA, Ajuied A. Biomechanical properties of bovine tendon xenografts treated with a modern processing method. J Biomech 2017; 53:144-147. [DOI: 10.1016/j.jbiomech.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
|
40
|
Hangody G, Szebényi G, Abonyi B, Kiss R, Hangody L, Pap K. Does a different dose of gamma irradiation have the same effect on five different types of tendon allografts? - a biomechanical study. INTERNATIONAL ORTHOPAEDICS 2016; 41:357-365. [PMID: 27847977 DOI: 10.1007/s00264-016-3336-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The goals of our study were to evaluate the biomechanical differences between five tendons and the changes in biomechanical properties caused by irradiation. METHODS Achilles, quadriceps, semitendinosus + gracilis (STG), tibialis anterior (TA) and the peroneus longus (PL) were harvested from 30 donors. Group A contained 50 tendons without gamma irradiation. The groups were irradiated with a dose of 21 kGy (group B 50 tendons) and with a dose of 42 kGy (group C 50 tendons). The grafts were soaked in a radio-protectant solution and frozen at -80 °C. Cyclic loading tests were performed followed by load to failure tests. Young modulus of elasticity, maximum force, strain at tensile strength and strain at rupture were calculated. RESULTS The Achilles tendons had significantly lower Young modulus than the TA (p = 0.0036) in group A. The Achilles showed significantly lower than PL (p = 0.000042) and TA (p = 0.00142) in group B and C. The quadriceps and the ST (p = 0.0037) provided poorer values than the TA (p = 0.0432) in group C. We found no difference in maximum loads among the tendons in group A. The maximum load of the Achilles and quadriceps showed better results than the PL (p = 0.0016), (p = 0.0018) and the STG (p = 0.0066), (p = 0.0019) in group C. The TA had similar results like the Achilles and quadriceps. DISCUSSION AND CONCLUSIONS The vulnerability of gamma irradiation of TA was less than Achilles and quadriceps tendons.
Collapse
Affiliation(s)
- Gyorgy Hangody
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary
| | - Gábor Szebényi
- Cooperation Research Center for Biomechanics, Budapest University of Technology and Economics, Bertalan Lajos Street 2, 1111, Budapest, Hungary
| | - Bence Abonyi
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary
| | - Rita Kiss
- Cooperation Research Center for Biomechanics, Budapest University of Technology and Economics, Bertalan Lajos Street 2, 1111, Budapest, Hungary
| | - László Hangody
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary
- Department of Traumatology, Semmelweis University, Uzsoki Street 29-41, 1145, Budapest, Hungary
| | - Károly Pap
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary.
- Department of Traumatology, Semmelweis University, Uzsoki Street 29-41, 1145, Budapest, Hungary.
| |
Collapse
|
41
|
Chou CP, Chou SC, Chen YH, Chen YH, Lee MS. Status quo of management of the human tissue banks in Taiwan. Cell Tissue Bank 2016; 18:69-73. [PMID: 27837287 DOI: 10.1007/s10561-016-9598-x] [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] [Received: 07/05/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
As the technologies associated with transplantation and biological tissue engineering continue to advance, human cells and tissues form an integral part to the practice of regenerative medicine. The patient's use of tissues entails the risk of introducing, transmitting and spreading communicable diseases. To prevent such risk and to ensure that the human organs, tissues and cells remain intact and functional after being handled and processed, the transplanted tissues must be subject to good management standards through all stages of collection, screening, processing, storage and distribution as the safety of the users is of the utmost importance. On February 2009, the government of Taiwan promulgated the Regulations for Administration on Human Organ Bank that requires all human tissues banks to adhere to the Good Tissue Practice for Human Organ, Tissue and Cell in terms of establishment and operation in order to cope with the international management trend and the development and management need of the domestic industry. Six years have passed since the law became effective. This article seeks to introduce the current management mechanism and status quo of management of human tissue banks in Taiwan. We also conducted statistical analysis of the data relating to the tissue banks to identify potential risks and the room for improvement. The study concludes that human tissue banks in Taiwan are on the right track with their management practice, leading to a state of steady development and progress.
Collapse
Affiliation(s)
- Ching-Pang Chou
- Division of Risk Management, Food and Drug Administration, Ministry of Health and Welfare, No.161-2, Kunyang St, Nangang District, Taipei City, 115-61, Taiwan, ROC
| | - Szu-Cheng Chou
- Division of Risk Management, Food and Drug Administration, Ministry of Health and Welfare, No.161-2, Kunyang St, Nangang District, Taipei City, 115-61, Taiwan, ROC.
| | - Ying-Hua Chen
- Division of Risk Management, Food and Drug Administration, Ministry of Health and Welfare, No.161-2, Kunyang St, Nangang District, Taipei City, 115-61, Taiwan, ROC
| | - Yu-Hsuan Chen
- Division of Risk Management, Food and Drug Administration, Ministry of Health and Welfare, No.161-2, Kunyang St, Nangang District, Taipei City, 115-61, Taiwan, ROC
| | - Ming-Shin Lee
- Division of Risk Management, Food and Drug Administration, Ministry of Health and Welfare, No.161-2, Kunyang St, Nangang District, Taipei City, 115-61, Taiwan, ROC
| |
Collapse
|
42
|
Singh R, Singh D, Singh A. Radiation sterilization of tissue allografts: A review. World J Radiol 2016; 8:355-369. [PMID: 27158422 PMCID: PMC4840193 DOI: 10.4329/wjr.v8.i4.355] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/05/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
Tissue substitutes are required in a number of clinical conditions for treatment of injured and diseased tissues. Tissues like bone, skin, amniotic membrane and soft tissues obtained from human donor can be used for repair or reconstruction of the injured part of the body. Allograft tissues from human donor provide an excellent alternative to autografts. However, major concern with the use of allografts is the risk of infectious disease transmission. Therefore, tissue allografts should be sterilized to make them safe for clinical use. Gamma radiation has several advantages and is the most suitable method for sterilization of biological tissues. This review summarizes the use of gamma irradiation technology as an effective method for sterilization of biological tissues and ensuring safety of tissue allografts.
Collapse
|
43
|
Abstract
PURPOSE OF REVIEW The purpose is to review and discuss the fundamentals, indications, surgical technique, controversies, and outcomes regarding meniscal transplantation, focusing on available evidence in pediatric populations. RECENT FINDINGS Recent studies have confirmed meniscal allograft transplantation as an effective procedure to improve symptoms, knee function, and quality of life following meniscectomy, particularly in symptomatic young patients. Associated procedures, such as osteotomies and cartilage-related surgeries, have expanded the indications for transplantation. Most patients return to sports following meniscal transplantation, and the procedure does not preclude the potential return to high-level athletic competition. The chondroprotective effect of transplantation has not been proven and as a result the role of prophylactic transplantation remains unclear. SUMMARY Meniscal allograft transplantation is indicated following symptomatic meniscal loss in young, active patients to relieve pain and improve knee function. The quality of the available evidence regarding meniscal transplantation is limited, and no published series to date has focused exclusively on a pediatric population. Further high-quality studies are needed to establish improved indications, timing, and outcomes in a pediatric population.
Collapse
|
44
|
Non-injected illicit drug use and infectious disease risk of donor tissue: a single institution retrospective review. Cell Tissue Bank 2015; 16:623-9. [PMID: 26006785 DOI: 10.1007/s10561-015-9511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/12/2015] [Indexed: 11/27/2022]
Abstract
This study assessed the relationship of non-injected illicit drug use and infectious disease seropositivity for human immunodeficiency virus (HIV-1), hepatitis B virus (HBV), hepatitis C virus (HCV), and Syphilis. In a retrospective review of 986 donor charts recovered from 2009 to 2011 at a single tissue bank, the absence of reported non-injected illicit drug use corresponded with seropositivity in 6.61 %, of recovered donors while reported illicit drug use in the medical and social history corresponded with seropositivity in 11.25 %, representing a 70 % increased risk. There was no significant difference noted for overall seropositivity rates between types on noninjected illicit drugs, although donors that used cocaine had a higher incidence of HIV, while marijuana use was associated with a higher rate of HBV, HCV, and syphilis positivity. Toxicology screening results were not an accurate predictor of seropositivity (PPV = 3.77 %; NPV = 91.56 %). Further, the degree of relationship between the donor and the next of kin had no bearing on the veracity of actual drug use when comparing the response of the medical-social history and the toxicology screen.
Collapse
|
45
|
Favinger JL, Ha AS, Brage ME, Chew FS. Osteoarticular Transplantation: Recognizing Expected Postsurgical Appearances and Complications. Radiographics 2015; 35:780-92. [DOI: 10.1148/rg.2015140070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
46
|
Abdelgaied A, Stanley M, Galfe M, Berry H, Ingham E, Fisher J. Comparison of the biomechanical tensile and compressive properties of decellularised and natural porcine meniscus. J Biomech 2015; 48:1389-96. [PMID: 25766391 DOI: 10.1016/j.jbiomech.2015.02.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 01/14/2023]
Abstract
Meniscal repair is widely used as a treatment for meniscus injury. However, where meniscal damage has progressed such that repair is not possible, approaches for partial meniscus replacement are now being developed which have the potential to restore the functional role of the meniscus, in stabilising the knee joint, absorbing and distributing stress during loading, and prevent early degenerative joint disease. One attractive potential solution to the current lack of meniscal replacements is the use of decellularised natural biological scaffolds, derived from xenogeneic tissues, which are produced by treating the native tissue to remove the immunogenic cells. The current study investigated the effect of decellularisation on the biomechanical tensile and compressive (indentation and unconfined) properties of the porcine medial meniscus through an experimental-computational approach. The results showed that decellularised medial porcine meniscus maintained the tensile biomechanical properties of the native meniscus, but had lower tensile initial elastic modulus. In compression, decellularised medial porcine meniscus generally showed lower elastic modulus and higher permeability compared to that of the native meniscus. These changes in the biomechanical properties, which ranged from less than 1% to 40%, may be due to the reduction of glycosaminoglycans (GAG) content during the decellularisation process. The predicted biomechanical properties for the decellularised medial porcine meniscus were within the reported range for the human meniscus, making it an appropriate biological scaffold for consideration as a partial meniscus replacement.
Collapse
Affiliation(s)
- A Abdelgaied
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Leeds LS2 9JT, UK.
| | - M Stanley
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Leeds LS2 9JT, UK
| | | | | | - E Ingham
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - J Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Leeds LS2 9JT, UK
| |
Collapse
|
47
|
|
48
|
Huang X, Bai S, Lu Q, Liu X, Liu S, Zhu H. Osteoinductive-nanoscaled silk/HA composite scaffolds for bone tissue engineering application. J Biomed Mater Res B Appl Biomater 2014; 103:1402-14. [DOI: 10.1002/jbm.b.33323] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/05/2014] [Accepted: 11/04/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Xiaowei Huang
- National Engineering Laboratory for Modern Silk & Collaborative Innovation Center of Suzhou Nano Science and Technology; Soochow University; Suzhou 215123 People's Republic of China
| | - Shumeng Bai
- National Engineering Laboratory for Modern Silk & Collaborative Innovation Center of Suzhou Nano Science and Technology; Soochow University; Suzhou 215123 People's Republic of China
| | - Qiang Lu
- National Engineering Laboratory for Modern Silk & Collaborative Innovation Center of Suzhou Nano Science and Technology; Soochow University; Suzhou 215123 People's Republic of China
| | - Xi Liu
- National Engineering Laboratory for Modern Silk & Collaborative Innovation Center of Suzhou Nano Science and Technology; Soochow University; Suzhou 215123 People's Republic of China
| | - Shanshan Liu
- National Engineering Laboratory for Modern Silk & Collaborative Innovation Center of Suzhou Nano Science and Technology; Soochow University; Suzhou 215123 People's Republic of China
| | - Hesun Zhu
- Research Center of Materials Science; Beijing Institute of Technology; Beijing 100081 People's Republic of China
| |
Collapse
|
49
|
Buzzi M, Guarino A, Gatto C, Manara S, Dainese L, Polvani G, Tóthová JD. Residual antibiotics in decontaminated human cardiovascular tissues intended for transplantation and risk of falsely negative microbiological analyses. PLoS One 2014; 9:e112679. [PMID: 25397402 PMCID: PMC4232473 DOI: 10.1371/journal.pone.0112679] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
We investigated the presence of antibiotics in cryopreserved cardiovascular tissues and cryopreservation media, after tissue decontamination with antibiotic cocktails, and the impact of antibiotic residues on standard tissue bank microbiological analyses. Sixteen cardiovascular tissues were decontaminated with bank-prepared cocktails and cryopreserved by two different tissue banks according to their standard operating procedures. Before and after decontamination, samples underwent microbiological analysis by standard tissue bank methods. Cryopreserved samples were tested again with and without the removal of antibiotic residues using a RESEP tube, after thawing. Presence of antibiotics in tissue homogenates and processing liquids was determined by a modified agar diffusion test. All cryopreserved tissue homogenates and cryopreservation media induced important inhibition zones on both Staphylococcus aureus- and Pseudomonas aeruginosa-seeded plates, immediately after thawing and at the end of the sterility test. The RESEP tube treatment markedly reduced or totally eliminated the antimicrobial activity of tested tissues and media. Based on standard tissue bank analysis, 50% of tissues were found positive for bacteria and/or fungi, before decontamination and 2 out of 16 tested samples (13%) still contained microorganisms after decontamination. After thawing, none of the 16 cryopreserved samples resulted positive with direct inoculum method. When the same samples were tested after removal of antibiotic residues, 8 out of 16 (50%) were contaminated. Antibiotic residues present in tissue allografts and processing liquids after decontamination may mask microbial contamination during microbiological analysis performed with standard tissue bank methods, thus resulting in false negatives.
Collapse
Affiliation(s)
- Marina Buzzi
- Cardiovascular Tissue Bank of Emilia-Romagna, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Anna Guarino
- Cardiovascular Tissue Bank of Lombardia, Centro Cardiologico Monzino, Milan, Italy
| | - Claudio Gatto
- Research and Development department, AL.CHI.MI.A. S.r.l., Ponte San Nicolò, Italy
| | - Sabrina Manara
- Cardiovascular Tissue Bank of Emilia-Romagna, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Luca Dainese
- Cardiovascular Tissue Bank of Lombardia, Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Cardiovascular Tissue Bank of Lombardia, Centro Cardiologico Monzino, Milan, Italy
| | - Jana D'Amato Tóthová
- Research and Development department, AL.CHI.MI.A. S.r.l., Ponte San Nicolò, Italy
- * E-mail:
| |
Collapse
|
50
|
DermACELL: a novel and biocompatible acellular dermal matrix in tissue expander and implant-based breast reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014; 37:529-538. [PMID: 25221385 PMCID: PMC4161921 DOI: 10.1007/s00238-014-0995-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/12/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acellular dermal matrices present a new alternative to supporting expanders and implants for breast reconstruction in breast cancer patients following mastectomy. However, some studies have suggested that acellular dermal matrix may increase the complication rates in certain clinical settings. DermACELL acellular dermal matrix offers advanced processing in order to attempt to decrease bio-intolerance and complications. METHODS Ten consecutive patients that presented for breast reconstruction and were candidates for tissue expanders underwent the procedure with the use of an acellular dermal matrix. The patients underwent postoperative expansion/adjuvant cancer therapy, then tissue expander exchange for permanent silicone breast prostheses. Patients were followed through the postoperative course to assess complication outcomes. Histologic evaluation of host integration into the dermal matrix was also assessed. RESULTS Of the ten patients, eight completed reconstruction while two patients failed reconstruction. The failures were related to chronic seromas and infection. Histology analysis confirms rapid integration of mesenchymal cells into the matrix compared to other acellular dermal matrices. CONCLUSIONS Based on our observations, DermACELL is an appropriate adjunct to reconstruction with expanders. Histological analysis of vascularization and recellularization support the ready incorporation of DermACELL into host tissue. Level of Evidence: Level IV, therapeutic study.
Collapse
|