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Fong S, Lee MS, Pettinelli N, Norman M, Park N, Gillinov SM, Zhu J, Gagné J, Lee AY, Mahatme RJ, Jimenez AE. Osteochondral Allograft or Autograft Transplantation of the Femoral Head Leads to Improvement in Outcomes but Variable Survivorship: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00128-2. [PMID: 38365122 DOI: 10.1016/j.arthro.2024.02.008] [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] [Received: 10/07/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To review patient-reported outcomes (PROs) and survivorship in patients undergoing osteochondral autograft or allograft transplantation (OAT) of the femoral head. METHODS PubMed, Cochrane Center for Register of Controlled Trials, and Scopus databases were searched in November 2022 with an updated search extending to December 2023 using criteria from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the following keywords: (hip OR femoral head) AND (mosaicplasty OR osteochondral allograft OR osteochondral autograft OR osteochondral lesion). Articles were included if they evaluated postoperative PROs in patients who underwent OAT of the femoral head and had a study size of 5 or more hips (n ≥ 5). Survivorship was defined as freedom from conversion to total hip arthroplasty. For PROs evaluated in 3 studies or more, forest plots were created and I2 was calculated. RESULTS Twelve studies were included in this review, with a total of 156 hips and a mean follow-up time ranging between 16.8 and 222 months. In total, 104 (66.7%) hips were male while 52 (33.3%) were female. Age of patients ranged from 17.0 to 35.4 years, while body mass index ranged from 23.3 to 28.1. Eight studies reported on osteochondral autograft transplantation and 4 studies on osteochondral allograft transplantation. Three studies reported significant improvement in at least 1 PRO. Survivorship ranged from 61.5% to 96% at minimum 2-year follow-up and from 57.1% to 91% at minimum 5-year follow-up. At a follow-up of less than 5 years, osteochondral allograft transplantation studies showed 70% to 87.5% survivorship, while autograft varied from 61.54% to 96%. CONCLUSIONS Patients with osteochondral lesions of the femoral head who underwent osteochondral autograft or allograft transplantation demonstrated improved PROs but variable survivorship rates. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | | | - Mackenzie Norman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Justin Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jack Gagné
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Amy Y Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
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2
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Tabbaa SM, Guilak F, Sah RL, Bugbee WD. Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature. Am J Sports Med 2022; 50:1702-1716. [PMID: 34310184 DOI: 10.1177/03635465211016832] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Storage procedures and parameters have a significant influence on the health of fresh osteochondral allograft (OCA) cartilage. To date, there is a lack of agreement on the optimal storage conditions for OCAs. PURPOSE To systematically review the literature on (1) experimental designs and reporting of key variables of ex vivo (laboratory) studies, (2) the effects of various storage solutions and conditions on cartilage health ex vivo, and (3) in vivo animal studies and human clinical studies evaluating the effect of fresh OCA storage on osteochondral repair and outcomes. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A systematic review was performed using the PubMed, Embase, and Cochrane databases. The inclusion criteria were laboratory studies (ex vivo) reporting cartilage health outcomes after prolonged storage (>3 days) of fresh osteochondral or chondral tissue explants and animal studies (in vivo) reporting outcomes of fresh OCA. The inclusion criteria for clinical studies were studies (>5 patients) that analyzed the relationship of storage time or chondrocyte viability at time of implantation to patient outcomes. Frozen, cryopreserved, decellularized, synthetic, or tissue-engineered grafts were excluded. RESULTS A total of 55 peer-reviewed articles met the inclusion criteria. Ex vivo studies reported a spectrum of tissue sources and storage solutions and conditions, although the majority of studies lacked complete reporting of key variables, including storage solution formula and environmental conditions. The effect of various conditions (eg, temperature) and storage solutions on cartilage health were inconsistent. Although 60% of animal models suggest that storage time may influence outcomes and 80% indicate inferior outcomes with frozen OCA as compared with fresh OCA, 75% of clinical studies report no correlation between storage time and outcomes. CONCLUSION Given the variability in experimental designs and lack of reporting across studies, it is still not possible to determine optimal storage conditions, although animal studies suggest that storage time and chondrocyte viability influence osteochondral repair outcomes. A list of recommendations was developed to encourage reporting of key variables, such as media formulation, environmental factors, and methodologies used. High-quality clinical data are needed to investigate the effects of storage and graft health on outcomes.
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Affiliation(s)
- Suzanne M Tabbaa
- University of California, San Francisco, San Francisco, California, USA
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3
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Matthews JR, Brutico JM, Abraham DT, Heard JC, Tucker BS, Tjoumakaris FP, Freedman KB. Differences in Clinical and Functional Outcomes Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for the Treatment of Focal Articular Cartilage Defects. Orthop J Sports Med 2022; 10:23259671211058425. [PMID: 35155699 PMCID: PMC8832612 DOI: 10.1177/23259671211058425] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Articular cartilage pathology can result from a spectrum of origins, including trauma, osteochondritis dissecans, avascular necrosis, or degenerative joint disease. Purpose: To compare the differences in clinical and patient-reported outcomes after autologous chondrocyte implantation (ACI) versus osteochondral allograft transplantation (OCA) in patients with focal articular cartilage defects without underlying bone loss. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review identified patients who underwent ACI or OCA between 2008 and 2016 for isolated grades 3 and 4 articular cartilage defects without underlying bone loss. Outcome measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and 12-Item Short Form Health Survey–Physical Component (SF-12-P) scores. Defect location, size, complications, and rate of subsequent surgery were determined. Results: Overall, 148 patients were included: 82 (55%) underwent ACI and 66 (45%) underwent OCA. The mean age at the time of surgery was 31.2 years within the ACI cohort and 37.7 years within the OCA cohort (P < .001); the mean follow-up for both cohorts was 6.7 years (P = .902). Within the ACI group, 28 (34%) patients had multifocal defects, 21 (26%) had defects confined to the femoral condyles, and 33 (40%) had defects in the patellofemoral region. Within the OCA group, 23 (35%) patients had multifocal defects, 30 (46%) had confined femoral condyle lesions, and 13 (20%) had patellofemoral defects. When comparing by lesion location, there were no significant differences in KOOS JR, and IKDC scores between the ACI and OCA cohorts (P < .05). There was, however, a significant difference for SF-12-P scores for FDD trochlear lesions. In both cohorts, traumatic patellofemoral pathology demonstrated lower patient-reported outcomes and higher failure rates than degenerative lesions. The overall rate of failure, defined as graft failure with revision surgery and/or conversion to arthroplasty, was significantly greater in the OCA group (21% vs 4%; P = .002). Conclusion: Study results indicated that ACI provides similar outcomes to OCA with or without concomitant procedures for the treatment of symptomatic articular cartilage defects in all lesion locations and may have a lower revision rate for multifocal and condylar lesions.
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Affiliation(s)
- John R. Matthews
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
| | - Joseph M. Brutico
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Jeremy C. Heard
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bradford S. Tucker
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Kevin B. Freedman
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
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4
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Denbeigh JM, Hevesi M, Paggi CA, Resch ZT, Bagheri L, Mara K, Arani A, Zhang C, Larson AN, Saris DB, Krych AJ, van Wijnen AJ. Modernizing Storage Conditions for Fresh Osteochondral Allografts by Optimizing Viability at Physiologic Temperatures and Conditions. Cartilage 2021; 13:280S-292S. [PMID: 31777278 PMCID: PMC8808875 DOI: 10.1177/1947603519888798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective. Osteochondral allograft (OCA) transplantation has demonstrated good long-term outcomes in treatment of cartilage defects. Viability, a key factor in clinical success, decreases with peri-implantation storage at 4°C during pathogen testing, matching logistics, and transportation. Modern, physiologic storage conditions may improve viability and enhance outcomes. Design. Osteochondral specimens from total knee arthroplasty patients (6 males, 5 females, age 56.4 ± 2.2 years) were stored in media and incubated at normoxia (21% O2) at 22°C or 37°C, and hypoxia (2% O2) at 37°C. Histology, live-dead staining, and quantitative polymerase chain reaction (qPCR) was performed 24 hours after harvest and following 7 days of incubation. Tissue architecture, cell viability, and gene expression were analyzed. Results. No significant viability or gene expression deterioration of cartilage was observed 1-week postincubation at 37°C, with or without hypoxia. Baseline viable cell density (VCD) was 94.0% ± 2.7% at day 1. At day 7, VCD was 95.1% (37°C) with normoxic storage and 92.2% (37°C) with hypoxic storage (P ≥ 0.27). Day 7 VCD (22°C) incubation was significantly lower than both the baseline and 37°C storage values (65.6%; P < 0.01). COL1A1, COL1A2, and ACAN qPCR expression was unchanged from baseline (P < 0.05) for all storage conditions at day 7, while CD163 expression, indicative of inflammatory macrophages and monocytes, was significantly lower in the 37°C groups (P < 0.01). Conclusion. Physiologic storage at 37°C demonstrates improved chondrocyte viability and metabolism, and maintained collagen expression compared with storage at 22°C. These novel findings guide development of a method to optimize short-term fresh OCA storage, which may lead to improved clinical results.
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Affiliation(s)
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Carlo A. Paggi
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Zachary T. Resch
- Center for Regenerative Medicine, Mayo
Clinic, Rochester, MN, USA
| | - Leila Bagheri
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristin Mara
- Department of Biomedical Statistics and
Informatics, Mayo Clinic, Rochester, MN, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Chenghao Zhang
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Daniel B.F. Saris
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Department of Orthopedics, University
Medical Center Utrecht, Utrecht, Netherlands,Reconstructive Medicine, University of
Twente, Enschede, Netherlands
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic,
Rochester, MN, USA
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Andre J. van Wijnen PhD, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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5
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Wissman R, Cook C, Cook JL, Okoye M, Rucisnki K, Stannard JP. Initial Validation of a Modified MRI Scoring System for Assessing Outcomes after Single-Surface Osteochondral Shell Allograft Transplantation in the Knee. J Knee Surg 2021; 36:548-554. [PMID: 34781396 DOI: 10.1055/s-0041-1739202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) provides a reproducible method for imaging-based grading for osteochondral allograft (OCA) transplants. However, the OCAMRISS does not account for larger whole-surface OCA shell grafts, and has not been validated for assessing outcomes after shell OCA transplantation. Therefore, the objective of this study was to evaluate a modified OCAMRISS for assessing single-surface shell OCAs in the knee based on strength of correlations for a modified OCAMRISS score with graft success and patient-reported outcomes for pain and function. With institutional review board approval and informed patient consent, patients who underwent large single-surface shell OCA transplantation and magnetic resonance imaging (MRI) exams at 1-year postsurgery were identified from a prospectively enrolled registry. All patients with a minimum of 2 years of clinical follow-up were included in the present study. A modified OCAMRISS, as well as assessment of the percentage of OCA bone incorporation, was used to score each knee. Two radiologists, blinded to patient demographics and outcomes, reviewed all MRIs together to determine a consensus score for each category and %-incorporation for each OCA. Thirteen patients (7 F, 6 M; mean age = 29.8 ± 9.4; mean body mass index = 27.1 ± 5.8); 8 medial femoral condyle, 4 patella, and 1 medial tibial plateau shell OCAs were evaluated. Mean modified OCAMRISS score was 5.2 ± 2.8, range (2-12) and %-integration was 72.7 ± 33.8, range (0-100). Moderate to strong correlations were noted for 1-year modified OCAMRISS total score with final follow-up (FFU) visual analog scale (VAS) pain (r = +0.58) and Single Assessment Numeric Evaluation (SANE) function (r = -0.7) scores, and for 1-year %-incorporation with FFU VAS pain (r = -0.76) and SANE function (r = +0.83) scores. The modified OCAMRISS total score and %-incorporation assessments determined at 1 year following single-surface shell OCA transplantation correlate well with initial patient outcomes and have clinical applicability for monitoring patients after large-shell OCA transplants in the knee.
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Affiliation(s)
- Robert Wissman
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Cristi Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Munachukwudi Okoye
- Department of Graduate Medical Education, School of Medicine, University of Missouri, Columbia, Missouri
| | - Kylee Rucisnki
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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6
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Patel S, Amirhekmat A, Le R, Williams Iii RJ, Wang D. Osteochondral Allograft Transplantation in Professional Athletes: Rehabilitation and Return to Play. Int J Sports Phys Ther 2021; 16:941-958. [PMID: 34123544 PMCID: PMC8169007 DOI: 10.26603/001c.22085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
For the treatment of large chondral and osteochondral defects of the knee, osteochondral allograft transplantation (OCA) is an effective solution with relatively high rates of return to sport. In professional athletes, rehabilitation following OCA is a critical component of the process of returning the athlete to full sports activity and requires a multidisciplinary team approach with frequent communication between the surgical and rehabilitation teams (physical therapists, athletic trainers, coaching staff). In this review, we describe our five-phase approach to progressive rehabilitation of the professional athlete after OCA, which takes into account the biological processes of healing and optimization of neuromuscular function required for the demands of elite-level sport. The principles of early range of motion, proper progression through the kinetic chain, avoidance of pain and effusion, optimization of movement, regimen individuation, and integration of sports-specific activities underlie proper recovery.
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Affiliation(s)
| | | | - Ryan Le
- University of California Irvine School of Medicine
| | | | - Dean Wang
- University of California Irvine School of Medicine; UCI Health
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7
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Bennett CH, Nadarajah V, Moore MC, Jauregui JJ, Dubina AG, Burt C, Davis DL, Uppal A, Henn RF. Cartiform Implantation for focal cartilage defects in the knee: A 2-year clinical and magnetic resonance imaging follow-up study. J Orthop 2021; 24:135-144. [PMID: 33716418 PMCID: PMC7932855 DOI: 10.1016/j.jor.2021.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/14/2021] [Indexed: 01/18/2023] Open
Abstract
The purpose of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes in patients who underwent cryopreserved viable osteochondral allograft (CVOCA) implantation for focal cartilage defects in the knee at a minimum of 2-years postoperatively. This is a retrospective follow-up study of twelve patients who underwent CVOCA implantation from 2013 to 2015 by a single surgeon for a International Cartilage Repair Society (ICRS) grade 3 or 4 chondral defect. Patient-reported outcome (PRO) measurements and MRI were obtained 2-years postoperatively. Collected PRO measures included: International Knee Documentation Committee (IKDC) form; Visual Analog Scale (VAS) pain score; Veterans RAND 12-Item Health Survey (VR-12); Knee Injury and Osteoarthritis Outcome Score (KOOS); and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Patients completed a standard return to work and sports/recreation survey. A blinded, fellowship-trained musculoskeletal radiologist independently evaluated each MRI to determine the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Mean follow-up was 2.1 years (2.0-2.3). There were 6 women and 6 men with a mean age of 46.2 ± 11.9 years. Mean PRO scores were: IKDC 72.6 ± 17.4; VAS 2.9 ± 2.8; WOMAC 84.2 ± 15.1; KOOS- Pain 83.8 ± 18.5, Symptoms 77.6 ± 16.0, ADL 88.0 ± 16.9, Sports/Rec 67.7 ± 33.3, QOL 54.8 ± 24.2; and VR-12 PCS 45.0 ± 8.5 and MCS 51.1 ± 9.5. The mean MOCART score was 59.5 ± 12.9. To our knowledge, this is the largest study to report clinical and MRI outcomes of CVOCA implantation in the knee. With positive functional outcomes and lack of failures at 2-year follow-up, CVOCA is a promising treatment option for focal chondral defects in the knee. STUDY DESIGN Retrospective case series, Level of evidence 4.
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Affiliation(s)
- Craig H. Bennett
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- LifeBridge Health Sports Medicine Institute, Owings Mills, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Michelle C. Moore
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew G. Dubina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cameran Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Derik L. Davis
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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8
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Moatshe G, LaPrade RF. Editorial Commentary: Knee Lateral Femoral Osteochondral Allografts Are Not Recommended for Medial Femoral Condylar Defects: If the Shoe Doesn't Fit, Don't Wear It! Arthroscopy 2020; 36:2909-2910. [PMID: 33172587 DOI: 10.1016/j.arthro.2020.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023]
Abstract
Treatment of large articular cartilage defects of the knee is challenging, particularly in young, high-demand patients. Osteochondral allograft (OCA) transplantation is a viable treatment option, providing fully mature articular cartilage during a single operation while avoiding donor site morbidity. Indications are symptomatic, full-thickness articular cartilage defects >3 cm2. Contraindications include a "kissing" lesion of the corresponding articular cartilage surface, uncorrected ligamentous instability, malalignment, peripheral osteophytes, joint-space narrowing, or absence of >50% of the meniscus in the affected compartment. Matching for size and contour is crucial; therefore, we use medial femoral condyle (MFC) allografts for MFC lesions and lateral femoral condyle (LFC) allografts for LFC lesions, and do not recommend LFC grafts for the MFC. Survival rates are 78.7% and 72.8% at 10 and 15 years, respectively.
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9
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Vivacqua TA, Prinz RD, Cavanellas N, Barretto JM, de Sousa EB, Aguiar DP. Protocol for Harvest, Transport and Storage of Human Osteochondral Tissue. Rev Bras Ortop 2020; 55:163-169. [PMID: 32346191 PMCID: PMC7186072 DOI: 10.1055/s-0039-3400522] [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: 08/27/2018] [Accepted: 01/22/2019] [Indexed: 11/16/2022] Open
Abstract
Objective
To elaborate a protocol for the harvest, transport, and preservation of human osteochondral tissue for use in tissue banks (TBs).
Methods
Osteochondral fragments measuring 2 cm
3
of 5 corpse donors aged between 15 and 45 years old were analyzed. The samples were stored in cell preservation medium containing: human albumin, Iscove's and vancomycin preserved at 4°C. The concentration of proteoglycans in the extracellular medium was quantified by the use of Safranin-O, while tissue structural analysis was assessed by histological study with hematoxylin-eosin stained slides. The images obtained were analyzed according to the histological scores of Mankin and the score proposed by the OsteoArthritis Research Society International. The samples were analyzed with 0, 15, 30 and 45 days of preservation.
Results
The osteochondral fragments studied showed a progressive decrease in proteoglycan concentration with increased preservation time. After 30 days of preservation, structural changes were identified with discontinuity of the cartilage surface layer. According to the results obtained by the Mankin score, there was a statistically significant difference between 15 and 30 days of tissue preservation.
Conclusion
The protocol described defined knee transport immersed in Lactated Ringer at a controlled temperature of 10° C until its arrival at the TB. After processing, the preservation solution was composed of Iscove's serum-free cell culture medium supplemented with 10% human albumin and 100 μg/ml vancomycin. The tissue was preserved at a temperature of 4°C until the moment of transplantation characterizing the fresh preservation.
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Affiliation(s)
- Thiago Alberto Vivacqua
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Rafael Dantas Prinz
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Naasson Cavanellas
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - João Maurício Barretto
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Eduardo Branco de Sousa
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Diego Pinheiro Aguiar
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
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10
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Chahla J, Sweet MC, Okoroha KR, Nwachukwu BU, Hinckel B, Farr J, Yanke AB, Bugbee WD, Cole BJ. Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review. Am J Sports Med 2019; 47:3009-3018. [PMID: 30525887 DOI: 10.1177/0363546518814236] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The initial focus of cartilage restoration algorithms has been on the femur; however, the patellofemoral compartment accounts for 20% to 30% of significant symptomatic chondral pathologies. While patellofemoral compartment treatment involves a completely unique subset of comorbidities, with a comprehensive and thoughtful approach many patients may benefit from osteochondral allograft treatment. PURPOSE To perform a systematic review of clinical outcomes and failure rates after osteochondral allograft transplantation (OCA) of the patellofemoral joint at a minimum 18-month follow-up. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA for patellofemoral joint chondral defects was performed with the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1990 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCA for the treatment of chondral defects in the patellofemoral joint, English language, minimum follow-up of 18 months, minimum study size of 5 patients, and human studies. The methodological quality of each study was assessed with a modified version of the Coleman methodology score. RESULTS The systematic search identified 8 studies with a total of 129 patients. The methods of graft procurement and storage time included fresh (121 patients, 93.8%), and cryopreserved (8 patients, 6.2%) grafts. The mean survival rate was 87.9% at 5 years and 77.2% at 10 years. The following outcome scores showed significant improvement from pre- to postoperative status: modified d'Aubigné-Postel, International Knee Documentation Committee, Knee Society Score-Function, and Lysholm Knee Score. CONCLUSION OCA of the patellofemoral joint results in improved patient-reported outcome measures with high patient satisfaction rates. Five- and 10-year survival rates of 87.9% and 77.2%, respectively, can be expected after this procedure. These findings should be taken with caution, as a high percentage of patellofemoral osteochondral allografts were associated with concomitant procedures; therefore, further research is warranted to determine the effect of isolated osteochondral transplantations.
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Affiliation(s)
- Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew C Sweet
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | - Betina Hinckel
- Kaiser Permanente Southern California, San Diego, California, USA
| | - Jack Farr
- Cartilage Restoration Center of Indiana, OrthoIndy, Indianapolis, Indiana, USA
| | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
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11
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Jaffe D, Vier D, Royer C. Unipolar allograft reconstruction for post-traumatic avascular necrosis of the distal tibia: A review of the literature, technique, and case series. Foot Ankle Surg 2019; 25:425-433. [PMID: 30321950 DOI: 10.1016/j.fas.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Avascular necrosis of the distal tibial plafond following ankle trauma is an underreported and potentially devastating phenomenon. Beyond conservative treatment options, surgical intervention has been limited to ankle arthrodesis, which sacrifices motion and may have longterm sequellae for adjacent hindfoot joints. Total ankle replacement has been historically contraindicated. Unipolar allograft reconstruction provides an option for joint salvage. We present a literature overview, implantation technique, and two cases utilizing matched unipolar distal tibial allograft. METHODS Two younger patients underwent distal tibia allograft reconstruction for tibial plafond collapse due to post-traumatic avascular necrosis. They were followed to assess for clinical improvement and radiographic graft subsidence. RESULTS Both patients returned to work and activity. One patient had no graft subsidence at four years, but the other patient became symptomatic with graft subsidence at one year. CONCLUSIONS Distal tibia allograft reconstruction can be utilized as a joint salvage surgery for post-traumatic avascular necrosis with collapse of the tibial plafond in younger patients that prefer an alternative to arthrodesis. Results may be mixed and necessitate an engaged, activated patient. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David Jaffe
- Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA.
| | - David Vier
- Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Christian Royer
- Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA
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12
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Familiari F, Cinque ME, Chahla J, Godin JA, Olesen ML, Moatshe G, LaPrade RF. Clinical Outcomes and Failure Rates of Osteochondral Allograft Transplantation in the Knee: A Systematic Review. Am J Sports Med 2018; 46:3541-3549. [PMID: 29039969 DOI: 10.1177/0363546517732531] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cartilage lesions are a significant cause of morbidity and impaired knee function; however, cartilage repair procedures have failed to reproduce native cartilage to date. Thus, osteochondral allograft (OCA) transplantation represents a 1-step procedure to repair large chondral defects without the donor site morbidity of osteochondral autograft transplantation. PURPOSE To perform a systematic review of clinical outcomes and failure rates after OCA transplantation in the knee at a minimum mean 2 years' follow-up. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA transplantation in the knee joint was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1980 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCAs for the treatment of chondral defects in the knee joint, English language, mean follow-up of 2 years and minimum follow-up of 18 months, minimum study size of 20 patients, and human studies. The methodological quality of each study was assessed using a modified version of the Coleman methodology score. RESULTS The systematic search identified 19 studies with a total of 1036 patients. The mean 5-year survival rate across the studies included in this review was 86.7% (range, 64.1%-100.0%), while the mean 10-year survival rate was 78.7% (range, 39.0%-93.0%). The mean survival rate was 72.8% at 15 years (range, 55.8%-84.0%) and 67.5% at 20 years (range, 66.0%-69.0%). The weighted mean patient age was 31.5 years (range, 10-82 years), and the weighted mean follow-up was 8.7 years (range, 2-32 years). The following outcome measures showed significant improvement from preoperatively to postoperatively: d'Aubigné-Postel, International Knee Documentation Committee, Knee Society function, and Lysholm scores. The weighted mean reoperation rate was 30.2% (range, 0%-63%). The weighted mean failure rate was 18.2% (range, 0%-31%). Of note, revision cases, patellar lesions, and bipolar lesions demonstrated worse survival rates. CONCLUSION Improved patient-reported outcomes can be expected after OCA transplantation, with a survival rate of 78.7% at 10 years. Revision cases, patellar lesions, and bipolar lesions were associated with worse survival rates; therefore, utilization of the most appropriate index cartilage restoration procedure and proper patient selection are key to improving results.
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Affiliation(s)
| | - Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Morten Lykke Olesen
- Orthopaedic Research Laboratory, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Oslo University Hospital, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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13
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Bruns J, Werner M, Habermann C. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint. Cartilage 2018; 9. [PMID: 28639852 PMCID: PMC6139592 DOI: 10.1177/1947603517715736] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. OCD is seen in children and adolescents with open growth plates (juvenile OCD) and adults with closed growth plates (adult OCD). The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Mechanical factors seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important. Regarding treatment, a tremendous number of publications exist. Spontaneous healing is expected unless there is an unstable fragment, and treatment involves rest and different degrees of immobilization until healing. Patients with open physes and low-grade lesions have good results with conservative therapy. When surgery is necessary, the procedure depends on the stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable. When the cartilage is damaged, several techniques can be used. While techniques such as drilling and microfracturing produce reparative cartilage, other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. There is a tendency toward better results when using procedures that reconstruct the bone and the cartilage and there is also a trend toward better long-term results when comorbidities are treated. Severe grades of osteoarthrosis are rare.
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Affiliation(s)
- Juergen Bruns
- Orthopedic Surgery, Krankenhaus “Groß-Sand”, Hamburg, Germany,Juergen Bruns, Orthopedic Surgery, Krankenhaus “Groß-Sand” Hamburg, Groß Sand 3, 21107 Hamburg, Germany.
| | - Mathias Werner
- Department of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Christian Habermann
- Radiology, Interventional Radiology, Marienkrankenhaus Hamburg, Hamburg, Germany
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14
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Vangsness CT, Higgs G, Hoffman JK, Farr J, Davidson PA, Milstein F, Geraghty S. Implantation of a Novel Cryopreserved Viable Osteochondral Allograft for Articular Cartilage Repair in the Knee. J Knee Surg 2018; 31:528-535. [PMID: 28738433 PMCID: PMC6053312 DOI: 10.1055/s-0037-1604138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Restoration and repair of articular cartilage injuries remain a challenge for orthopaedic surgeons. The standard first-line treatment of articular cartilage lesions is marrow stimulation; however, this procedure can often result in the generation of fibrous repair cartilage rather than the biomechanically superior hyaline cartilage. Marrow stimulation is also often limited to smaller lesions, less than 2 cm2. Larger lesions may require implantation of a fresh osteochondal allograft, though a short shelf life, size-matched donor requirements, potential challenges of bone healing, limited availability, and the relatively high price limit the wide use of this therapeutic approach. We present a straightforward, single-stage surgical technique of a novel reparative and restorative approach for articular cartilage repair with the implantation of a cryopreserved viable osteochondral allograft (CVOCA). The CVOCA contains full-thickness articular cartilage and a thin layer of subchondral bone, and maintains the intact native cartilage architecture with viable chondrocytes, growth factors, and extracellular matrix proteins to promote articular cartilage repair. We report the results of a retrospective case series of three patients who presented with articular cartilage lesions more than 2 cm2 and were treated with the CVOCA using the presented surgical technique. Patients were followed up to 2 years after implantation of the CVOCA and all three patients had satisfactory outcomes without adverse events. Controlled randomized studies are suggested for evaluation of CVOCA efficacy, safety, and long-term outcomes.
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Affiliation(s)
- C. Thomas Vangsness
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California,Address for correspondence C. Thomas Vangsness Jr., MD Department of Orthopaedic Surgery, University of Southern CaliforniaKeck School of Medicine, 1520 San Pablo St, Suite 2000, Los Angeles, CA 90033
| | - Geoffrey Higgs
- Department of Orthopaedic Surgery and Sports Medicine, OrthoCare Institute, Lumin Health, Plano, Texas
| | - James K. Hoffman
- Department of Orthopaedic Surgery, Coordinated Health, Bethlehem, Pennsylvania
| | - Jack Farr
- Cartilage Restoration Center of Indiana, OrthoIndy Hospital, Indianapolis, Indiana,Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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15
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Tírico LEP, McCauley JC, Pulido PA, Bugbee WD. Does Anterior Cruciate Ligament Reconstruction Affect the Outcome of Osteochondral Allograft Transplantation? A Matched Cohort Study With a Mean Follow-up of 6 Years. Am J Sports Med 2018; 46:1836-1843. [PMID: 29768019 DOI: 10.1177/0363546518767636] [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: 01/31/2023]
Abstract
BACKGROUND Few studies have evaluated the influence of anterior cruciate ligament (ACL) reconstruction on the outcome of cartilage repair. Hypothesis/Purpose: The purpose was to investigate the association between ACL reconstruction and functional outcomes after osteochondral allograft (OCA) transplantation. The hypothesis was that patients treated with OCA transplantation who had a history of ACL reconstruction would have inferior clinical outcomes and lower osteochondral graft survivorship when compared with a matched group of patients undergoing OCA transplantation without a history of ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study compared 31 knees that underwent OCA transplantation with a history of ACL reconstruction (OCA and ACL group) and 62 knees treated with isolated OCA transplantation (OCA group) that had an intact ACL. Groups were matched by age, diagnosis, year of surgery, and graft size. Minimum follow-up was 2 years. Frequency and type of reoperation were assessed. Clinical failure was defined as revision OCA transplantation or conversion to arthroplasty. Subjective outcome measures included International Knee Documentation Committee scores, Knee injury and Osteoarthritis Outcome Scores, and patient satisfaction. RESULTS Clinical failure occurred in 3 of 31 knees (9.7%) in the OCA and ACL group and 6 of 62 knees (9.7%) in the OCA group ( P ≤ .999). Five- and 10-year survivorship of the OCA was 94.7% and 82.3% for the OCA and ACL group and 93.4% and 79.6% for OCA group, respectively ( P = .979). Mean follow-up was 6.2 ± 3.3 years among all knees with grafts in situ. Changes from preoperative to latest follow-up visit (difference scores) on all subjective outcome measures were greater in the OCA group; however, none of the difference scores were statistically significant. Satisfaction with the results of OCA transplantation was reported in 78.3% of the OCA and ACL group and 71.7% of the OCA group ( P = .551). CONCLUSION Treatment of cartilage lesions with OCA transplantation proved to be reliable and effective regardless of a history of ACL reconstruction as demonstrated by the improvements in outcome scores, long survivorship, and high satisfaction rates. History of ACL reconstruction did not influence outcome of OCA transplantation.
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Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - Pamela A Pulido
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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16
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Qi J, Cao F, Han Y, Xie D, Song H, Chen B, Zhou L. Reliability of cartilage digestion and FDA–EB fluorescence staining for the detection of chondrocyte viability in osteochondral grafts. Cell Tissue Bank 2018; 19:399-404. [DOI: 10.1007/s10561-018-9685-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/24/2018] [Indexed: 11/28/2022]
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17
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Abstract
BACKGROUND The clinical outcome of fresh allogeneic osteochondral allografts (OCA) is greatly dependent on the number of viable chondrocytes at the time of implantation. The selection and preparation of a suitable recipient can be very time-consuming and the number of tissue donors is greatly limited; therefore, the preservation of high allograft viability before transplantation is a focal point of current research. OBJECTIVE The objective of this review is to give an overview of established storage strategies for OCA and to serve as a decision-making aid for German clinics in the choice of a suitable storage strategy. MATERIAL AND METHODS A search of the literature published between January 2002 and May 2017 was independently performed by two persons with respect to original works on storage strategies of OCA with a focus on storage medium, use of fetal bovine serum, storage temperature and change of medium. A total of 20 suitable studies were selected for this review. RESULTS Based on the current studies a clearly superior storage solution could not be identified; however, storage at 4 °C seems to give better results with respect to cell viability than storage at 37 °C. High chondrocyte viability rates after 28 days of storage were also achieved using media without the addition of fetal bovine serum. CONCLUSION A major difficulty in comparing the relevant studies on storage solutions is that multiple aspects in the study design varied between the studies. Due to this no definite conclusion on what the ideal storage strategy should look like could be drawn. Further studies are needed to conclusively show whether cell culture medium-based storage solutions are truly superior to those based on Ringer-lactate solutions.
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18
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Okeagu CN, Baker EA, Barreras NA, Vaupel ZM, Fortin PT, Baker KC. Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus. Foot Ankle Int 2017; 38:808-819. [PMID: 28385038 DOI: 10.1177/1071100717697649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Osteochondral lesions of the talus (OLTs) are an increasingly implicated cause of ankle pain and instability. Several treatment methods exist with varying clinical outcomes. Due in part to successful osteochondral allografting (OCA) in other joints, such as the knee and shoulder, OCA has gained popularity as a treatment option, especially in the setting of large lesions. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. Several preclinical studies have demonstrated the ability for bone and cartilage tissue to invoke an immune response, and a limited number of clinical studies have suggested that this response may have the potential to influence outcomes after transplantation. Further research is warranted to investigate the role of immunological mechanisms as an etiology of OCA failure. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Chikezie N Okeagu
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Erin A Baker
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Nicholas A Barreras
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Zachary M Vaupel
- 2 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Paul T Fortin
- 2 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Kevin C Baker
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
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19
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Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ. Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 2017; 8:19-30. [PMID: 27994717 PMCID: PMC5154424 DOI: 10.1177/1947603516670708] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (<15 mm) lesions. Osteochondral autograft can be harvested most commonly from the ipsilateral knee and carries the benefit of repairing defects with native hyaline cartilage. Osteochondral allograft transplant is reserved for large cystic lesions that lack subchondral bone integrity. Cell-based repair techniques such as autologous chondrocyte implantation and matrix-associated chondrocyte implantation have been increasingly used in an attempt to repair the lesion with hyaline cartilage though these techniques require adequate subchondral bone. Biological agents such as platelet-rich plasma and bone marrow aspirate have been more recently studied as an adjunct to operative treatment but their use remains theoretical. The present article reviews the current concepts in the evaluation and management of osteochondral lesions of the talus, with a focus on the available surgical treatment options.
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Affiliation(s)
- Christopher A. Looze
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Jason Capo
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Michael K. Ryan
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - John P. Begly
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Cary Chapman
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - David Swanson
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Brian C. Singh
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Eric J. Strauss
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
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20
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Black LO, Ko JWK, Quilici SM, Crawford DC. Fresh Osteochondral Allograft to the Humeral Head for Treatment of an Engaging Reverse Hill-Sachs Lesion: Technical Case Report and Literature Review. Orthop J Sports Med 2016; 4:2325967116670376. [PMID: 27896291 PMCID: PMC5117164 DOI: 10.1177/2325967116670376] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Loren O Black
- Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
| | - Jia-Wei Kevin Ko
- Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
| | - Samantha M Quilici
- Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
| | - Dennis C Crawford
- Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
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21
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Krych AJ, Gobbi A, Lattermann C, Nakamura N. Articular cartilage solutions for the knee: present challenges and future direction. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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22
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Mickevicius T, Pockevicius A, Kucinskas A, Gudas R, Maciulaitis J, Noreikaite A, Usas A. Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts. BMC Musculoskelet Disord 2015; 16:314. [PMID: 26497227 PMCID: PMC4619008 DOI: 10.1186/s12891-015-0776-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/15/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteochondral allograft transplantation has a good clinical outcome, however, there is still debate on optimization of allograft storage protocol. Storage temperature and nutrient medium composition are the most critical factors for sustained biological activity of grafts before implantation. In this study, we performed a time-dependent in vitro experiment to investigate the effect of various storage conditions on electromechanical, histological and histochemical properties of articular cartilage. METHODS Osteochondral grafts derived from goat femoral condyles were frozen at -70 °C or stored at 4 °C and 37 °C in the medium supplemented with or without insulin-like growth factor-1 (IGF-1). After 14 and 28 days the cartilage samples were quantitatively analysed for electromechanical properties, glycosaminoglycan distribution, histological structure, chondrocyte viability and apoptosis. The results were compared between the experimental groups and correlations among different evaluation methods were determined. RESULTS Storage at -70 °C and 37 °C significantly deteriorated cartilage electromechanical, histological and histochemical properties. Storage at 4 °C maintained the electromechanical quantitative parameter (QP) and glycosaminoglycan expression near the normal levels for 14 days. Although hypothermic storage revealed reduced chondrocyte viability and increased apoptosis, these parameters were superior compared with the storage at -70 °C and 37 °C. IGF-1 supplementation improved the electromechanical QP, chondrocyte viability and histological properties at 37 °C, but the effect lasted only 14 days. Electromechanical properties correlated with the histological grading score (r = 0.673, p < 0.001), chondrocyte viability (r = -0.654, p < 0.001) and apoptosis (r = 0.416, p < 0.02). In addition, apoptosis correlated with glycosaminoglycan distribution (r = -0.644, p < 0.001) and the histological grading score (r = 0.493, p = 0.006). CONCLUSIONS Our results indicate that quality of allografts is better preserved at currently established 4 °C storage temperature. Storage at -70 °C or at 37 °C is unable to maintain cartilage function and metabolic activity. IGF-1 supplementation at 37 °C can enhance chondrocyte viability and improve electromechanical and histological properties of the cartilage, but the impact persists only 14 days. The correlations between cartilage electromechanical quantitative parameter (QP) and metabolic activity were detected. Our findings indicate that non-destructive assessment of cartilage by Arthro-BST is a simple and reliable method to evaluate allograft quality, and could be routinely used before implantation.
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Affiliation(s)
- Tomas Mickevicius
- Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Alius Pockevicius
- Pathology Center, Department of Infectious Diseases, Veterinary Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audrius Kucinskas
- Large Animal Clinic, Veterinary Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimtautas Gudas
- Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Institute of Sports, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justinas Maciulaitis
- Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Institute of Sports, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelija Noreikaite
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arvydas Usas
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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23
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Ding L, Zampogna B, Vasta S, Jang KW, De Caro F, Martin JA, Amendola A. Why Do Osteochondral Allografts Survive? Comparative Analysis of Cartilage Biochemical Properties Unveils a Molecular Basis for Durability. Am J Sports Med 2015; 43:2459-68. [PMID: 26311444 PMCID: PMC5038986 DOI: 10.1177/0363546515596407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transplantation of osteochondral allografts (OCAs) freshly preserved for ≥30 days has proven to be a reliable technique for cartilage resurfacing. However, the prolonged storage of allografts comes at the expense of chondrocyte viability, which declines precipitously after 14 days under refrigeration. Despite this, radiographic data indicate that most allograft cartilage remains stable for years after implantation. The apparent durability of partially devitalized cartilage begs the question of how the extracellular matrix is maintained. HYPOTHESIS Compared with patients' defect cartilage, replacement OCAs freshly preserved for 36 days on average contain significantly lower levels of cartilage matrix-destructive metalloproteinases, which may contribute to the long-term stability of implanted grafts. STUDY DESIGN Descriptive laboratory study. METHODS Chondrocyte density was determined by the cell yield from digested cartilage and by double-strand DNA content quantified with PicoGreen assay. Chondrocyte viability was estimated by staining enzymatically isolated chondrocytes with calcein AM and ethidium homodimer-2. Cartilage proteoglycan (PG) content was analyzed with dimethylmethylene blue assay. The in vitro 48-hour release of PG-depleting metalloproteinases including matrix metalloproteinase (MMP)-1, -3, -13, and ADAMTS-5 from cartilage was examined with Western blotting. The data were compared between diseased cartilage from patients and samples from matched grafts. The relative amount of MMP-3 to its endogenous inhibitor, tissue inhibitor of MMP-1 (TIMP-1), was also determined with Western blotting. RESULTS Chondrocyte density decreased linearly with allograft storage time and declined by an average of 43%. PG content decreased while the percentage of nonviable chondrocytes increased with storage time, with the former showing less linearity. However, PG content remained in the normal range and was significantly higher than that in patients' defect cartilage. Correspondingly, significantly less PG-depleting metalloproteinases and a much lower MMP-3/TIMP-1 ratio were detected in allograft cartilage than in patients' diseased cartilage. CONCLUSION These findings indicated that, at the time of implantation, fresh-preserved OCAs contained significantly lower levels of PG-depleting metalloproteinases compared with patients' defect cartilage, which might contribute to their long-term stability in vivo. CLINICAL RELEVANCE The comparatively low expression of cartilage-dissolving metalloproteinases in human OCAs freshly preserved over 30 days offers support to the long-term durability of implanted grafts. Based on study data that showed similarity in the response to inflammatory cytokines between patients' cartilage and OCA cartilage, strategies that can alleviate inflammation may provide extra benefit for the survival of implanted grafts. In terms of the practice of graft preservation, agents that can keep balance between the ATP supply and demand or stabilize the cell membrane or inhibit the activation of metalloproteinases may significantly improve cell viability in fresh-preserved OCAs with a storage time longer than 5 weeks.
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Affiliation(s)
- Lei Ding
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA,Address correspondence to Lei Ding, MD, PhD, or Annunziato Amendola, MD, Department of Orthopaedics and Rehabilitation, University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242, USA ( or )
| | - Biagio Zampogna
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA,Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA,Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Kee Woong Jang
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Francesca De Caro
- Orthopaedic Clinic and Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - James A. Martin
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Annunziato Amendola
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA,Address correspondence to Lei Ding, MD, PhD, or Annunziato Amendola, MD, Department of Orthopaedics and Rehabilitation, University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242, USA ( or )
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Li S, Yang X, Tang S, Zhang X, Feng Z, Cui S. Repair of massively defected hemi-joints using demineralized osteoarticular allografts with protected cartilage. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:227. [PMID: 26319778 DOI: 10.1007/s10856-015-5557-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/06/2015] [Indexed: 06/04/2023]
Abstract
Surgical replacement of massively defected joints necessarily relies on osteochondral grafts effective to both of bone and cartilage. Demineralized bone matrix (DBM) retains the osteoconductivity but destroys viable chondrocytes in the cartilage portion essential for successful restoration of defected joints. This study prepared osteochondral grafts of DBM with protected cartilage. Protected cartilage portions was characterized by cellular and molecular biology and the grafts were allogenically used for grafting. Protected cartilage showed similar histomorphological structure and protected proteins estimated by total proteins and cartilage specific proteins as in those of fresh controls when DBMs were generated in bone portions. Such grafts were successfully used for simultaneously repair of bone and cartilage in massively defected osteoarticular joints within 16 weeks post-surgery. These results present an allograft with clinical potential for simultaneous restoration of bone and cartilage in defected joints.
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Affiliation(s)
- Siming Li
- Guangzhou Institute of Traumatic Surgery, The Fourth Affiliated Hospital, Jinan University School of Medicine, 396 Tongfu Zhonglu Road, Haizhu District, Guangzhou, 510220, Guangdong Province, People's Republic of China,
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Hyaluronic Acid (800 kDa) Supplementation of University of Wisconsin Solution Improves Viability of Osteochondral Grafts and Reduces Matrix Metalloproteinase Expression during Cold Preservation. ScientificWorldJournal 2015. [PMID: 26199955 PMCID: PMC4496492 DOI: 10.1155/2015/631369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Osteochondral allografting is a promising option for the treatment of large cartilage defects. However, because the cell viability of osteochondral tissues (OCTs) gradually reduces during storage at 4°C, methods for maintaining the cell viability of fresh OCTs are needed to improve transplantation outcomes. Here, we evaluated whether the supplementation of preservation solution with one of three different molecular weight forms of hyaluronic acid (HA) improved the viability of rat OCTs during long-term cold storage. The supplementation of University of Wisconsin (UW) solution with 800 kDa significantly improved the cell viability of OCT after 14 days at 4°C compared to nonsupplemented UW solution. In contrast, UW solution supplemented with either 1900 or 6000 kDa HA did not markedly improve the cell viability of the OCT. Real-time PCR analysis revealed that the levels of matrix metalloproteinases 2, 3, and 9 were significantly decreased in OCT stored in UW solution supplemented with 800 kDa HA. Although further studies in human OCT are warranted, these findings demonstrate that the use of 800 kDa HA in place of serum may be a suitable approach for the long-term preservation of osteochondral allografts designated for the repair of large cartilage defects in the clinical setting.
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Geraghty S, Kuang JQ, Yoo D, LeRoux-Williams M, Vangsness CT, Danilkovitch A. A novel, cryopreserved, viable osteochondral allograft designed to augment marrow stimulation for articular cartilage repair. J Orthop Surg Res 2015; 10:66. [PMID: 25968127 PMCID: PMC4436093 DOI: 10.1186/s13018-015-0209-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/06/2015] [Indexed: 12/22/2022] Open
Abstract
Background Here, we describe the design and characterization of a novel, cryopreserved, viable osteochondral allograft (CVOCA), along with evidence that the CVOCA can improve outcomes of marrow stimulation for articular cartilage repair. Methods Histological staining was performed to evaluate the CVOCA tissue architecture. CVOCAs were tested for the presence of extracellular matrix (ECM) proteins and chondrogenic growth factors using ELISA. Cell viability and composition were examined via live/dead staining, fluorescence-activated cell sorting (FACS) analysis, and immunofluorescence staining. FACS analysis and a TNF-α secretion bioassay were used to confirm the lack of immunogenic cells. Effects of the CVOCA on mesenchymal stem cells (MSCs) were tested using in vitro migration and chondrogenesis assays. The ability of the CVOCA to augment marrow stimulation in vivo was evaluated in a goat model. Results A method of tissue processing and preservation was developed resulting in a CVOCA with pores and minimal bone. The pores were found to increase the flexibility of the CVOCA and enhance growth factor release. Histological staining revealed that all three zones of hyaline cartilage were preserved within the CVOCA. Chondrogenic growth factors (TGF-β1, TGF-β3, BMP-2, BMP-4, BMP-7, bFGF, IGF-1) and ECM proteins (type II collagen, hyaluronan) were retained within the CVOCA, and their sustained release in culture was observed (TGF β1, TGF-β2, aggrecan). The cells within the CVOCA were confirmed to be chondrocytes and remained viable and functional post-thaw. Immunogenicity testing confirmed the absence of immunogenic cells. The CVOCA induced MSC migration and chondrogenesis in vitro. Experimental results using devitalized flash frozen osteochondral allografts revealed the importance of preserving all components of articular cartilage in the CVOCA. Goats treated with the CVOCA and marrow stimulation exhibited better repair compared to goats treated with marrow stimulation alone. Conclusions The CVOCA retains viable chondrocytes, chondrogenic growth factors, and ECM proteins within the intact architecture of native hyaline cartilage. The CVOCA promotes MSC migration and chondrogenesis following marrow stimulation, improving articular cartilage repair.
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Affiliation(s)
- Sandra Geraghty
- Osiris Therapeutics, Inc., Albert Einstein Drive, Columbia, MD, USA.
| | - Jin-Qiang Kuang
- Osiris Therapeutics, Inc., Albert Einstein Drive, Columbia, MD, USA.
| | - Dana Yoo
- Osiris Therapeutics, Inc., Albert Einstein Drive, Columbia, MD, USA. .,Tissue Banks International, Park Avenue, Baltimore, MD, USA.
| | - Michelle LeRoux-Williams
- Osiris Therapeutics, Inc., Albert Einstein Drive, Columbia, MD, USA. .,Tissue Banks International, Park Avenue, Baltimore, MD, USA.
| | - C Thomas Vangsness
- Department of Orthopaedics, Keck School of Medicine, University of Southern California, San Pablo Street, Los Angeles, CA, USA.
| | - Alla Danilkovitch
- Osiris Therapeutics, Inc., Albert Einstein Drive, Columbia, MD, USA.
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Chui K, Jeys L, Snow M. Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts. World J Orthop 2015; 6:340-350. [PMID: 25893177 PMCID: PMC4390896 DOI: 10.5312/wjo.v6.i3.340] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per 100000 people. These lesions can become symptomatic causing pain, swelling and decreased function of the knee, and may eventually progress to osteoarthritis. In the young and active population, partial or total knee arthroplasty (TKA) is rarely the treatment of choice due to risk of early failure. Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom TKA is not recommended. Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset. Patients with bipolar lesions, uncorrectable malalignment, advanced osteoarthritis, and those over 40 tend to have less favourable outcomes.
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Approaches to preserve human osteochondral allografts. Cell Tissue Bank 2014; 16:425-31. [PMID: 25479814 DOI: 10.1007/s10561-014-9486-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
Osteochondral defects may progress to osteoarthritis. Many attempts have been developed to overcome this issue, including osteochondral autografts and allografts. The goal of this study was to develop a new protocol for storage of human osteochondral allografts. Osteochondral plugs were randomly allocated in the following groups: control, immediate freezing up to -70 °C, cooling at 4 °C, and storage at 37 °C. Samples from the cooling at 4 °C and storage at 37 °C groups were stored in tubes containing medium plus human albumin and analyzed after 1, 3, and 14 days. The frozen groups' samples were cryopreserved for 1 year in cryotubes containing medium only (FM), medium plus human albumin (FA), and medium plus human albumin and glucose (FG) and were then analyzed. Analysis involved histological study with hematoxylin-eosin and Safranin O and a modified Live/Dead assay. In samples stored both at 37 and 4 °C, analysis showed statistically significant higher cellular mortality at 14 days compared to 1 and 3 days, but mortality in the 4 °C group was lower. In the freezing protocols, the FA group showed less cellular mortality than the FM and FG groups. Cooling at 4 °C offers better preservation capacity than storage at 37 °C, but both offer the capacity for preservation for 14 days. Adding human albumin to the storage medium is useful in reducing cellular mortality in samples frozen for 1 year.
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Carulli C, Matassi F, Soderi S, Nistri L, Civinini R, Innocenti M. Open traumatic osteochondral fracture of the femoral medial condyle and trochlea treated by mosaicplasty: a case report at 11-year follow-up. HSS J 2014; 10:276-9. [PMID: 25264446 PMCID: PMC4171443 DOI: 10.1007/s11420-014-9406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/27/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Christian Carulli
- Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
| | - Stefano Soderi
- Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
| | - Lorenzo Nistri
- Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy
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Nicolini AP, Carvalho RT, Dragone B, Lenza M, Cohen M, Ferretti M. Updates in biological therapies for knee injuries: full thickness cartilage defect. Curr Rev Musculoskelet Med 2014; 7:256-62. [PMID: 25012907 PMCID: PMC4596164 DOI: 10.1007/s12178-014-9226-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Full thickness cartilage defect might occur at different ages, but a focal defect is a major concern in the knee of young athletes. It causes impairment and does not heal by itself. Several techniques were described to treat symptomatic full thickness cartilage defect. Recently, several advances were described on the known techniques of microfracture, osteochondral allograft, cell therapy, and others. This article brings an update of current literature on these well-described techniques for full thickness cartilage defect.
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Affiliation(s)
- Alexandre Pedro Nicolini
- />Division of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - 3 Andar/Bloco A1, Morumbi, 05651-901 São Paulo, SP Brazil
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Rogerio Teixeira Carvalho
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Bruno Dragone
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Mario Lenza
- />Division of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - 3 Andar/Bloco A1, Morumbi, 05651-901 São Paulo, SP Brazil
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Moises Cohen
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Mario Ferretti
- />Division of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - 3 Andar/Bloco A1, Morumbi, 05651-901 São Paulo, SP Brazil
- />Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
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Camp CL, Stuart MJ, Krych AJ. Current concepts of articular cartilage restoration techniques in the knee. Sports Health 2014; 6:265-73. [PMID: 24790697 PMCID: PMC4000472 DOI: 10.1177/1941738113508917] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Context: Articular cartilage injuries are common in patients presenting to surgeons with primary complaints of knee pain or mechanical symptoms. Treatment options include comprehensive nonoperative management, palliative surgery, joint preservation operations, and arthroplasty. Evidence Acquisition: A MEDLINE search on articular cartilage restoration techniques of the knee was conducted to identify outcome studies published from 1993 to 2013. Special emphasis was given to Level 1 and 2 published studies. Study Design: Clinical review. Level of Evidence: Level 3. Results: Current surgical options with documented outcomes in treating chondral injuries in the knee include the following: microfracture, osteochondral autograft transfer, osteochondral allograft transplant, and autologous chondrocyte transplantation. Generally, results are favorable regarding patient satisfaction and return to sport when proper treatment algorithms and surgical techniques are followed, with 52% to 96% of patients demonstrating good to excellent clinical outcomes and 66% to 91% returning to sport at preinjury levels. Conclusion: Clinical, functional, and radiographic outcomes may be improved in the majority of patients with articular cartilage restoration surgery; however, some patients may not fully return to their preinjury activity levels postoperatively. In active and athletic patient populations, biological techniques that restore the articular surface may be options that provide symptom relief and return patients to their prior levels of function.
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Affiliation(s)
- Christopher L Camp
- Department of Orthopedic Surgery and the Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Michael J Stuart
- Department of Orthopedic Surgery and the Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery and the Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JDF, Kennedy JG. Osteochondral lesions of the talus: aspects of current management. Bone Joint J 2014; 96-B:164-71. [PMID: 24493179 DOI: 10.1302/0301-620x.96b2.31637] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.
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Affiliation(s)
- C P Hannon
- Hospital for Special Surgery, 523 East 72nd Street, 5th Floor Rm 514, New York, USA
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Vannini F, Buda R, Pagliazzi G, Ruffilli A, Cavallo M, Giannini S. Osteochondral Allografts in the Ankle Joint: State of the Art. Cartilage 2013; 4:204-13. [PMID: 26069666 PMCID: PMC4297090 DOI: 10.1177/1947603513479605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The aim of this systematic review is to report about the clinical use of partial and total fresh osteochondral allograft in the ankle joint. The state of the art of allografts with regard to basic science, procurement and storage methods, immunogenicity, generally accepted indications and contraindications, and the rationale of the allografting procedure have been described. METHODS All studies published in PubMed from 2000 to January 2012 addressing fresh osteochondral allograft procedures in the ankle joint were identified, including those that fulfilled the following criteria: (a) level I-IV evidence addressing the areas of interest outlined above; (b) measures of functional, clinical, or imaging outcome; and (c) outcome related to ankle cartilage lesions or ankle arthritis treated by allografts. RESULTS The analysis showed a progressively increasing number of articles from 2000. The number of selected articles was 14; 9 of those focused on limited dimension allografts (plugs, partial) and 5 on bipolar fresh osteochondral allografts. The evaluation of evidence level showed 14 case series and no randomized studies. CONCLUSIONS Fresh osteochondral allografts are now a versatile and suitable option for the treatment of different degrees of osteochondral disease in the ankle joint and may even be used as total joint replacement. Fresh osteochondral allografts used for total joint replacement are still experimental and might be considered as a salvage procedure in otherwise unsolvable situations. A proper selection of the patients is therefore a key point. Moreover, the patients should be adequately informed about the possible risks, benefits, and alternatives to the allograft procedure.
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Affiliation(s)
| | - Roberto Buda
- I Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | | | - Marco Cavallo
- I Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
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Pallante-Kichura AL, Chen AC, Temple-Wong MM, Bugbee WD, Sah RL. In vivo efficacy of fresh versus frozen osteochondral allografts in the goat at 6 months is associated with PRG4 secretion. J Orthop Res 2013; 31:880-6. [PMID: 23362152 PMCID: PMC4076778 DOI: 10.1002/jor.22319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/05/2013] [Indexed: 02/04/2023]
Abstract
The long-term efficacy of osteochondral allografts is due to the presence of viable chondrocytes within graft cartilage. Chondrocytes in osteochondral allografts, especially those at the articular surface that normally produce the lubricant proteoglycan-4 (PRG4), are susceptible to storage-associated death. The hypothesis of this study was that the loss of chondrocytes within osteochondral grafts leads to decreased PRG4 secretion, after graft storage and subsequent implant. The objectives were to determine the effect of osteochondral allograft treatment (FROZEN vs. FRESH) on secretion of functional PRG4 after (i) storage, and (ii) 6 months in vivo in adult goats. FROZEN allograft storage reduced PRG4 secretion from cartilage by ∼85% compared to FRESH allograft storage. After 6 months in vivo, the PRG4-secreting function of osteochondral allografts was diminished with prior FROZEN storage by ∼81% versus FRESH allografts and by ∼84% versus non-operated control cartilage. Concomitantly, cellularity at the articular surface in FROZEN allografts was ∼96% lower than FRESH allografts and non-operated cartilage. Thus, the PRG4-secreting function of allografts appears to be maintained in vivo based on its state after storage. PRG4 secretion may be not only a useful marker of allograft performance, but also a biological process protecting the articular surface of grafts following cartilage repair.
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Affiliation(s)
| | - Albert C. Chen
- Department of Bioengineering, University of California-San Diego, La Jolla, CA
| | | | - William D. Bugbee
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA,Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA
| | - Robert L. Sah
- Department of Bioengineering, University of California-San Diego, La Jolla, CA,Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA,Institute of Engineering in Medicine, University of California-San Diego, La Jolla, CA,Address correspondence and reprint requests to: R.L. Sah, Department of Bioengineering, University of California-San Diego, 9500 Gilman Drive MC:0412, La Jolla CA 92093-0412, USA. Tel: 858-534-0821; Fax: 858-822-0448;
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Chahal J, Gross AE, Gross C, Mall N, Dwyer T, Chahal A, Whelan DB, Cole BJ. Outcomes of osteochondral allograft transplantation in the knee. Arthroscopy 2013; 29:575-88. [PMID: 23544690 DOI: 10.1016/j.arthro.2012.12.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/04/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE The objectives of this study were (1) to conduct a systematic review of clinical outcomes after osteochondral allograft transplantation in the knee and (2) to identify patient-, defect-, and graft-specific prognostic factors. METHODS We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies that evaluated clinical outcomes in adult patients after osteochondral allograft transplantation for chondral defects in the knee were included. Pooled analyses for pertinent continuous and dichotomous variables were performed where appropriate. RESULTS There were 19 eligible studies resulting in a total of 644 knees with a mean follow-up of 58 months (range, 19 to 120 months). The overall follow-up rate was 93% (595 of 644). The mean age was 37 years (range, 20 to 62 years), and 303 patients (63%) were men. The methods of procurement and storage time included fresh (61%), prolonged fresh (24%), and fresh frozen (15%). With regard to etiology, the most common indications for transplantation included post-traumatic (38%), osteochondritis dissecans (30%), osteonecrosis from all causes (12%), and idiopathic (11%). Forty-six percent of patients had concomitant procedures, and the mean defect size across studies was 6.3 cm(2). The overall satisfaction rate was 86%. Sixty-five percent of patients (72 of 110) showed little to no arthritis at final follow-up. The reported short-term complication rate was 2.4%, and the overall failure rate was 18%. Heterogeneity in functional outcome measures precluded a meta-analysis; a qualitative synthesis allowed for the identification of several positive and negative prognostic factors. CONCLUSIONS Osteochondral allograft transplantation for focal and diffuse (single-compartment) chondral defects results in predictably favorable outcomes and high satisfaction rates at intermediate follow-up. Patients with osteochondritis dissecans and traumatic and idiopathic etiologies have more favorable outcomes, as do younger patients with unipolar lesions and short symptom duration. Future studies should include comparative control groups and use established outcome instruments that will allow for pooling of data across studies. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Jaskarndip Chahal
- Toronto Western Hospital and Women's College Hospital, Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada.
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Sawyer GA, Heard WMR, Terek RM. Fresh Osteochondral Allograft Transplantation for Treatment of Chondroblastoma of the Femoral Head: A Case Report. JBJS Case Connect 2013; 3:e13. [PMID: 29252318 DOI: 10.2106/jbjs.cc.l.00122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Gregory A Sawyer
- University Orthopedics, 2 Dudley Street, Suite 200, Providence, RI 02905.
| | - Wendell M R Heard
- Department of Orthopaedics, Tulane Medical Center, SL-32, 1430 Tulane Avenue, New Orleans, LA 70012
| | - Richard M Terek
- University Orthopedics, 2 Dudley Street, Suite 200, Providence, RI 02905.
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Giorgini A, Donati D, Cevolani L, Frisoni T, Zambianchi F, Catani F. Fresh osteochondral allograft is a suitable alternative for wide cartilage defect in the knee. Injury 2013; 44 Suppl 1:S16-20. [PMID: 23351864 DOI: 10.1016/s0020-1383(13)70005-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are several surgical options to restore a wide osteochondral defect in the knee. Fresh osteochondral allografts are usually considered a poor alternative due to their difficulties in surgical application. The aim of this work is first to present our experience including the surgical technique and the functional results of patients receiving fresh osteochondral allograft to restore major knee lesions, then, to compare our results with other results presented in literature. METHODS Between 2006 and 2011, we treated 11 patients with osteochondral lesion of the knee (Outerbridge IV°). The average lesion size was 10.3 cm(2) (range 3-20 cm(2)). The average age was 34 years (range 18-66). Patients were followed from 12 to 55 months (average of 26.5) through clinical examination, X-ray film and MRI every 3 months for the first year, then every 6 months. RESULTS The treatment was successful in 10 patients showing pain regression and mean IKDC subjective score improvements from 27.3 to 58.7. The IKDC objective score also improved of at least one class for each patient except the who failed. The radiographs show good osteointegration in all cases but one. CONCLUSIONS Fresh allograft is an effective therapy for osteochondral defects repair because it allows functional recovery in a considerable number of patients. This technique obtains better results in lesion smaller than 8 cm(2). However larger lesion show good results. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Affiliation(s)
- A Giorgini
- Modena Policlinic, Department of Orthopaedic Surgery, Modena, Italy.
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Abstract
BACKGROUND Fresh osteochondral allograft transplantation is an increasingly common treatment option for chondral and osteochondral lesions in the knee, but the long-term outcome is unknown. QUESTIONS/PURPOSES We determined (1) pain and function, (2) frequency and types of reoperations, (3) survivorship at a median of 13.5 years, and (4) predictors of osteochondral allograft failure in the distal femur. METHODS We evaluated 122 patients (129 knees) who underwent osteochondral allograft transplantation of the femoral condyle. Mean age was 33 years and 53% were male. Clinical evaluation included the modified Merle d'Aubigné-Postel (18-point), IKDC, and Knee Society function (KS-F) scores. We defined graft failure as revision osteochondral allografting or conversion to arthroplasty. We determined whether patient characteristics or attributes of the graft influenced failure. Minimum followup was 2.4 years (median, 13.5 years); 91% had more than 10 years of followup. RESULTS Mean modified Merle d'Aubigné-Postel score improved from 12.1 to 16, mean IKDC pain score from 7.0 to 3.8, mean IKDC function score from 3.4 to 7.2, and mean KS-F score from 65.6 to 82.5. Sixty-one knees (47%) underwent reoperations. Thirty-one knees (24%) failed at a mean of 7.2 years. Survivorship was 82% at 10 years, 74% at 15 years, and 66% at 20 years. Age of more than 30 years at time of surgery and having two or more previous surgeries for the operated knee were associated with allograft failure. CONCLUSIONS Followup of femoral condyle osteochondral allografting demonstrated durable improvement in pain and function, with graft survivorship of 82% at 10 years.
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Pallante AL, Görtz S, Chen AC, Healey RM, Chase DC, Ball ST, Amiel D, Sah RL, Bugbee WD. Treatment of articular cartilage defects in the goat with frozen versus fresh osteochondral allografts: effects on cartilage stiffness, zonal composition, and structure at six months. J Bone Joint Surg Am 2012; 94:1984-95. [PMID: 23138239 PMCID: PMC3489067 DOI: 10.2106/jbjs.k.00439] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding the effectiveness of frozen as compared with fresh osteochondral allografts at six months after surgery and the resultant consequences of traditional freezing may facilitate in vivo maintenance of cartilage integrity. Our hypothesis was that the state of the allograft at implantation affects its performance after six months in vivo. METHODS The effect of frozen as compared with fresh storage on in vivo allograft performance was determined for osteochondral allografts that were transplanted into seven recipient goats and analyzed at six months. Allograft performance was assessed by examining osteochondral structure (cartilage thickness, fill, surface location, surface degeneration, and bone-cartilage interface location), zonal cartilage composition (cellularity, matrix content), and cartilage biomechanical function (stiffness). Relationships between cartilage stiffness or cartilage composition and surface degeneration were assessed with use of linear regression. RESULTS Fresh allografts maintained cartilage load-bearing function, while also maintaining zonal organization of cartilage cellularity and matrix content, compared with frozen allografts. Overall, allograft performance was similar between fresh allografts and nonoperative controls. However, cartilage stiffness was approximately 80% lower (95% confidence interval [CI], 73% to 87%) in the frozen allografts than in the nonoperative controls or fresh allografts. Concomitantly, in frozen allografts, matrix content and cellularity were approximately 55% (95% CI, 22% to 92%) and approximately 96% (95% CI, 94% to 99%) lower, respectively, than those in the nonoperative controls and fresh allografts. Cartilage stiffness correlated positively with cartilage cellularity and matrix content, and negatively with surface degeneration. CONCLUSIONS Maintenance of cartilage load-bearing function in allografts is associated with zonal maintenance of cartilage cellularity and matrix content. In this animal model, frozen allografts displayed signs of failure at six months, with cartilage softening, loss of cells and matrix, and/or graft subsidence, supporting the importance of maintaining cell viability during allograft storage and suggesting that outcomes at six months may be indicative of long-term (dys)function. CLINICAL RELEVANCE Fresh versus frozen allografts represent the "best versus worst" conditions with respect to chondrocyte viability, but "difficult versus simple" with respect to acquisition and distribution. The outcomes described from these two conditions expand the current understanding of in vivo cartilage remodeling and describe structural properties (initial graft subsidence), which may have implications for impending graft failure.
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Affiliation(s)
- Andrea L. Pallante
- Department of Bioengineering, University of California at San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412
| | - Simon Görtz
- Department of Orthopaedic Surgery, University of California at San Diego, 200 West Arbor Drive, MC 8894, San Diego, CA 92103-8894
| | - Albert C. Chen
- Department of Bioengineering, University of California at San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412
| | - Robert M. Healey
- Department of Orthopaedic Surgery, University of California at San Diego, 9500 Gilman Drive, MC 0863, La Jolla, CA 92093-0863
| | - Derek C. Chase
- Department of Orthopaedic Surgery, University of California at San Diego, 200 West Arbor Drive, MC 8894, San Diego, CA 92103-8894
| | - Scott T. Ball
- Department of Orthopaedic Surgery, University of California at San Diego, 200 West Arbor Drive, MC 8894, San Diego, CA 92103-8894
| | - David Amiel
- Department of Orthopaedic Surgery, University of California at San Diego, 9500 Gilman Drive, MC 0863, La Jolla, CA 92093-0863
| | - Robert L. Sah
- Department of Bioengineering, University of California at San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412
| | - William D. Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS 116, La Jolla, CA 92037. E-mail address:
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Onuma K, Urabe K, Naruse K, Uchida K, Itoman M. Allogenic serum improves cold preservation of osteochondral allografts. Clin Orthop Relat Res 2012; 470:2905-14. [PMID: 22095130 PMCID: PMC3441994 DOI: 10.1007/s11999-011-2182-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/07/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although several types of culture medium have been used for preservation of osteochondral allografts, the viability of chondrocytes decreases with increasing storage duration. We previously showed the University of Wisconsin solution is more suitable for graft preservation than culture medium. QUESTIONS/PURPOSES We determined whether the addition of allogenic serum to University of Wisconsin solution increases chondrocyte survival during prolonged storage of osteochondral allografts. METHODS Osteochondral tissue samples harvested from the distal femora of rats were preserved in University of Wisconsin solution supplemented with 0%, 1%, 10%, and 50% allogenic serum at 4 °C for 14 days. Cell viability and chondrocyte degenerative changes of the samples then were assessed using a tetrazolium assay and histologic methods. We also evaluated time-dependent changes in cell viability and histologic findings of samples preserved for 7, 14, and 21 days in University of Wisconsin solution supplemented with or without 10% allogenic serum. RESULTS After 14 days of preservation, osteochondral tissue samples maintained in University of Wisconsin solution containing 10% or greater allogenic serum exhibited the highest cell viability and lowest degenerative changes in chondrocytes. In the evaluation of time-dependent changes, we found the chondrocyte degenerative changes were greater in cartilage preserved in University of Wisconsin solution alone than in University of Wisconsin solution containing 10% allogenic serum after day 7 or later. CONCLUSIONS Our results suggest the addition of 10% allogenic serum to University of Wisconsin solution enhances viability of osteochondral tissue samples. CLINICAL RELEVANCE The use of allogenic serum-supplemented University of Wisconsin solution is expected to prolong the duration of osteochondral allograft storage and result in higher-quality grafts.
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Affiliation(s)
- Kenji Onuma
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374 Japan
| | - Ken Urabe
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374 Japan
| | - Kouji Naruse
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374 Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374 Japan
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Balcom NT, Berg-Johansen B, Dills KJ, Van Donk JR, Williams GM, Chen AC, Hazelwood SJ, Sah RL, Klisch SM. In vitro articular cartilage growth with sequential application of IGF-1 and TGF-β1 enhances volumetric growth and maintains compressive properties. J Biomech Eng 2012; 134:031001. [PMID: 22482681 DOI: 10.1115/1.4005851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In vitro cultures with insulin-like growth factor-1 (IGF-1) and transforming growth factor-β1 (TGF-β1) have previously been shown to differentially modulate the growth of immature bovine articular cartilage. IGF-1 stimulates expansive growth yet decreases compressive moduli and increases compressive Poisson's ratios, whereas TGF-β1 maintains tissue size, increases compressive moduli, and decreases compressive Poisson's ratios. The current study's hypothesis was that sequential application of IGF-1 and TGF-β1 during in vitro culture produces geometric and compressive mechanical properties that lie between extreme values produced when using either growth factor alone. Immature bovine articular cartilage specimens were harvested and either untreated (D0, i.e., day zero) or cultured in vitro for either 6 days with IGF-1 (D6 IGF), 12 days with IGF-1 (D12 IGF), or 6 days with IGF-1 followed by 6 days with TGF-β1 (D12 SEQ, i.e., sequential). Following treatment, all specimens were tested for geometric, biochemical, and compressive mechanical properties. Relative to D0, D12 SEQ treatment enhanced volumetric growth, but to a lower value than that for D12 IGF. Furthermore, D12 SEQ treatment maintained compressive moduli and Poisson's ratios at values higher and lower, respectively, than those for D12 IGF. Considering the previously described effects of 12 days of treatment with TGF-β1 alone, D12 SEQ induced both growth and mechanical property changes between those produced with either IGF-1 or TGF-β1 alone. The results suggest that it may be possible to vary the durations of select growth factors, including IGF-1 and TGF-β1, to more precisely modulate the geometric, biochemical, and mechanical properties of immature cartilage graft tissue in clinical repair strategies.
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Affiliation(s)
- Nathan T Balcom
- Mechanical Engineering Department, California Polytechnic State University, San Luis Obispo, CA 93405, USA
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43
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Abstract
Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.
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Affiliation(s)
- Marco Demange
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Andreas H. Gomoll
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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Pallante AL, Chen AC, Ball ST, Amiel D, Masuda K, Sah RL, Bugbee WD. The in vivo performance of osteochondral allografts in the goat is diminished with extended storage and decreased cartilage cellularity. Am J Sports Med 2012; 40:1814-23. [PMID: 22707746 PMCID: PMC4041579 DOI: 10.1177/0363546512449321] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, osteochondral allografts (OCA) are typically used after 4°C storage for prolonged durations (15-43 days), which compromises chondrocyte viability, especially at the articular surface. The long-term in vivo performance of these fresh-stored allografts, in association with variable cellularity, is unknown. PURPOSE To determine the effect of 4°C storage duration (14, 28 days) versus the best (fresh) and worst (frozen) conditions of chondrocyte viability on structure, composition, and function of cartilage in the goat and the association of retrieved chondrocyte cellularity with those tissue properties. STUDY DESIGN Controlled laboratory study. METHODS The effect of allograft storage on in vivo repair outcomes was determined for OCA transplanted into 15 recipient goats and analyzed at 12 months. Repair outcomes were assessed by examining cartilage structure (gross, histopathology), composition (cellularity by depth, matrix fixed charge), and biomechanical function (stiffness). Relationships between cellularity and structural scores, matrix fixed charge, and stiffness were assessed by linear regression. RESULTS Repair outcomes in 4°C-stored OCA were similar after 14 and 28 days of storage, and both were inferior to fresh OCA and were accompanied by diminished cellularity at the surface, matrix fixed charge, and histopathological structure. Overall, cellularity by depth and matrix fixed charge in cartilage of fresh OCA were similar to nonoperated controls. However, cellularity at the articular surface and matrix fixed charge in 4°C-stored OCA were lower than fresh, by ~55% (95% confidence interval [CI], 32%-76%) and ~20% (CI, 9%-30%), respectively. In frozen OCA, cellularity and matrix fixed charge were lower than 4°C-stored OCA, by ~93% (CI, 88%-99%) and ~22% (CI, 10%-35%), respectively. Cellularity correlated negatively with cartilage health indices, including structural scores, and positively with matrix fixed charge and stiffness. CONCLUSION Reduced cellularity at the articular surface, resulting from 4°C storage, was associated with variable long-term outcomes versus consistently good repair by fresh allografts. Cellularity at the articular surface was an important index of biological performance. CLINICAL RELEVANCE Normal chondrocyte density in vivo, especially in the superficial region of cartilage, is important for maintaining long-term cartilage function and matrix content. In human cartilage, containing cells at ~3 to 5 times lower density than goat, repair outcomes may be related to absolute minimum number of cells rather than density.
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Affiliation(s)
- Andrea L. Pallante
- Department of Bioengineering, University of California-San Diego, La Jolla, CA
| | - Albert C. Chen
- Department of Bioengineering, University of California-San Diego, La Jolla, CA
| | - Scott T. Ball
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA
| | - David Amiel
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA
| | - Robert L. Sah
- Department of Bioengineering, University of California-San Diego, La Jolla, CA
,Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA
,Institute of Engineering in Medicine, University of California-San Diego, La Jolla, CA
| | - William D. Bugbee
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA
,Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA
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45
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Pearsall IV AW, Madanagopal SG, Tucker JA. The Evaluation of Refrigerated and Frozen Osteochondral Allografts in the Knee. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ss.2011.25052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Bolen G, Haye D, Dondelinger R, Busoni V. Magnetic resonance signal changes during time in equine limbs refrigerated at 4 degrees C. Vet Radiol Ultrasound 2010; 51:19-24. [PMID: 20166388 DOI: 10.1111/j.1740-8261.2009.01615.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
When ex vivo magnetic resonance (MR) imaging studies are undertaken, specimen conservation should be taken into account when interpreting MR imaging results. The purpose of this study was to assess MR changes during time in the anatomic structures of the equine digit on eight cadaver limbs stored at 4 degrees C. The digits were imaged within 12 h after death and then after 1, 2, 7, and 14 days of refrigeration. After the last examination, four feet were warmed at room temperature for 24 h and reimaged. Sequences used were turbo spin echo (TSE) T1, TSE T2, short tau inversion recovery (STIR), and double-echo steady state (DESS). Images obtained were compared subjectively side by side for image quality and signal changes. Signal-to-noise ratio (SNR) was measured and compared between examinations. There were no subjective changes in image quality. A mild size reduction of the synovial recesses was detected subjectively. No signal change was seen subjectively except for bone marrow that appeared slightly hyperintense in STIR and slightly hypointense in TSE T2 sequence after refrigeration compared with day 0. Using quantitative analysis, significant SNR changes in bone marrow of refrigerated limbs compared with day 0 were detected in STIR and TSE T2 sequences. Warming at room temperature for 24 h produced a reverse effect on SNR compared with refrigeration with a significant increase in SNR in TSE T2 images. After 14 days of refrigeration a statistically significant decrease of SNR was found in bone marrow in TSE T2 and DESS sequences. The SNR in the deep digital flexor tendon was not characterized by significant change in SNR.
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Affiliation(s)
- Géraldine Bolen
- Department of Companion Animals and Equidae, Medical Imaging Section, Faculty of Veterinary Medicine, University of Liège, Boulevard de Colonster, 20, Baltiment B41, 4000 Liège, Belgium.
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47
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Bae JY, Han DW, Wakitani S, Nawata M, Hyon SH. Biological and Biomechanical Evaluations of Osteochondral Allografts Preserved in Cold Storage Solution Containing Epigallocatechin Gallate. Cell Transplant 2010; 19:681-9. [DOI: 10.3727/096368910x508771] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The beneficial effects of (-)-epigallocatechin-3- O-gallate (EGCG) on the nonfrozen preservation of mammalian cells and tissues are generally not well understood. A storage solution containing EGCG was employed to test the hypothesis that EGCG is capable of extending the storage duration for the cold preservation of articular cartilages. Human articular cartilages were preserved in a storage solution composed of serum-free RPMI-1640 medium with 1% antibiotic-antimycotic solution and 1 mM EGCG at 4°C for 1, 2, and 4 weeks. The chondrocyte viability (CCK-8 assay), biochemical and immunohistochemical composition [glycosaminoglycans (GAG) and (type II) collagen], and biomechanical property (compressive elastic modulus) were assessed. The chondrocyte viability of the cartilages preserved with EGCG was significantly well maintained for at least 2 weeks with high content of GAG and total collagen. These beneficial effects of EGCG were confirmed by the immunohistochemical observations of well-preserved cartilaginous structures and delayed denaturation of the extracellular matrix in preserved cartilages. There was no significant difference in the compressive elastic modulus (MPa) between the cartilages preserved with and without EGCG. These results suggest that EGCG may play an effective role in preserving osteochondral allografts, which can be exploited in devising strategies for the long-term preservation of other tissues under cold storage conditions.
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Affiliation(s)
- Jung Yoon Bae
- Department of Medical Simulation Engineering, Research Center for Nano Medical Engineering, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Dong-Wook Han
- Department of Nanomedical Engineering, College of Nanoscience & Nanotechnology, Pusan National University, Busan, Korea
| | - Shigeyuki Wakitani
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masashi Nawata
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Japan
| | - Suong Hyu Hyon
- Department of Medical Simulation Engineering, Research Center for Nano Medical Engineering, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
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48
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McCarty WJ, Pallante AL, Rone RJ, Bugbee WD, Sah RL. The proteoglycan metabolism of articular cartilage in joint-scale culture. Tissue Eng Part A 2010; 16:1717-27. [PMID: 20038199 PMCID: PMC2952130 DOI: 10.1089/ten.tea.2009.0663] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 12/23/2009] [Indexed: 11/13/2022] Open
Abstract
Understanding and controlling chondrocyte and cartilage metabolism in osteochondral tissues may facilitate ex vivo maintenance and application, both for allografts and tissue-engineered grafts. The hypothesis of this study was that maintenance of chondrocyte viability and matrix content and release of sulfated glycosaminoglycan (sGAG) in the articular cartilage of joint-scale osteochondral fragments are temperature and metabolism dependent. The aims were to assess, for adult goat joints, the effects of incubation temperature (37 degrees C vs. 4 degrees C) on cartilage chondrocyte viability and tissue matrix content and mechanical function, and the effects of temperature and cellular biosynthesis on sGAG release. Chondrocyte viability was maintained with 37 degrees C incubation for 28 days, but decreased by approximately 30% with 4 degrees C incubation. Concomitantly, with 37 degrees C incubation, cartilage sGAG was depleted by approximately 52% with the lost sGAG predominantly unable to aggregate with hyaluronan, whereas collagen content, tissue thickness, and tissue stiffness were maintained. The depletion of sGAG was diminished by slowing metabolism, with 4 degrees C decreasing release by approximately 79% compared with 37 degrees C incubation, and cycloheximide inhibition of cell metabolism at 37 degrees C decreasing release by approximately 47%. These results indicate that the articular cartilage of joint-scale grafts have enhanced chondrocyte viability with incubation at 37 degrees C, but may need anabolic stimuli or catabolic inhibitors to maintain sGAG content.
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Affiliation(s)
- William J. McCarty
- Department of Bioengineering, University of California–San Diego, La Jolla, California
| | - Andrea L. Pallante
- Department of Bioengineering, University of California–San Diego, La Jolla, California
| | - Rebecca J. Rone
- Department of Bioengineering, University of California–San Diego, La Jolla, California
| | - William D. Bugbee
- Department of Orthopaedic Surgery, University of California–San Diego, La Jolla, California
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Robert L. Sah
- Department of Bioengineering, University of California–San Diego, La Jolla, California
- Institute of Engineering in Medicine, University of California–San Diego, La Jolla, California
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49
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Abstract
Articular cartilage has a poor intrinsic capacity for healing. The goal of surgical techniques to repair articular cartilage injuries is to achieve the regeneration of organized hyaline cartilage. Microfracture and other bone marrow stimulation techniques involve penetration of the subchondral plate in order to recruit mesenchymal stem cells into the chondral defect. The formation of a stable clot that fills the lesion is of paramount importance to achieve a successful outcome. Mosaicplasty is a viable option with which to address osteochondral lesions of the knee and offers the advantage of transplanting hyaline cartilage. However, limited graft availability and donor site morbidity are concerns. Transplantation of an osteochondral allograft consisting of intact, viable articular cartilage and its underlying subchondral bone offers the ability to address large osteochondral defects of the knee, including those involving an entire compartment. The primary theoretical advantage of autologous chondrocyte implantation is the development of hyaline-like cartilage rather than fibrocartilage in the defect, which presumably leads to better long-term outcomes and longevity of the healing tissue. Use of synthetic scaffolds is a potentially attractive alternative to traditional cartilage procedures as they are readily available and, unlike allogeneic tissue transplants, are associated with no risk of disease transmission. Their efficacy, however, has not been proven clinically.
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Affiliation(s)
- Asheesh Bedi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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50
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Evans KN, Providence BC. Case report: Fresh-stored osteochondral allograft for treatment of osteochondritis dissecans the femoral head. Clin Orthop Relat Res 2010; 468:613-8. [PMID: 19727986 PMCID: PMC2806996 DOI: 10.1007/s11999-009-0997-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 07/08/2009] [Indexed: 01/31/2023]
Abstract
Osteochondral defects of the femoral head are exceedingly rare, with limited treatment options. Restoration procedures for similar defects involving the knee and ankle have been well described. In this report, we present a young patient who had a symptomatic osteochondral defect of the femoral head develop secondary to trauma and underwent subsequent treatment using a fresh-stored osteochondral allograft via a trochanteric osteotomy. At the 1-year followup, the patient was symptom free with near-complete incorporation of the graft radiographically. Our observations in this case suggest osteoarticular implantation may be an appropriate alternative to consider when treating osteochondral defects of the femoral head.
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Affiliation(s)
- Korboi N Evans
- Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA.
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