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Crisol M, Wu K, Congdon B, Skene-Arnold TD, Laouar L, Elliott JAW, Jomha NM. Chondrocyte Viability of Particulated Porcine Articular Cartilage Is Maintained in Tissue Storage After Cryoprotectant Exposure, Vitrification, and Tissue Warming. Cartilage 2024; 15:139-146. [PMID: 37148124 DOI: 10.1177/19476035221118656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE Vitrification of articular cartilage (AC) is a promising technique which may enable long-term tissue banking of AC allografts. We previously developed a 2-step, dual-temperature, multi-cryoprotectant agent (CPA) loading protocol to cryopreserve particulated AC (1 mm3 cubes). Furthermore, we also determined that the inclusion of ascorbic acid (AA) effectively mitigates CPA toxicity in cryopreserved AC. Prior to clinical translation, chondrocytes must remain viable after tissue re-warming and before transplantation. However, the effects of short-term hypothermic storage of particulated AC after vitrification and re-warming are not documented. This study evaluated the chondrocyte viability of post-vitrified particulated AC during a 7-day tissue storage period at 4 °C. We hypothesized that porcine particulated AC could be stored for up to 7 days after successful vitrification without significant loss of cell viability, and these results would be enhanced when cartilage is incubated in storage medium supplemented with clinical grade AA. DESIGN Three experimental groups were examined at 5 time points: a fresh control (only incubated in medium), a vitrified - AA group, and a vitrified + AA group (N = 7). RESULTS There was a mild decline in cell viability but both treatment groups maintained a viability of greater than 80% viable cells which is acceptable for clinical translation. CONCLUSION We determined that particulated AC can be stored for up to 7 days after successful vitrification without a clinically significant decline in chondrocyte viability. This information can be used to guide tissue banks regarding the implementation of AC vitrification to increase cartilage allograft availability.
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Affiliation(s)
- Mary Crisol
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Sports Medicine Centre, Department of Orthopedic Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Barry Congdon
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Desai B, Assid E, Jacobs G, Dasgupta A, Williams G, Choate WS, Montgomery S, Godshaw B, Suri M, Jones D. Viable cartilage allograft outperforms existing treatments for focal knee cartilage defects. Knee Surg Sports Traumatol Arthrosc 2024; 32:636-644. [PMID: 38391111 DOI: 10.1002/ksa.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Viable cartilage allograft (VCA) is a cartilage tissue matrix that contains cryopreserved viable allogeneic cartilage fibres. This study aimed to assess safety and benefits in treating focal knee cartilage defects with VCA. We hypothesized that VCA is a safe single-stage procedure in isolated chondral defects. METHOD In vitro analysis, in vivo studies and a prospective case series were performed. VCA was evaluated in a goat cartilage repair model. Symptomatic International Cartilage Repair Society grade 3/4A lesions of the femoral condyle or patella were implanted with VCA. International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome (KOOS) subscales, Lysholm, Short Form-12, Visual Analog Scale and pain frequency levels were assessed. Radiographic and magnetic resonance imaging (MRI) was performed at regular intervals postoperatively. Data were analysed by statisticians to determine the power and significance of the results. RESULTS The goat study confirmed that VCA is effective for cartilage repair. Twenty patients were implanted; the mean age was 28.1 (16-56), the mean body mass index (BMI) was 27.9 ± 5.6 and the mean follow-up was 24.1 months (range = 12.0-36.0 months). Lesions were in either the femoral condyle (7) or patella (13). Lesion sizes ranged from 1.5 to 6.0 cm2 (mean = 4.58 cm2 ). Outcome scores improved from preoperative baseline (POB): IKDC (78.2), Lysholm (89.0), KOOS: Pain (95.8), Symptoms (86.3), ADL (87.8), Sports (85.0) and QOL (75.0). MRI imaging demonstrated excellent osteochondral allograft assimilation. Second-look arthroscopy (two patients) demonstrated complete fill and incorporation (Brittberg scores 11/12). Functional scores were maintained at 24 (M): IKDC (86.24 ± 17.2), Lysholm (87.23 ± 15.0), KOOS: Pain (91.72 ± 17.3), Symptoms (84.92 ± 16.1), ADLs (93.80 ± 16.1), Sports (84.45 ± 27.7), QOL (81.30 ± 20.8). CONCLUSION VCA is an off-the-shelf, single-stage, conformable allogeneic graft that treats chondral defects with no additional fixation. Preclinical and short-term prospective clinical studies show that VCA can safely treat chondral defects with potential advantages to existing options. LEVEL OF EVIDENCE Level IV study.
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Affiliation(s)
- Bhumit Desai
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
| | - Eric Assid
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Graylin Jacobs
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Anouska Dasgupta
- MTF (Musculoskeletal Transplant Foundation) Biologics, Edison, New Jersey, USA
| | - Gerard Williams
- Howard University Orthopaedic Hospital, Washington, District of Columbia, USA
| | - Walter Stephen Choate
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Scott Montgomery
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Brian Godshaw
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Misty Suri
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Deryk Jones
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
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3
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Coladonato C, Perez AR, Hanna AJ, Campbell MP, Destine H, Dees AN, Johnson EE, Tucker BS, Freedman KB. Outcomes of Osteochondral Allograft Transplantation: A Comparative Study of BioUni and Snowman Techniques for Ovoid Lesions. Cureus 2023; 15:e46958. [PMID: 38021922 PMCID: PMC10640722 DOI: 10.7759/cureus.46958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Treatment of large articular cartilage lesions of the knee includes surgical options one of which includes cartilage replacement therapies. Among these therapies include osteochondral allograft (OCA) transplantation, which can be performed utilizing a BioUni® (Arthrex BioUni® Instrumentation System; Arthrex, Naples, FL) replacement and a 'snowman' technique of repair. HYPOTHESIS/PURPOSE To compare clinical and radiographic outcomes in patients who have undergone multiplug OCA transplantations utilizing a BioUni® replacement and a 'snowman' technique of repair. METHODS Patients who underwent OCA transplantation utilizing a snowman technique or BioUni® replacement between January 1st, 2012 and December 31st, 2018, and who had a minimum 1-year follow-up at the same institution were identified for inclusion in this study via current procedural terminology (CPT) codes. Charts of included patients were reviewed for injury and treatment details as well as demographic information. Imaging studies and operative reports were reviewed and pre and postoperative subjective and objective outcome measures were recorded. RESULTS Twenty-eight patients underwent OCA transplantation with either BioUni® replacement (n=5) or with snowman technique repair (n=23). Defects in both groups had similar characteristics including size, area, location, and classifications. Patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR), International Knee Documentation Committee (IKDC), and Physical Health Composite Score (PCS-12) were similar at baseline and increased post-operatively for both groups with no significant differences between techniques after a mean follow-up of 2.77 ± 0.83. Although it did not reach significance, the snowman group had higher rates of knee-related complications (13%) and need for revision surgery (22%) when compared to BioUni® (0% and 0%, respectively). CONCLUSION The use of both BioUni® and snowman techniques for large, unicondylar articular cartilage lesions of the femoral condyle demonstrate improved patient-reported outcomes at short-term follow-up. The use of the snowman technique presents relatively higher rates of revision similar to previous studies with no statistical difference in patient-reported outcomes when compared to those of a single plug OCA using a BioUni® system.
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Affiliation(s)
- Carlo Coladonato
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Andres R Perez
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Adeeb J Hanna
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | | | - Henson Destine
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Azra N Dees
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Emma E Johnson
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | | | - Kevin B Freedman
- Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
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Ead M, Wu K, Jar C, Duke K, Jomha N, Westover L. Mechanical Properties of Fresh, Frozen and Vitrified Articular Cartilage. Ann Biomed Eng 2023; 51:2001-2012. [PMID: 37129781 DOI: 10.1007/s10439-023-03220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Osteochondral allograft transplantations are typically used to treat focal articular cartilage injuries where the damaged cartilage is replaced with fresh cadaveric donor grafts. Despite the notable success rate of this procedure, it is limited by fresh donor tissue availability which can only be stored for approximately 28 days after harvest. Vitrification, a form of cryopreservation, can extend the storage time of cartilage. Although it has shown to preserve chondrocyte viability, its effect on the mechanical properties of the tissue has not been thoroughly investigated. Therefore, in this study, the mechanical properties of fresh, frozen, and vitrified articular cartilage were evaluated through unconfined compression testing. Results showed that the peak modulus, equilibrium modulus, and relaxation time constants of the vitrified and control samples (tested one day after harvest) were similar and higher than the fresh (tested 21 days after harvest) and frozen samples. This demonstrated that vitrification does not adversely affect the mechanical properties of cartilage and can be used as an alternative to fresh allografts which are limited by storage time. The fresh samples also had inferior mechanical properties compared to the control samples suggesting that vitrified allografts could potentially improve clinical outcomes in addition to increasing donor tissue availability.
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Affiliation(s)
- Maha Ead
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada.
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Canada
- Sports Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chester Jar
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Kajsa Duke
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Nadr Jomha
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
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5
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Yong KW, Wu K, Elliott JAW, Jomha NM. The effect of sucrose supplementation on chondrocyte viability in porcine articular cartilage following vitrification. Cryobiology 2022; 109:53-61. [PMID: 36155184 DOI: 10.1016/j.cryobiol.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 02/05/2023]
Abstract
Vitrification can extend the banking life of articular cartilage (AC) and improve osteochondral transplantation success. Current vitrification protocols require optimization to enable them to be implemented in clinical practice. Sucrose as a non-permeating cryoprotective agent (CPA) and clinical grade chondroitin sulfate (CS) and ascorbic acid (AA) as antioxidants were investigated for their ability to improve a current vitrification protocol for AC. The aim of this study was to assess the impact of sucrose and CS/AA supplementation on post-warming chondrocyte viability in vitrified AC. Porcine osteochondral dowels were randomly vitrified and warmed with one established protocol (Protocol 1) and seven modified protocols (Protocols 2-8) followed by chondrocyte viability assessment. Sucrose supplementation in both vitrification and warming media (Protocol 4) resulted in significantly higher (p = 0.018) post-warming chondrocyte viability compared to the protocol without sucrose (Protocol 1). There was no significant difference (p = 0.298) in terms of post-warming chondrocyte viability between sucrose-supplemented DMEM + CS solution (Protocol 4) and Unisol-CV (UCV) + CS (Protocol 6) solution. Clinical grade CS and AA contributed to similar post-warming chondrocyte viability to previous studies using research grade CS and AA, indicating their suitability for clinical use. The addition of an initial step (step 0) to reduce the initial concentration of CPAs to minimize osmotic effects did not enhance chondrocyte viability in the superficial layer of AC. In conclusion, sucrose-supplemented DMEM + clinical grade CS (Protocol 4) could be an ideal protocol to be investigated for future use in clinical applications involving vitrified AC.
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Affiliation(s)
- Kar Wey Yong
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Kezhou Wu
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada; Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Nadr M Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
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6
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He J, Wine I, Wu K, Sevick J, Laouar L, Jomha NM, Westover L. Effect of vitrification on mechanical properties of porcine articular cartilage. Proc Inst Mech Eng H 2022; 236:1521-1527. [PMID: 36169308 PMCID: PMC9574425 DOI: 10.1177/09544119221122066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/08/2022] [Indexed: 02/05/2023]
Abstract
Articular cartilage (AC) injuries do not heal primarily and large lesions progress to degenerative osteoarthritis. Osteochondral allograft transplantation is an effective surgical treatment but is limited by the lack of donor tissue availability. Fresh allografts can be stored hypothermically up to 28-45 days after which the tissue is no longer viable for transplantation. Vitrification is a method of cryopreservation with the potential to extend the storage time of AC. A specific protocol has been demonstrated to preserve high chondrocyte viability; however, its effect on various mechanical properties of the extracellular matrix (ECM) remains unknown and is the focus of this initial study. Porcine AC was subject to a defined vitrification protocol, using fresh and frozen samples as positive and negative controls, respectively; n = 20 for all three groups. Unconfined compression testing was used to assess mechanical properties of the tissue under rapid load, stress relaxation, and equilibrium conditions. The stress relaxation time constants (modeled with a 2-term Prony series) τ1 and τ2 were significantly lower for frozen (p = 0.014, p < 0.001) and vitrified (p = 0.009, p = 0.003) tissue compared to fresh, with no differences between frozen and vitrified samples (p = 0.848 and 0.105 for τ1 and τ2, respectively). These values indicate that frozen and vitrified samples relaxed more rapidly than fresh, which may suggest altered matrix composition and permeability post-treatment. These results represent the initial study in our experimental path to evaluate differences in mechanical properties of vitrified tissues.
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Affiliation(s)
- Jenny He
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Itai Wine
- Department of Civil and Environmental Engineering, University of
Alberta, Edmonton, AB, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou
University Medical College, Shantou, Guangdong, China
| | - Johnathan Sevick
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta,
Edmonton, AB, Canada
- Lindsey Westover, Department of Mechanical
Engineering, University of Alberta, 9211 116 Street NW, 10-371 D-ICE Building,
Edmonton, AB T6G 1H9, Canada.
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7
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A Comparative Study Using Fluorescent Confocal Microscopy and Flow Cytometry to Evaluate Chondrocyte Viability in Human Osteochondral Allografts. Bioengineering (Basel) 2022; 9:bioengineering9100515. [DOI: 10.3390/bioengineering9100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
The preservation conditions of fresh osteochondral allografts for clinical applications are critical due their objective: to transplant mature hyaline cartilage containing viable chondrocytes, maintaining their metabolic activity and also preserving the structural and functional characteristics of the extracellular matrix. The aim of the present study was to compare fluorescence confocal microscopy and flow cytometry techniques to evaluate the viability of the chondrocytes present in the osteochondral tissue, in order to determine their effectiveness and thus ensure reproducibility and robustness of the analysis. To this end, osteochondral allografts from human cadaveric donors were preserved at 4 °C for 3 weeks in a preservation medium supplemented with antibiotic and antifungal agents. Cell viability of chondrocytes was determined by monitoring the cartilage for 3 weeks of preservation by confocal fluorescence microscopy and flow cytometry, obtaining cell viabilities of 83.7 ± 2.6% and 55.8 ± 7.8% for week three, respectively. The confocal fluorescence microscopy approach is more advantageous and accurate, as it correlates better with actual cell viability values for monitoring osteochondral graft preservation, detecting only the cells that died a natural death associated with the preservation method.
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8
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Dong R, Clark S, Laouar L, Heinrichs L, Wu K, Jomha NM, Elliott JAW. Evaluation of the permeation kinetics of formamide in porcine articular cartilage. Cryobiology 2022; 107:57-63. [PMID: 35636502 DOI: 10.1016/j.cryobiol.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 02/05/2023]
Abstract
Cryopreservation of articular cartilage will increase tissue availability for osteochondral allografting and improve clinical outcomes. However, successful cryopreservation of articular cartilage requires the precise determination of cryoprotectant permeation kinetics to develop effective vitrification protocols. To date, permeation kinetics of the cryoprotectant formamide in articular cartilage have not been sufficiently explored. The objective of this study was to determine the permeation kinetics of formamide into porcine articular cartilage for application in vitrification. The permeation of dimethyl sulfoxide was first measured to validate existing methods from our previously published literature. Osteochondral dowels from dissected porcine femoral condyles were incubated in 6.5 M dimethyl sulfoxide for a designated treatment time (1 s, 1 min, 2 min, 5 min, 10 min, 15 min, 30 min, 60 min, 120 min, 180 min, 24 h) at 22 °C (N = 3). Methods were then repeated with 6.5 M formamide at one of three temperatures: 4 °C, 22 °C, 37 °C (N = 3). Following incubation, cryoprotectant efflux into a wash solution occurred, and osmolality was measured from each equilibrated wash solution. Concentrations of effluxed cryoprotectant were calculated and diffusion coefficients were determined using an analytical solution to Fick's law for axial and radial diffusion in combination with a least squares approach. The activation energy of formamide was determined from the Arrhenius equation. The diffusion coefficient (2.7-3.3 × 10-10 m2/s depending on temperature) and activation energy (0.9±0.6 kcal/mol) for formamide permeation in porcine articular cartilage were established. The determined permeation kinetics of formamide will facilitate its precise use in future articular cartilage vitrification protocols.
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Affiliation(s)
- Rachael Dong
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Clark
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Luke Heinrichs
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Sports Medicine Centre, Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
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9
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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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10
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Abstract
OBJECTIVE Successful preservation of articular cartilage will increase the availability of osteochondral allografts to treat articular cartilage defects. We compared the effects of 2 methods for storing cartilage tissues using 10-mm diameter osteochondral dowels or femoral condyles at -196°C: (a) storage with a surrounding vitrification solution versus (b) storage without a surrounding vitrification solution. We investigated the effects of 2 additives (chondroitin sulfate and ascorbic acid) for vitrification of articular cartilage. DESIGN Healthy porcine stifle joints (n = 11) from sexually mature pigs were collected from a slaughterhouse within 6 hours after slaughtering. Dimethyl sulfoxide, ethylene glycol, and propylene glycol were permeated into porcine articular cartilage using an optimized 7-hour 3-step cryoprotectant permeation protocol. Chondrocyte viability was assessed by a cell membrane integrity stain and chondrocyte metabolic function was assessed by alamarBlue assay. Femoral condyles after vitrification were assessed by gross morphology for cartilage fractures. RESULTS There were no differences in the chondrocyte viability (~70%) of 10-mm osteochondral dowels after vitrification with or without the surrounding vitrification solution. Chondrocyte viability in porcine femoral condyles was significantly higher after vitrification without the surrounding vitrification solution (~70%) compared to those with the surrounding vitrification solution (8% to 36%). Moreover, articular cartilage fractures were not seen in femoral condyles vitrified without surrounding vitrification solution compared to fractures seen in condyles with surrounding vitrification solution. CONCLUSIONS Vitrification of femoral condyle allografts can be achieved by our optimized approach. Removing the surrounding vitrification solution is advantageous for vitrification outcomes of large size osteochondral allografts.
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Affiliation(s)
- Kezhou Wu
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthopedic Surgery, First
Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong,
China
| | - Leila Laouar
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A. W. Elliott
- Department of Chemical and Materials
Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and
Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M. Jomha
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Nadr M. Jomha, 2D2.32 WMC, Division of
Orthopedic Surgery, Department of Surgery, University of Alberta Hospital,
Edmonton, Alberta, Canada T6G 2B7.
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11
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Osteochondral allograft transplantation in the knee, after prolonged fresh storage at 37 °C. Determination of viability of human cartilage allografts, indications, technique, and evidence. Follow up 10 years. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Yue L, Vuong B, Yao H, Owens BD. Doxycycline preserves chondrocyte viability and function in human and calf articular cartilage ex vivo. Physiol Rep 2021; 8:e14571. [PMID: 32918797 PMCID: PMC7507091 DOI: 10.14814/phy2.14571] [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: 07/10/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023] Open
Abstract
Prolonging chondrocyte survival is essential to ensure fresh osteochondral (OC) grafts for treatment of articular cartilage lesions. Doxycycline has been shown to enhance cartilage growth, disrupt terminal differentiation of chondrocytes, and inhibit cartilage matrix degradation. It is unknown whether doxycycline prolongs chondrocyte survival in OC grafts. We hypothesized that doxycycline protects against chondrocyte death and maintains function of articular cartilage. To test this hypothesis, we employed human and calf articular cartilages, and incubated chondrocytes isolated from cartilage or cartilage plugs with doxycycline (0, 1 or 10 μg/ml) at either 37°C or 4°C. Chondrocyte viability, apoptosis, glycosaminoglycan (GAG), collagen, and mechanical test in cartilage plugs were measured. We found that reduced chondrocyte viability, increased chondrocyte apoptosis, reduced GAG contents, and impaired equilibrium modulus in cartilage plugs were observed in a time-dependent manner at both 37°C and 4°C. Chondrocyte viability was further reduced when the plugs were cultured at 4°C as compared to 37°C. Doxycycline prolonged viability and reduced apoptosis of chondrocytes during culture of cartilage plugs. Functionally, doxycycline protected against reduced production of GAG and collagen II as well as impaired mechanical properties in cartilage plugs during culture. Mechanistically, doxycycline increased mitochondrial respiration in cultured chondrocytes. In conclusion, preservation at 37°C is beneficial for maintaining chondrocyte viability in cartilage plugs compared to 4°C. Incubation of doxycycline protects against chondrocyte apoptosis, reduced extracellular matrix, and impaired mechanical properties in cartilage plugs. The findings provide a potential approach using doxycycline at 37°C to preserve chondrocyte viability in fresh OC grafts for treatment of articular cartilage lesions.
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Affiliation(s)
- Li Yue
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Brian Vuong
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hongwei Yao
- Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.,University Orthopedics, East Providence, RI, USA
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13
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Osteochondral allograft transplantation in the knee, after prolonged fresh storage at 37°C. Determination of viability of human cartilage allografts, indications, technique, and evidence. Follow up 10 years. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33933401 DOI: 10.1016/j.recot.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Osteochondral allografts (OA) kept fresh for a long time, are presented as a viable option for the treatment of large chondral and osteochondral lesions. GOALS Chondrocyte viability decreases substantially when allografts are stored for more than 15 days. The objective of this work is to validate the viability and clinical and functional results of OA transplantation stored at 37°C in a cell culture medium, applied in cartilage defects of the knee, defining the means and limits of allograft storage, among 15 and 28 days after extraction. PATIENTS AND METHOD This study presents the results of 20 consecutive patients, operated between 2003 and 2019, who underwent a fresh-preserved osteochondral allograft, implanted on cartilage defects of the femoral condyle and patella. The minimum follow-up time was 10 years and the maximum 17. The mean age of the patients was 29 (14-44). The clinical control data were collected using International Knee Documentation Committee (IKDC) (knee-specific), Knee injury and Osteoarthritis Outcome Score (KOOS) protocols. Likewise, the degree of satisfaction was evaluated. Cartilage control was performed using the International Cartilage Repair Society Score (ICRS) and the Oswestry Arthroscopy Score (OAS). Radiological evaluations were performed using MRI and helical CT. RESULTS Statistically significant improvements, P<.0001, were observed for the IKDC: 30-65; the 5 components of the KOOS protocol, pain; 66-85; specific symptoms: 72-82; activities of daily living: 74-91; sports and recreational function: 37-70; related to the knee, quality of life: 25-60. Regarding the degree of satisfaction, 89% answered being satisfied or very satisfied. The ICRS and OAS results, all patients went from grade IV to grade I, except for one who is currently in IV. The incorporation of the graft in the recipient area occurred at three months, verified by helical CT and MRI. CONCLUSION Osteochondral allograft transplants stored fresh at 37°C are established as a long-term solution for the treatment of localized osteochondral defects in the knee.
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14
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Wu K, Shardt N, Laouar L, Elliott JAW, Jomha NM. Vitrification of particulated articular cartilage via calculated protocols. NPJ Regen Med 2021; 6:15. [PMID: 33741977 PMCID: PMC7979917 DOI: 10.1038/s41536-021-00123-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023] Open
Abstract
Preserving viable articular cartilage is a promising approach to address the shortage of graft tissue and enable the clinical repair of articular cartilage defects in articulating joints, such as the knee, ankle, and hip. In this study, we developed two 2-step, dual-temperature, multicryoprotectant loading protocols to cryopreserve particulated articular cartilage (cubes ~1 mm3 in size) using a mathematical approach, and we experimentally measured chondrocyte viability, metabolic activity, cell migration, and matrix productivity after implementing the designed loading protocols, vitrification, and warming. We demonstrated that porcine and human articular cartilage cubes can be successfully vitrified and rewarmed, maintaining high cell viability and excellent cellular function. The vitrified particulated articular cartilage was stored for a period of 6 months with no significant deterioration in chondrocyte viability and functionality. Our approach enables high-quality long-term storage of viable articular cartilage that can alleviate the shortage of grafts for use in clinically repairing articular cartilage defects.
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Affiliation(s)
- Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Nadia Shardt
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada.
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
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15
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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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16
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Wu K, Shardt N, Laouar L, Chen Z, Prasad V, Elliott JAW, Jomha NM. Comparison of three multi-cryoprotectant loading protocols for vitrification of porcine articular cartilage. Cryobiology 2020; 92:151-160. [PMID: 31917159 DOI: 10.1016/j.cryobiol.2020.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023]
Abstract
Vitrification is a cryopreservation technique for the long-term storage of viable tissue, but the success of this technique relies on multiple factors. In 2012, our group published a working vitrification protocol for intact human articular cartilage and reported promising chondrocyte recovery after using a four-step multi-cryoprotectant (CPA) loading method that required 570 min. However, this protocol requires further optimization for clinical practice. Herein, we compared three multi-step CPA loading protocols to investigate their impact on chondrocyte recovery after vitrification of porcine articular cartilage on a bone base, including our previous four-step protocol (original: 570 min), and two shorter three-step protocols (optimized: 420 min, and minimally vitrifiable: 310 min). Four different CPAs were used including glycerol, dimethyl sulfoxide, ethylene glycol and propylene glycol. As vitrification containers, two conical tubes (50 ml and 15 ml) were evaluated for their heat transfer impact on chondrocyte recovery after vitrification. Osteochondral dowels were cored into two diameters of 10.0 mm and 6.9 mm with an approximately 10-mm thick bone base, and then allocated into the twelve experimental groups based on CPA loading protocol, osteochondral dowel size, and vitrification container size. After vitrification at -196 °C and tissue warming and CPA removal, samples in all groups were assessed for both chondrocyte viability and metabolic activity. The optimized protocol proposed based on mathematical modelling resulted in similar chondrocyte recovery to our original protocol and it was 150 min shorter. Furthermore, this study illustrated the role of CPA permeation (dowel size) and heat transfer (container size) on vitrification protocol outcome.
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Affiliation(s)
- Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Nadia Shardt
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Zhirong Chen
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Vinay Prasad
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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17
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Gaul F, Bugbee WD. Applications for osteochondral allografts. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Calvo R, Espinosa M, Figueroa D, Pozo LM, Conget P. Assessment of Cell Viability of Fresh Osteochondral Allografts in N-Acetylcysteine-Enriched Medium. Cartilage 2020; 11:117-121. [PMID: 29985056 PMCID: PMC6921953 DOI: 10.1177/1947603518786547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of N-acetylcysteine (NAC)-enriched storage medium on fresh osteochondral viability at 4°C. Our hypothesis was that the cell viability of chondrocytes obtained from human osteochondral tissue and stored at 4°C significantly improves in the presence of NAC. DESIGN Controlled laboratory study. For this study, 8 samples of femoral condyle osteochondral tissue were obtained from patients undergoing total knee replacement. The samples were stored at either 4°C in phosphate-buffered saline (PBS) or at 3 different concentrations of NAC (NAC 1, 2, and 5 mM). Cell viability was analyzed at time 0 and 4 weeks by flow cytometry. The results of cell viability (median) were analyzed statistically using analysis of variance and Tukey's post hoc test. P values <0.05 were considered statistically significant. RESULTS The viability at time 0 was 95.5% ± 3.7%. At 4 weeks, the cell viability was 56.8% ± 20.1% in the control group (PBS), 83.8% ± 11.9% in the group stored with NAC 1 mM, 73.4% ± 13.6% in the group stored with NAC 2 mM, and 66.4% ± 27.7% in the group stored with NAC 5 mM. A statistically significant difference from the baseline viability (time 0) was observed in the PBS control group (P = 0.0018) but not in the other groups. A statistically significant difference was observed in the NAC 1 mM group compared with the PBS group (P = 0.0255). CONCLUSION The use of NAC at 1 mM concentration improves cell viability after 4 weeks of storage in chondrocytes obtained from human osteochondral tissue.
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Affiliation(s)
- Rafael Calvo
- Departamento de Traumatología, Facultad
de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Maximiliano Espinosa
- Departamento de Traumatología, Facultad
de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile,Maximiliano Espinosa, Faculty of Medicine,
Clínica Alemana–Universidad del Desarrollo, Vitacura 5951, Santiago, Región
Metropolitana, Chile.
| | - David Figueroa
- Departamento de Traumatología, Facultad
de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Luz María Pozo
- Instituto de Ciencias e Innovación en
Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo,
Santiago, Chile
| | - Paulette Conget
- Instituto de Ciencias e Innovación en
Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo,
Santiago, Chile
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19
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Gaul F, Bugbee WD. Einsatzmöglichkeiten osteochondraler Allografts. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Meloni GR, Farran A, Mohanraj B, Guehring H, Cocca R, Rabut E, Mauck RL, Dodge GR. Recombinant human FGF18 preserves depth-dependent mechanical inhomogeneity in articular cartilage. Eur Cell Mater 2019; 38:23-34. [PMID: 31393594 PMCID: PMC7273689 DOI: 10.22203/ecm.v038a03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Articular cartilage is a specialised tissue that has a relatively homogenous endogenous cell population but a diverse extracellular matrix (ECM), with depth-dependent mechanical properties. Repair of this tissue remains an elusive clinical goal, with biological interventions preferred to arthroplasty in younger patients. Osteochondral transplantation (OCT) has emerged for the treatment of cartilage defects and osteoarthritis. Fresh allografts stored at 4 °C have been utilised, though matrix and cell viability loss remains an issue. To address this, several studies have developed media formulations to maintain cartilage explants in vitro. One promising factor for these applications is sprifermin, a human-recombinant fibroblast growth factor-18, which stimulates chondrocyte proliferation and matrix synthesis and is in clinical trials for the treatment of osteoarthritis. The study hypothesis was that addition of sprifermin during storage would maintain the unique depth-dependent mechanical profile of articular cartilage explants, a feature not often evaluated. Explants were maintained for up to 6 weeks with or without a weekly 24 h exposure to sprifermin (100 ng/mL) and the compressive modulus was assessed. Results showed that sprifermin-treated samples maintained their depth-dependent mechanical profile through 3 weeks, whereas untreated samples lost their mechanical integrity over 1 week of culture. Sprifermin also affected ECM balance by maintaining the levels of extracellular collagen and suppressing matrix metalloproteinase production. These findings support the use of sprifermin as a medium additive for OCT allografts during in vitro storage and present a potential mechanism where sprifermin may impact a functional characteristic of articular cartilage in repair strategies.
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Affiliation(s)
- Gregory R. Meloni
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Alexandra Farran
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bhavana Mohanraj
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Ryan Cocca
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Emilie Rabut
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - George R. Dodge
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA,Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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21
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Cells, soluble factors and matrix harmonically play the concert of allograft integration. Knee Surg Sports Traumatol Arthrosc 2019; 27:1717-1725. [PMID: 30291395 DOI: 10.1007/s00167-018-5182-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/20/2018] [Indexed: 01/05/2023]
Abstract
Implantation of allograft tissues has massively grown over the last years, especially in the fields related to sports medicine. Beside the fact that often no autograft option exists, autograft related disadvantages as donor-site morbidity and prolonged operative time are drastically reduced with allograft tissues. Despite the well documented clinical success for bone allograft procedures, advances in tissue engineering raised the interest in meniscus, osteochondral and ligament/tendon allografts. Notably, their overall success rates are constantly higher than 80%, making them a valuable treatment option in orthopaedics, especially in knee surgery. Complications reported for allografting procedures are a small risk of disease transmission, immunologic rejection, and decreased biologic incorporation together with nonunion at the graft-host juncture and, rarely, massive allograft resorption. Although allografting is a successful procedure, improved techniques and biological knowledge to limit these pitfalls and maximize graft incorporation are needed. A basic understanding of the biologic processes that affect the donor-host interactions and eventual incorporation and remodelling of various allograft tissues is a fundamental prerequisite for their successful clinical use. Further, the importance of the interaction of immunologic factors with the biologic processes involved in allograft incorporation has yet to be fully dissected. Finally, new tissue engineering techniques and use of adjunctive growth factors, cell based and focused gene therapies may improve the quality and uniformity of clinical outcomes. The aim of this review is to shed light on the biology of meniscus, osteochondral and ligament/tendon allograft incorporation and how collection and storage techniques may affect graft stability and embodiment.Level of evidence V.
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22
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Tírico LEP, McCauley JC, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation of the Femoral Condyle Utilizing a Thin Plug Graft Technique. Am J Sports Med 2019; 47:1613-1620. [PMID: 31100008 DOI: 10.1177/0363546519844212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies showed clinical benefit and durable results of osteochondral allograft (OCA) transplantation for the treatment of femoral condyle lesions. However, the majority of these studies are difficult to interpret owing to the mixed results of different techniques and anatomic locations. PURPOSE To evaluate the outcome of OCA transplantation with thin plug grafts for treatment of isolated femoral condyle osteochondral lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included 187 patients (200 knees) who underwent OCA transplantation for isolated osteochondral lesions on the femoral condyle between 1999 and 2014. For all cases, a thin plug technique was used with commercially available surgical instruments and the minimum amount of bone necessary for fixation. Evaluation included International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and patient satisfaction. Frequency and type of further surgery were assessed. Failure of the allograft was defined as further surgery involving removal of the allograft. RESULTS Mean follow-up was 6.7 years (range, 1.9-16.5 years). The mean age of patients at the time of surgery was 31 years, and 63% were male. The medial femoral condyle was affected in 69% of knees. A single thin plug graft was used in 145 knees (72.5%), and 2 grafts were used in 55 knees (27.5%). Mean allograft area was 6.3 cm2, and graft thickness was 6.5 mm (cartilage and bone combined). Further surgery was required for 52 knees (26%), of which 16 (8% of entire cohort) were defined as allograft failures (4 OCA revisions, 1 arthrosurface, 6 unicompartmental knee arthroplasties, and 5 total knee arthroplasties). Median time to failure was 4.9 years. Survivorship of the allograft was 95.6% at 5 years and 91.2% at 10 years. Among patients with grafts remaining in situ at latest follow-up, clinically meaningful improvement in pain, function, and quality of life was reported. Satisfaction was reported by 89% of patients. CONCLUSION OCA transplantation with a thin plug graft technique is a valuable procedure for the treatment of femoral condyle osteochondral lesions, resulting in significant improvement in clinical scores, high patient satisfaction, and low reoperation and clinical failure rates.
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Affiliation(s)
- Luís E P Tírico
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.,Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - 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.,Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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23
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Cusano J, Curry EJ, Murakami AM, Li X. Fresh Femoral Condyle Allograft Transplant for Knee Osteonecrosis in a Young, Active Patient. Orthop J Sports Med 2018; 6:2325967118798355. [PMID: 30246044 PMCID: PMC6146332 DOI: 10.1177/2325967118798355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joseph Cusano
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Akira M Murakami
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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24
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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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Mei XY, Alshaygy IS, Safir OA, Gross AE, Kuzyk PR. Fresh Osteochondral Allograft Transplantation for Treatment of Large Cartilage Defects of the Femoral Head: A Minimum Two-Year Follow-Up Study of Twenty-Two Patients. J Arthroplasty 2018; 33:2050-2056. [PMID: 29573913 DOI: 10.1016/j.arth.2018.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy remains over the surgical management of large osteochondral lesions of the femoral head in young, active patients. The purpose of this study is to assess midterm clinical and radiographic outcomes after fresh osteochondral allograft transplantation (OAT) for large femoral head lesions at minimum 2-year follow-up. METHODS A retrospective review of prospectively collected data was performed for 22 patients under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2015. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and Kellgren & Lawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty. RESULTS At a mean follow-up of 68.8 months (26-113), the mean mHHS improved significantly (P < .001) from 48.9 (19-84) to 77.4 (35-98). Sixteen of 22 patients (72.7%) had an mHHS ≥70 at the latest follow-up. Arthritic progression, as indicated by an increase in the Kellgren & Lawrence Grade, occurred in 4 of 22 hips (18.2%). Five patients (22.7%) underwent conversion to total hip arthroplasty. Graft survivorship was 86.4 ± 7.3% at 2 years, 78.5 ± 10.0% at 5 years, and 67.3 ± 13.5% at 9 years. CONCLUSION Fresh OAT may be a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity.
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Affiliation(s)
- Xin Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ibrahim S Alshaygy
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Oleg A Safir
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Allan E Gross
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Paul R Kuzyk
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
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Pisanu G, Cottino U, Rosso F, Blonna D, Marmotti AG, Bertolo C, Rossi R, Bonasia DE. Large Osteochondral Allografts of the Knee: Surgical Technique and Indications. JOINTS 2018; 6:42-53. [PMID: 29675506 PMCID: PMC5906123 DOI: 10.1055/s-0038-1636925] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Large osteochondral allograft (OCA) transplant has become a valid alternative to restore articular surface in challenging articular lesions in young and active patients, either in primary or in revision procedures. Several studies support the effectiveness and safety of OCA, but costs and graft availability limit their use. The indications are the treatment of symptomatic full-thickness cartilage lesions greater than 3 cm
2
, deep lesions with subchondral damage, or revision procedures when a previous treatment has failed. The goal of the transplant is to restore the articular surface with a biological implant, allow return to daily/sports activities, relieve symptoms, and delay knee arthroplasty. Grafts can be fresh, fresh-frozen, or cryopreserved; these different storage procedures significantly affect cell viability, immunogenicity, and duration of the storage. Dowel and shell technique are the two most commonly used procedures for OCA transplantation. While most cartilage lesions can be treated with the dowel technique, large and/or geometrically irregular lesions should be treated with the shell technique. OCA transplantation for the knee has demonstrated reliable mid- to long-term results in terms of graft survival and patient satisfaction. Best results are reported: in unipolar lesions, in patients younger than 30 years, in traumatic lesions and when the treatment is performed within 12 months from the onset of symptoms.
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Affiliation(s)
- Gabriele Pisanu
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Davide Blonna
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | | | - Corrado Bertolo
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
| | - Davide E Bonasia
- Department of Orthopaedics and Traumatology, University of Study of Turin, Turin, Italy
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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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Wang D, Jones KJ, Eliasberg CD, Pais MD, Rodeo SA, Williams RJ. Condyle-Specific Matching Does Not Improve Midterm Clinical Outcomes of Osteochondral Allograft Transplantation in the Knee. J Bone Joint Surg Am 2017; 99:1614-1620. [PMID: 28976425 DOI: 10.2106/jbjs.16.01542] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Condyle-specific matching for osteochondral allograft transplantation (OCA) pairs donor and recipient condyles in an attempt to minimize articular incongruity. While the majority of cartilage defects are located on the medial femoral condyle, lateral femoral condyles are more commonly available as a graft source. The purpose of this study was to compare the clinical outcomes of patients treated with non-orthotopic (lateral-to-medial condyle or medial-to-lateral condyle) OCA with those treated with traditional orthotopic (medial-to-medial condyle or lateral-to-lateral condyle) OCA. We hypothesized that clinical outcomes would be similar between groups at midterm follow-up. METHODS A retrospective review of prospectively collected data on patients treated with OCA from 2000 to 2014 was conducted. Seventy-seven patients with a full-thickness cartilage defect of a femoral condyle were treated with either orthotopic (n = 50) or non-orthotopic (n = 27) OCA. A minimum follow-up of 2 years was required for analysis. Patients in each group were matched according to sex, age, and total chondral defect size. Reoperations and patient responses to validated outcome measures were reviewed. Failure was defined as any revision cartilage procedure or conversion to knee arthroplasty. RESULTS The mean duration of follow-up was 4.0 years (range, 2 to 16 years). The orthotopic and non-orthotopic OCA groups were comparable in terms of demographics, the mean number of prior ipsilateral knee operations, and the percentage of concomitant procedures at baseline. Reoperation (p = 0.427) and failure (p = 0.917) rates did not differ significantly between groups. Both groups demonstrated significant increases in the Short Form-36 (SF-36) physical functioning and pain, International Knee Documentation Committee (IKDC), and Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scores compared with baseline (p < 0.004). Outcome scores (baseline and postoperative) and change scores did not differ significantly between groups. CONCLUSIONS Clinical outcomes do not differ between patients treated with orthotopic OCA and those treated with non-orthotopic OCA, suggesting that condyle-specific matching may not be necessary. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dean Wang
- 1Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 2Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Meyer MA, McCarthy MA, Gitelis ME, Poland SG, Urita A, Chubinskaya S, Yanke AB, Cole BJ. Effectiveness of Lavage Techniques in Removing Immunogenic Elements from Osteochondral Allografts. Cartilage 2017; 8:369-373. [PMID: 28934881 PMCID: PMC5613898 DOI: 10.1177/1947603516681132] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to compare standard saline lavage to combination saline and high-pressure carbon dioxide (CO2) lavage in removing marrow elements from osteochondral allografts. Design Six fresh hemicondyles were obtained. Three osteochondral allograft plugs (15-mm diameter, 6-mm depth) were harvested from each hemicondyle and randomized to 1 of 3 treatment arms: A, no lavage; B, 1 L standard saline lavage; C, simultaneous saline (1 L) and 1-minute high-pressure CO2 lavage. After hematoxylin and eosin staining, a "percentage fill" of remaining marrow elements was calculated for each overall sample and then repeated in 3 distinct compartments for each sample based on depth from surface: 1, deepest third; 2, middle third; and 3, most superficial third. Trial arms B and C were compared with 1-tailed Student t tests. Results Group A had an overall percentage fill of 51.2% ± 8.8%. While both lavage techniques decreased overall remaining marrow elements, group B yielded significantly higher percentages of remaining marrow elements than group C (28.6% ± 16.5%, 14.6% ± 8.7%, P = 0.045). On depth analysis, group A exhibited homogenous filling of trabecular space (63.0% ± 15.5%, 67.6% ± 13.7%, and 55.2% ± 10.1% in zones 1, 2, and 3, respectively). Both lavage arms equally removed marrow elements from superficial zone 3 (B, 17.4% ± 9.2%; C, 15.6% ± 12.4%, P = 0.41) and middle zone 2 (B, 30.2% ± 17.7%; C, 21.4% ± 15.5%, P = 0.18). However, group C lavage removed significantly more marrow elements in deep zone 1 than group B (29.7% ± 10.9%, 58.5% ± 25.2%, P = 0.01). Conclusion Combination saline and high-pressure CO2 lavage more effectively clears marrow elements from osteochondral allografts than saline alone.
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Affiliation(s)
- Maximilian A. Meyer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mark A. McCarthy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew E. Gitelis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sarah G. Poland
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Adam B. Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J. Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,Brian J. Cole, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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Linka K, Itskov M, Truhn D, Nebelung S, Thüring J. T2 MR imaging vs. computational modeling of human articular cartilage tissue functionality. J Mech Behav Biomed Mater 2017; 74:477-487. [PMID: 28760354 DOI: 10.1016/j.jmbbm.2017.07.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/10/2017] [Accepted: 07/18/2017] [Indexed: 12/31/2022]
Abstract
The detection of early stages of cartilage degeneration remains diagnostically challenging. One promising non-invasive approach is to functionally assess the tissue response to loading by serial magnetic resonance (MR) imaging in terms of T2 mapping under simultaneous mechanical loading. As yet, however, it is not clear which cartilage component contributes to the tissue functionality as assessed by quantitative T2 mapping. To this end, quantitative T2 maps of histologically intact cartilage samples (n=8) were generated using a clinical 3.0-T MR imaging system. Using displacement-controlled quasi-static indentation loading, serial T2 mapping was performed at three defined strain levels and loading-induced relative changes were determined in distinct regions-of-interest. Samples underwent conventional biomechanical testing (by unconfined compression) as well as histological assessment (by Mankin scoring) for reference purposes. Moreover, an anisotropic hyperelastic constitutive model of cartilage was implemented into a finite element (FE) code for cross-referencing. In efforts to simulate the evolution of compositional and structural intra-tissue changes under quasi-static loading, the indentation-induced changes in quantitative T2 maps were referenced to underlying changes in cartilage composition and structure. These changes were parameterized as cartilage fluid, proteoglycan and collagen content as well as collagen orientation. On a pixel-wise basis, each individual component correlation with T2 relaxation times was determined by Spearman's ρs and significant correlations were found between T2 relaxation times and all four tissue parameters for all indentation strain levels. Thus, the biological changes in functional MR Imaging parameters such as T2 can further be characterized to strengthen the scientific basis of functional MRI techniques with regards to their perspective clinical applications.
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Affiliation(s)
- Kevin Linka
- Department of Continuum Mechanics, RWTH Aachen University, Kackertstr. 9, 52072 Aachen, Germany.
| | - Mikhail Itskov
- Department of Continuum Mechanics, RWTH Aachen University, Kackertstr. 9, 52072 Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Johannes Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
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Tschon M, Veronesi F, Giannini S, Fini M. Fresh osteochondral allotransplants: Outcomes, failures and future developments. Injury 2017; 48:1287-1295. [PMID: 28551052 DOI: 10.1016/j.injury.2017.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteochondral allografts are used to treat many different conditions as acute traumatic large-sized lesions, degenerative osteoarthritis, osteochondritis dissecans, avascular necrosis or in case of failure of previous procedures particularly in young patients for whom primary prosthesis is not desirable. Fresh allografts present the advantage of having mature viable hyaline cartilage, not causing donor morbidity, allowing the restoration of even large defects in a single surgical session. Conversely, they could account for risks of disease transmission, immunologic reactions, and for limited availability. The present review aimed to analyze published studies of the last decade in which patients received fresh osteochondral allografts by dividing them for knee or ankle regenerative purposes. We wish to report the observed failure rates and particularly to collect any other reported side effect or outcome for identifying major problems and limits linked to the procedure and for delineating possible future researches and approaches. The overall success rates resulted ranging from 5.3% to 48.3% in the ankle at a mean follow up of 3.3 years and from 0% to 85.7% in the knee at a mean follow up of 7.1 years. Among other outcomes, occurrence or progression of arthritis, osteolysis, graft instability, fractures, nonunions, edema and infections were recorded. Overall, the lack of well designed randomized and controlled clinical trials, of immunological determination of the anti-donor antibodies development and of local and systemic biomarkers to detect reaction to the graft seems to be the major drawback. Improvements in these limiting factors might be desirable in order to enhance the clinical scenario of a well-established and successful procedure to give, especially for young patients, a real regeneration of the joint.
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Affiliation(s)
- M Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - F Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - S Giannini
- Biomedical and Neuromotor Sciences Department, University of Bologna, Via Ugo Foscolo, 7, 40123 Bologna, Italy
| | - M Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
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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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Pomajzl RJ, Baker EA, Baker KC, Fleischer MM, Salisbury MR, Phillips DM, Fortin PT. Case Series With Histopathologic and Radiographic Analyses Following Failure of Fresh Osteochondral Allografts of the Talus. Foot Ankle Int 2016; 37:958-67. [PMID: 27272267 DOI: 10.1177/1071100716651963] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fresh osteochondral allografting of the talus is one treatment option for large chondral defects. Following positive early term results, failure rates of up to 35% have been reported. A retrieval study was performed to characterize failed talar allografts. METHODS Failed fresh osteochondral allografts of the talus were retrieved on revision. Cases of deep infection were excluded. After tissue fixation, samples were decalcified, embedded, and stained with Safranin-O/Fast Green, osteocalcin, tumor necrosis factor alpha (TNF-α), CD4, CD8, and CD68. Slides were graded according to the modified Mankin scoring system or severity scale. Medical record review was performed. RESULTS Eight allografts (7 patients) were retrieved from patients, following an average term of implantation of 31 months (range, 12-58). There were 3 types of allografts in this series (hemidome, n=5; segmental, n=2; bipolar, n=1). Reasons for transplantation were post-traumatic arthritis or osteonecrosis; reasons for revision were graft failure/collapse, nonunion, progressive arthritis, and/or pain. Prior to revision, all grafts exhibited collapse and subchondral lucencies. At the graft host interface, Safranin-O staining demonstrated substantial loss of sulfated glycosaminoglycans, Osteocalcin immunostaning was nearly absent, CD68 (indicating osteoclast activity) was predominantly exhibited, and CD4+ helper T cells as well as CD8+ cytotoxic T cells and NK cells-cell types commonly implicated in allogeneic organ transplant rejection-were found in high concentrations. TNF-α was present throughout the graft. CONCLUSION A histopathologic analysis of 8 retrieved, failed talar allografts was performed. Graft failure appeared to be primarily biologic, with an extensive loss of viable cartilaginous and osseous tissue at the graft-host interface. This study provides the first evidence of a potential CD4+ and CD8+ lymphocyte-mediated failure mechanism in fresh osteochondral allografts that were revised following collapse. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Ryan Joseph Pomajzl
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Erin Ann Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Kevin Charles Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | | | - Meagan R Salisbury
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Dylan M Phillips
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Paul Thomas Fortin
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
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35
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Shardt N, Al-Abbasi KK, Yu H, Jomha NM, McGann LE, Elliott JAW. Cryoprotectant kinetic analysis of a human articular cartilage vitrification protocol. Cryobiology 2016; 73:80-92. [PMID: 27221520 DOI: 10.1016/j.cryobiol.2016.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/17/2022]
Abstract
We recently published a protocol to vitrify human articular cartilage and a method of cryoprotectant removal in preparation for transplantation. The current study's goal was to perform a cryoprotectant kinetic analysis and theoretically shorten the procedure used to vitrify human articular cartilage. First, the loading of the cryoprotectants was modeled using Fick's law of diffusion, and this information was used to predict the kinetics of cryoprotectant efflux after the cartilage sample had been warmed. We hypothesized that diffusion coefficients obtained from the permeation of individual cryoprotectants into porcine articular cartilage could be used to provide a reasonable prediction of the cryoprotectant loading and of the combined cryoprotectant efflux from vitrified human articular cartilage. We tested this hypothesis with experimental efflux measurements. Osteochondral dowels from three patients were vitrified, and after warming, the articular cartilage was immersed in 3 mL X-VIVO at 4 °C in two consecutive solutions, each for 24 h, with the solution osmolality recorded at various times. Measured equilibrium values agreed with theoretical values within a maximum of 15% for all three samples. The results showed that diffusion coefficients for individual cryoprotectants determined from experiments with 2-mm thick porcine cartilage can be used to approximate the rate of efflux of the combined cryoprotectants from vitrified human articular cartilage of similar thickness. Finally, Fick's law of diffusion was used in a computational optimization to shorten the protocol with the constraint of maintaining the theoretical minimum cryoprotectant concentration needed to achieve vitrification. The learning provided by this study will enable future improvements in tissue vitrification.
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Affiliation(s)
- Nadia Shardt
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton T6G 1H9, Canada
| | | | - Hana Yu
- Department of Surgery, University of Alberta, Edmonton T6G 2B7, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton T6G 2B7, Canada
| | - Locksley E McGann
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton T6G 2R7, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton T6G 1H9, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton T6G 2R7, Canada.
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Qi J, Hu Z, Song H, Chen B, Xie D, Zhou L, Zhang Y. Cartilage storage at 4 °C with regular culture medium replacement benefits chondrocyte viability of osteochondral grafts in vitro. Cell Tissue Bank 2016; 17:473-9. [PMID: 27130198 PMCID: PMC5010590 DOI: 10.1007/s10561-016-9556-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/26/2016] [Indexed: 10/26/2022]
Abstract
Maintenance of articular cartilage allografts in culture media is a common method of tissue storage; however, the technical parameters of graft storage remain controversial. In this study, we examined the optimal temperature and culture medium exchange rate for the storage of osteochondral allografts in vitro. Cylindrical osteochondral grafts (n = 120), harvested from the talar joint surface of ten Boer goats, were randomly classified into four groups and stored under the following conditions: Group A1 was maintained at 4 °C in culture medium that was refreshed every 2 days; Group A2 was maintained at 4 °C in the same culture medium, without refreshing; Group B1, was maintained at 37 °C in culture medium that was refreshed every 2 days; Group B2, was maintained at 37 °C in the same culture medium, without refreshing. Chondrocyte viability in the grafts was determined by ethidium bromide/fluorescein diacetate staining on days 7, 21, and 35. Proteoglycan content was measured by Safranin-O staining. Group A1 exhibited the highest chondrocyte survival rates of 90.88 %, 88.31 % and 78.69 % on days 7, 21, and 35, respectively. Safranin O staining revealed no significant differences between groups on days 21 and 35. These results suggest that storage of osteochondral grafts at 4 °C with regular culture medium replacement should be highly suitable for clinical application.
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Affiliation(s)
- Jianhong Qi
- Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China.
| | - Zunjie Hu
- Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China
| | - Hongqiang Song
- Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China
| | - Bin Chen
- Life Science Center, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China
| | - Di Xie
- Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China
| | - Lu Zhou
- Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China
| | - Yanming Zhang
- Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong Province, People's Republic of China
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Abstract
Over the past decade, osteochondral allograft transplantation has soared in popularity. Advances in storage techniques have demonstrated improved chondrocyte viability at longer intervals and allowed for potential of increased graft availability. Recent studies have stratified outcomes according to location and etiology of the chondral or osteochondral defect. Unipolar lesions generally have favorable outcomes with promising 10-year survival rates. Though those undergoing osteochondral allograft transplantation often require reoperation, patient satisfaction remains high.
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Affiliation(s)
- Arissa M Torrie
- Department of Orthopaedics, Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA
| | - William W Kesler
- Department of Orthopaedics, Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA
| | - Joshua Elkin
- Department of Orthopaedics, Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA
| | - Robert A Gallo
- Department of Orthopaedics, Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA.
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Nover AB, Stefani RM, Lee SL, Ateshian GA, Stoker AM, Cook JL, Hung CT. Long-term storage and preservation of tissue engineered articular cartilage. J Orthop Res 2016; 34:141-8. [PMID: 26296185 PMCID: PMC4710567 DOI: 10.1002/jor.23034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/18/2015] [Indexed: 02/04/2023]
Abstract
With limited availability of osteochondral allografts, tissue engineered cartilage grafts may provide an alternative treatment for large cartilage defects. An effective storage protocol will be critical for translating this technology to clinical use. The purpose of this study was to evaluate the efficacy of the Missouri Osteochondral Allograft Preservation System (MOPS) for room temperature storage of mature tissue engineered grafts, focusing on tissue property maintenance during the current allograft storage window (28 days). Additional research compares MOPS to continued culture, investigates temperature influence, and examines longer-term storage. Articular cartilage constructs were cultured to maturity using adult canine chondrocytes, then preserved with MOPS at room temperature, in refrigeration, or kept in culture for an additional 56 days. MOPS storage maintained desired chondrocyte viability for 28 days of room temperature storage, retaining 75% of the maturity point Young's modulus without significant decline in biochemical content. Properties dropped past this time point. Refrigeration maintained properties similar to room temperature at 28 days, but proved better at 56 days. For engineered grafts, MOPS maintained the majority of tissue properties for the 28-day window without clearly extending that period as it had for native grafts. These results are the first evaluating engineered cartilage storage.
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Affiliation(s)
- Adam B. Nover
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, Mail Code: 8904, New York, New York 10027
| | - Robert M. Stefani
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, Mail Code: 8904, New York, New York 10027
| | - Stephanie L. Lee
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, Mail Code: 8904, New York, New York 10027
| | - Gerard A. Ateshian
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, Mail Code: 8904, New York, New York 10027,Department of Mechanical Engineering, Columbia University, 242 S. W. Mudd, 500 West 120th Street, Mail Code: 4703, New York, New York 10027
| | - Aaron M. Stoker
- Department of Veterinary Medicine and Surgery, University of Missouri, 900 E Campus Dr., Columbia, Missouri 65211
| | - James L. Cook
- Department of Veterinary Medicine and Surgery, University of Missouri, 900 E Campus Dr., Columbia, Missouri 65211,Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, DC953.000, Columbia, Missouri 65212
| | - Clark T. Hung
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, Mail Code: 8904, New York, New York 10027
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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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Guermazi A, Roemer FW, Alizai H, Winalski CS, Welsch G, Brittberg M, Trattnig S. State of the Art: MR Imaging after Knee Cartilage Repair Surgery. Radiology 2015; 277:23-43. [DOI: 10.1148/radiol.2015141146] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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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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Kay A, Hoyland J, Rooney P, Kearney J, Pegg D. A liquidus tracking approach to the cryopreservation of human cartilage allografts. Cryobiology 2015; 71:77-84. [DOI: 10.1016/j.cryobiol.2015.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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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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Streit JJ, Idoine J, Shishani Y, Gobezie R. Allograft Around the Shoulder. OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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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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46
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Hydrogen supplementation of preservation solution improves viability of osteochondral grafts. ScientificWorldJournal 2014; 2014:109876. [PMID: 25506061 PMCID: PMC4253708 DOI: 10.1155/2014/109876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 01/12/2023] Open
Abstract
Allogenic osteochondral tissue (OCT) is used for the treatment of large cartilage defects. Typically, OCTs collected during the disease-screening period are preserved at 4°C; however, the gradual reduction in cell viability during cold preservation adversely affects transplantation outcomes. Therefore, improved storage methods that maintain the cell viability of OCTs are needed to increase the availability of high-quality OCTs and improve treatment outcomes. Here, we evaluated whether long-term hydrogen delivery to preservation solution improved the viability of rat OCTs during cold preservation. Hydrogen-supplemented Dulbecco's Modified Eagles Medium (DMEM) and University of Wisconsin (UW) solution both significantly improved the cell viability of OCTs during preservation at 4°C for 21 days compared to nonsupplemented media. However, the long-term cold preservation of OCTs in DMEM containing hydrogen was associated with the most optimal maintenance of chondrocytes with respect to viability and morphology. Our findings demonstrate that OCTs preserved in DMEM supplemented with hydrogen are a promising material for the repair of large cartilage defects in the clinical setting.
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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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Wright GJ, Brockbank KGM, Rahn E, Halwani DO, Chen Z, Yao H. Impact of storage solution formulation during refrigerated storage upon chondrocyte viability and cartilage matrix. Cells Tissues Organs 2014; 199:51-8. [PMID: 25171188 DOI: 10.1159/000363134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/19/2022] Open
Abstract
Various preservation solutions have been evaluated for longer hypothermic cartilage storage for tissue transplantation; however, the results are mixed. This research was carried out to determine whether phosphate-buffered saline (PBS) or organ preservation solutions would preserve both the extracellular matrix and chondrocytes of articular cartilage better than culture medium during refrigerated storage in the time frame that cartilage is stored for clinical use. Porcine cartilage plugs were stored, without the underlying bone, in culture medium with and without fetal bovine serum (FBS), PBS, Belzer's and Unisol solutions for 1 month at 4°C. Metabolic activity was tested using a resazurin reduction method, and matrix permeability was evaluated by measuring electrical conductivity. Storage in culture medium with 10% FBS was shown to provide good cartilage metabolic function for 7 days, decreasing to about 36% after 1 month of storage. There was no significant difference between samples stored in culture medium with and without FBS after 1 month of storage (p = 0.5005). Refrigerated storage of cartilage in PBS and two different solutions (Belzer's and Unisol) designed for optimal refrigerated tissue and organ storage results in loss of chondrocyte function and retention of matrix permeability. In contrast, the opposite, namely significantly better retention of chondrocyte function and loss of matrix permeability, was observed with culture medium. Future research should be focused on combining retention of chondrocyte function and matrix permeability by storage solution formulation.
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Affiliation(s)
- Gregory J Wright
- Clemson-Medical University of South Carolina Joint Bioengineering Program, Department of Bioengineering, Clemson University, Charleston, S.C., USA
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Vernon L, Abadin A, Wilensky D, Huang CYC, Kaplan L. Subphysiological compressive loading reduces apoptosis following acute impact injury in a porcine cartilage model. Sports Health 2014; 6:81-8. [PMID: 24427447 PMCID: PMC3874225 DOI: 10.1177/1941738113504379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute cartilage injuries induce cell death and are associated with an increased incidence of osteoarthritis development later in life. The objective of this study was to investigate the effect of posttraumatic cyclic compressive loading on chondrocyte viability and apoptosis in porcine articular cartilage plugs. HYPOTHESIS Compressive loading of acutely injured cartilage can maintain chondrocyte viability by reducing apoptosis after a traumatic impact injury. STUDY DESIGN In vitro controlled laboratory study. LEVEL OF EVIDENCE Level 5. METHODS Each experiment compared 4 test groups: control, impact, impact with compressive loading (either 0.5 or 0.8 MPa), and no impact but compressive loading (n = 15 per group). Flat, full-thickness articular cartilage plugs were harvested from the trochlear region of porcine knees. A drop tower was utilized to introduce an impact injury. The articular plugs were subjected to two 30-minute cycles of either 0.5 or 0.8 MPa of dynamic loading. Cell viability, apoptosis, and gene expression of samples were evaluated 24 hours postimpaction. RESULTS Cell viability staining showed that 0.5 MPa of dynamic compressive loading increased cell viability compared with the impact group. Apoptotic analysis revealed a decrease in apoptotic expression in the group with 0.5 MPa of dynamic compressive loading compared with the impact group. Significantly higher caspase 3 and lower collagen II expressions were observed in impacted samples without compressive loading, compared with those with. Compressive loading of nonimpacted samples significantly increased collagen II and decreased caspase 3 expressions. CONCLUSION In this porcine in vitro model, dynamic compressive loading at subphysiological levels immediately following impact injury decreases apoptotic expression, thereby maintaining chondrocyte viability. CLINICAL RELEVANCE Therapeutic exercises could be designed to deliver subphysiological loading to the injured cartilage, thereby minimizing injury.
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Affiliation(s)
- Lauren Vernon
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
- Division of Sports Medicine, UHealth Sports Performance and Wellness Institute, University of Miami Hospital, Miami, Florida
| | - Andre Abadin
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
| | - David Wilensky
- Division of Sports Medicine, UHealth Sports Performance and Wellness Institute, University of Miami Hospital, Miami, Florida
| | - C.-Y. Charles Huang
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
| | - Lee Kaplan
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
- Division of Sports Medicine, UHealth Sports Performance and Wellness Institute, University of Miami Hospital, Miami, Florida
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