1
|
Wang T, Gao SL, McCauley JC, Densley SM, Bugbee WD. Outcomes After Osteochondral Allograft Transplantation of the Medial Femoral Condyle in Patients With Varus and Nonvarus Alignment. Am J Sports Med 2024:3635465241273947. [PMID: 39324486 DOI: 10.1177/03635465241273947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. PURPOSE To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigné-Postel score, and overall patient satisfaction score. RESULTS The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. CONCLUSION Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.
Collapse
Affiliation(s)
- Tim Wang
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Sean L Gao
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA
| | - Sebastian M Densley
- Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| |
Collapse
|
2
|
Elias TJ, Allahabadi S, Haneberg E, Morgan V, Walker A, Beals C, Cole BJ, Yanke AB. Osteochondral Allograft Reaming Significantly Affects Chondrocyte Viability. Am J Sports Med 2024; 52:2874-2881. [PMID: 39186448 DOI: 10.1177/03635465241268969] [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: 08/28/2024]
Abstract
BACKGROUND Chondrocyte viability is associated with the clinical success of osteochondral allograft (OCA) transplantation. PURPOSE To investigate the effect of distal femoral OCA plug harvest and recipient site preparation on regional cell viability using traditional handheld saline irrigation versus saline submersion. STUDY DESIGN Controlled laboratory study. METHODS For each of 13 femoral hemicondyles, 4 cartilage samples were harvested: (1) 5-mm control cartilage, (2) 15-mm OCA donor plug harvested with a powered coring reamer and concurrent handheld saline irrigation ("traditional"), (3) 15-mm OCA donor plug harvested while submerged under normal saline ("submerged"), and (4) 5-mm cartilage from the peripheral rim of a recipient socket created with a 15-mm cannulated counterbore reamer to a total depth of 7 mm with concurrent handheld saline irrigation ("recipient"). The 15 mm-diameter plugs were divided into the central 5 mm and the peripheral 5 mm (2 edges) for comparisons. Samples were stained using calcein and ethidium, and live/dead cell percentages were calculated and compared across groups. RESULTS Compared with the submerged group, the traditional group had significantly lower percentages of live cells across the whole plug (71.54% ± 4.82% vs 61.42% ± 4.98%, respectively; P = .003), at the center of the plug (72.76% ± 5.87% vs 62.30% ± 6.11%, respectively; P = .005), and at the periphery of the plug (70.93% ± 4.51% vs 60.91% ± 4.75%, respectively; P = .003). The traditional group had significantly fewer live cells in all plug regions compared with the control group (77.51% ± 9.23%; P < .0001). There were no significant differences in cell viability between the control and submerged groups (whole: P = .590; center: P = .713; periphery: P = .799). There were no differences between the central and peripheral 5-mm plug regions for the traditional (62.30% ± 6.11% vs 60.91% ± 4.75%, respectively; P = .108) and submerged (72.76% ± 5.87% vs 70.93% ± 4.51%, respectively; P = .061) groups. The recipient group (61.10% ± 5.02%) had significantly lower cell viability compared with the control group (P < .0001) and the periphery of the submerged group (P = .009) but was equivalent to the periphery of the traditional group (P = .990). CONCLUSION There was a significant amount of chondrocyte death induced by OCA donor plug harvesting using a powered coring reamer with traditional handheld saline irrigation, which was mitigated by harvesting the plug while the allograft was submerged under saline. CLINICAL RELEVANCE Mitigating this thermally induced damage by harvesting the OCA plug while the allograft was submerged in saline maintained chondrocyte viability throughout the plug and may help to improve the integration and survival of OCAs.
Collapse
Affiliation(s)
- Tristan J Elias
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
- University of Texas Medical Branch, Galveston, TX, USA
| | - Sachin Allahabadi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
- Houston Methodist Hospital, Houston, Texas, USA
| | - Erik Haneberg
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Vince Morgan
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Alexandra Walker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Corey Beals
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
3
|
Luk J, Bozynski CC, Williams J, Stoker AM, Stannard JP, Teixeiro E, Cook JL. Cell-Mediated Immune Responses May Play Roles in Osteochondral Allograft Transplantation Osteointegration Failures. J Knee Surg 2024; 37:812-819. [PMID: 38754436 DOI: 10.1055/s-0044-1787058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Prolonged and incomplete osteochondral allograft (OCA) osteointegration is consistently cited as a major mechanism for OCA treatment failure. Subrejection immune responses may play roles in this mode of failure. Preimplantation OCA preparation techniques, including subchondral bone drilling, thorough irrigation, and autogenous bone marrow aspirate concentrate saturation, may dampen immune responses and improve OCA osteointegration. This study sought to further characterize potential immune system contributions to OCA transplantation treatment failures by analyzing donor-recipient ABO and Rh-factor mismatches and histological and immunohistochemical assessments of transplanted OCA tissues recovered from revision surgeries. Using a dedicated registry, OCA transplant recipients with documented treatment failures who met inclusion criteria (n = 33) as well as age-, body mass index-, and joint-matched patients with successful outcomes (n = 70) were analyzed to compare matched cohorts of patients with successful versus failed OCA transplantation outcomes. Tissues recovered from 18 failed OCA transplants and portions of 7 nonimplanted OCA controls were further analyzed to provide contributing evidence for potential immune response mechanisms. For patients analyzed, no statistically significant differences in proportions for treatment success versus failure based on mismatches for ABO type, Rh factor, or both were noted. Further, no statistically significant differences in proportions for histological immune response presence or absence based on mismatches for ABO type, Rh factor, or both were noted. Twelve (67%) of the failed OCA tissues contained lymphocyte aggregations in the subchondral bone, which were comprised of combinations of CD3 + , CD4 + , CD8 + , and CD20+ lymphocytes. The mechanisms of failure for these 12 OCA transplants involved insufficient OCA osteointegration. Results of this study suggest that T- and B-cell-mediated subrejection immune responses may play roles in OCA transplant treatment failures independent of donor-recipient blood type mismatch effects.
Collapse
Affiliation(s)
- Josephine Luk
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Jonathan Williams
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- Department of Molecular Microbiology and Immunology, Department of Surgery, University of Missouri, Roy Blunt NextGen Precision Health, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| |
Collapse
|
4
|
Wang S, Mueller D, Chen P, Pan G, Wilson M, Sun S, Chen Z, Lee T, Damon B, Hepfer RG, Hill C, Kern MJ, Pullen WM, Wu Y, Brockbank KGM, Yao H. Viable Vitreous Grafts of Whole Porcine Menisci for Transplant in the Knee and Temporomandibular Joints. Adv Healthc Mater 2024; 13:e2303706. [PMID: 38523366 PMCID: PMC11368656 DOI: 10.1002/adhm.202303706] [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: 10/25/2023] [Revised: 03/20/2024] [Indexed: 03/26/2024]
Abstract
The shortage of suitable donor meniscus grafts from the knee and temporomandibular joint (TMJ) impedes treatments for millions of patients. Vitrification offers a promising solution by transitioning these tissues into a vitreous state at cryogenic temperatures, protecting them from ice crystal damage using high concentrations of cryoprotectant agents (CPAs). However, vitrification's success is hindered for larger tissues (>3 mL) due to challenges in CPA penetration. Dense avascular meniscus tissues require extended CPA exposure for adequate penetration; however, prolonged exposure becomes cytotoxic. Balancing penetration and reducing cell toxicity is required. To overcome this hurdle, a simulation-based optimization approach is developed by combining computational modeling with microcomputed tomography (µCT) imaging to predict 3D CPA distributions within tissues over time accurately. This approach minimizes CPA exposure time, resulting in 85% viability in 4-mL meniscal specimens, 70% in 10-mL whole knee menisci, and 85% in 15-mL whole TMJ menisci (i.e., TMJ disc) post-vitrification, outperforming slow-freezing methods (20%-40%), in a pig model. The extracellular matrix (ECM) structure and biomechanical strength of vitreous tissues remain largely intact. Vitreous meniscus grafts demonstrate clinical-level viability (≥70%), closely resembling the material properties of native tissues, with long-term availability for transplantation. The enhanced vitrification technology opens new possibilities for other avascular grafts.
Collapse
Affiliation(s)
- Shangping Wang
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Dustin Mueller
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Peng Chen
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Ge Pan
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Marshall Wilson
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Shuchun Sun
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Zhenzhen Chen
- Tissue Testing Technologies LLC, North Charleston, SC, 29406, USA
| | - Thomas Lee
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Brooke Damon
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - R Glenn Hepfer
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Cherice Hill
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Michael J Kern
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - William M Pullen
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Yongren Wu
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kelvin G M Brockbank
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Tissue Testing Technologies LLC, North Charleston, SC, 29406, USA
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29425, USA
| |
Collapse
|
5
|
Jiang Z, Clausen JD, Jahn D, Wulsten D, Gladitz LM, Bundkirchen K, Krettek C, Neunaber C. Ex vivo storage of human osteochondral allografts: Long-term analysis over 300 days using a Ringer-based solution. J Orthop Res 2024; 42:1719-1726. [PMID: 38440833 DOI: 10.1002/jor.25821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024]
Abstract
Large osteochondral defects are a major challenge in orthopedics, for which osteochondral allograft (OCA) transplantation is nowadays considered as an option, especially in young patients. However, a major issue with OCA is the need for graft storage, which ensures adequate cartilage integrity over time. The aim of this study was to test how long a Ringer-based storage solution can provide good graft quality after explantation and thus meet the requirements for OCA. For this purpose, human osteochondral allografts of the knee and ankle were analyzed. Live/Dead analysis was performed and glycosaminoglycan, as well as hydroxyproline content, were measured as crucial chondrocyte integrity factors. Furthermore, biomechanical tests focusing on stress relaxation and elastic compression modulus were performed. The critical value of 70% living chondrocytes, which corresponds to a number of 300 cells/mm², was reached after an average of 16 weeks of storage. In addition, a constant cell shrinkage was observed over time. The amount of glycosaminoglycan and hydroxyroline showed a slight and constant decrease over time, but no significant differences when compared from Day 0 to the values at Weeks 40-43. Biomechanical testing also revealed no significant differences at the different time points. Therefore, the results show that the Ringer-based storage solution at 4°C is able to provide a chondrocyte survival of 70% until Week 16. This is comparable to previously published storage solutions. Therefore, the study contributes to the establishment of a Ringer-based osteochondral allograft transplantation system for countries where medium-based storage solution cannot be approved.
Collapse
Affiliation(s)
- Zhida Jiang
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Jan-Dierk Clausen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Denise Jahn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Dag Wulsten
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Luisa M Gladitz
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Katrin Bundkirchen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Krettek
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
6
|
Lydon KL, Struijk C, Michielsen J, Prokop L, Krych AJ, Saris D, Verdonk P. Fresh Versus Frozen Meniscal Allograft Transplant: Revisit or Redundant? A Systematic Review. Am J Sports Med 2024; 52:2159-2167. [PMID: 38282584 DOI: 10.1177/03635465231200236] [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: 01/30/2024]
Abstract
BACKGROUND Fresh-frozen allografts are the current standard in meniscal allograft transplant (MAT) surgery, due to their availability, ease of preservation, and affordability. However, fresh-frozen grafts are associated with several clinical challenges such as graft shrinkage and extrusion, among many others. PURPOSE To present the current knowledge on the use of fresh meniscal allografts, presenting whether benefits associated with fresh grafts provide sufficient evidence to support their use in clinical practice. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A comprehensive search was conducted with keywords listed below. After an initial screening on title and abstract, full-text articles were assessed with the inclusion criteria. RESULTS A total of 78 studies matched the inclusion criteria. Literature and preclinical studies indicated that fresh meniscal allografts are beneficial for maintaining mechanical properties, graft ultrastructure, and matrix metabolism due to the presence of viable cells. Therefore, fresh allografts may address common complications associated with fresh-frozen MAT. To overcome challenges associated with both fresh-frozen and fresh allografts, a group has studied treating fresh-frozen allografts with a cell-based injection therapy. CONCLUSION Fresh meniscal allografts pose several challenges including limited availability, demanding preservation procedures, and high costs. Although the role of viable cells within meniscal allografts remains controversial, these cells may be vital for maintaining tissue properties.
Collapse
Affiliation(s)
- Katherine L Lydon
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Struijk
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
| | - Jozef Michielsen
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
| | - Larry Prokop
- Library Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Saris
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, University Medical Centre, Utrecht, the Netherlands
| | - Peter Verdonk
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
- ORTHOCA, Antwerp, Belgium
| |
Collapse
|
7
|
Sangiorgio A, Andriolo L, Gersoff W, Kon E, Nakamura N, Nehrer S, Vannini F, Filardo G. Subchondral bone: An emerging target for the treatment of articular surface lesions of the knee. J Exp Orthop 2024; 11:e12098. [PMID: 39040436 PMCID: PMC11260998 DOI: 10.1002/jeo2.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose When dealing with the health status of the knee articular surface, the entire osteochondral unit has gained increasing attention, and in particular the subchondral bone, which plays a key role in the integrity of the osteochondral unit. The aim of this article was to discuss the current evidence on the role of the subchondral bone. Methods Experts from different geographical regions were involved in performing a review on highly discussed topics about the subchondral bone, ranging from its etiopathogenetic role in joint degeneration processes to its prognostic role in chondral and osteochondral defects, up to treatment strategies to address both the subchondral bone and the articular surface. Discussion Subchondral bone has a central role both from an aetiologic point of view and as a diagnostic tool, and its status was found to be relevant also as a prognostic factor in the follow-up of chondral treatment. Finally, the recognition of its importance in the natural history of these lesions led to consider subchondral bone as a treatment target, with the development of osteochondral scaffolds and procedures to specifically address osteochondral lesions. Conclusion Subchondral bone plays a central role in articular surface lesions from different points of view. Several aspects still need to be understood, but a growing interest in subchondral bone is to be expected in the upcoming future towards the optimization of joint preservation strategies. Level of Evidence Level V, expert opinion.
Collapse
Affiliation(s)
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Wayne Gersoff
- Orthopedic Centers of Colorado Joint Preservation Institute, Clinical InstructorUniversity of Colorado Health Sciences CenterAuroraColoradoUSA
| | - Elizaveta Kon
- IRCCS Humanitas Research HospitalRozzanoItaly
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Department of Traumatology, Orthopaedics and Disaster SurgerySechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Norimasa Nakamura
- Institute for Medical Science in SportsOsaka Health Science UniversityOsakaJapan
- Center for Advanced Medical Engineering and InformaticsOsaka UniversitySuitaJapan
| | - Stefan Nehrer
- Faculty Health & MedicineUniversity for Continuing EducationKremsAustria
- Department of Orthopaedics and TraumatologyUniversity Hospital Krems, Karl Landsteiner University of Health SciencesKremsAustria
| | - Francesca Vannini
- Clinica Ortopedica e Traumatologica1 IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of SurgeryEOCLuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera ItalianaLuganoSwitzerland
- Applied and Translational Research (ATR) CenterIRCCS Istituto Ortopedico RizzoliBolognaItaly
| |
Collapse
|
8
|
Leite CBG, Ormsby RT, Mekhail J, Charles JF, Görtz S, Merkely G, Lattermann C. Culturing Osteochondral Explants Under Rotary Shaking or After Removing Bone Marrow Elements Increases Explant Cellular Viability. Am J Sports Med 2024; 52:2384-2390. [PMID: 39101736 DOI: 10.1177/03635465241254401] [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: 08/06/2024]
Abstract
BACKGROUND Reduced viability in the deepest zones of osteochondral allografts (OCAs) can weaken the subchondral interface, potentially increasing the risk of failure. This reduction may result from nutritional imbalances due to uneven media distribution or interference from bone marrow elements. PURPOSE To investigate whether culturing OCAs using a rotary shaker or removing the bone marrow elements would increase graft cellular viability. STUDY DESIGN Controlled laboratory study. METHODS Bovine osteochondral explants were stored for 28 days at 4°C under 3 different conditions (n = 6 explants per group): static (control group), rotary shaker at 150 rpm (shaker group), and static after removal of bone marrow elements using a Waterpik device (Waterpik group). Chondrocyte viability was assessed using live/dead staining across the entire tissue and in each zone (superficial, middle, deep). Subchondral bone viability was assessed using TUNEL (terminal deoxynucleotidal transferase-mediated biotin-deoxyuridine triphosphate nick-end labeling) staining to detect apoptotic cells. RESULTS Both shaker (64.2%; P = .010) and Waterpik (65.6%; P = .005) conditions showed significantly higher chondrocyte viability compared with control (49.8%). When samples were analyzed by zone, the shaker and Waterpik groups displayed higher cellular viability at the middle zone (shaker = 60.6%, P < .001; Waterpik = 56.1%, P < .001) and deep zone (shaker = 63.1%, P = .018; Waterpik = 61.5%, P = .025) than the control group (25.6% at middle zone; 32.8% at deep zone). Additionally, shaker (56.7%; P = .018) and Waterpik (51.4%; P = .007) groups demonstrated a lower percentage of apoptotic cells in subchondral bone compared with control (88.0%). No significant differences were observed between the shaker and Waterpik groups in any of the analyses. CONCLUSION Both rotary shaking and removal of bone marrow elements during storage of osteochondral explants led to higher chondrocyte viability at the middle and deep zones of the graft compared with the static storage condition. Enhancing nutrition delivery to the graft could improve its quality, potentially improving outcomes of OCA transplantation. CLINICAL RELEVANCE The use of a rotary shaker or the removal of bone marrow elements may significantly improve the culture conditions, increasing graft viability and integrity after OCA storage.
Collapse
Affiliation(s)
- Chilan B G Leite
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Renee T Ormsby
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie Mekhail
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia F Charles
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Görtz
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gergo Merkely
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Lattermann
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Abdelwahab N, Shahsavari M, Wu K, Laouar L, Skene-Arnold TD, Elliott JAW, Jomha NM. Effect of storage media on chondrocyte viability during cold storage of osteochondral dowels. Cell Tissue Bank 2024; 25:485-491. [PMID: 37550401 DOI: 10.1007/s10561-023-10104-1] [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: 03/01/2023] [Accepted: 07/16/2023] [Indexed: 08/09/2023]
Abstract
Osteochondral allograft transplantation is a successfully proven method to repair articular cartilage defects and prevent the degenerative effects of osteoarthritis. The number of osteochondral transplantations that can be performed each year is limited by availability of donor cartilage tissue and storage time constraints. Osteochondral transplantation success has been linked to high chondrocyte viability of the donor cartilage tissue at the time of implantation. Determining optimal storage conditions for donor cartilage is essential for tissue banks to safely provide quality cartilage tissue. In this study, we compared three tissue/cell media (DMEM/F12, RPMI-1640 and X-VIVO 10) for their ability to maintain chondrocyte viability during hypothermic storage for 28 days. Porcine osteochondral dowels were stored in each media for 28 days and cell viability was assessed every 7 days. Over the 28 day storage period, the chondrocyte viability of dowels stored in DMEM/F12, RPMI-1640, and X-VIVO 10 media all declined in a similar fashion. Our results show that all three media were equivalent in their ability to maintain cell viability of the cartilage tissue and provides rationale for the use of lower cost cell media (DMEM/F12 and RPMI-1640) for hypothermic storage of articular cartilage tissue.
Collapse
Affiliation(s)
- Noor Abdelwahab
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Sports Medicine Centre, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, Alberta, 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, Alberta, Canada.
| |
Collapse
|
10
|
Ma Y, Lin Q, Wang X, Liu Y, Yu X, Ren Z, Zhang Y, Guo L, Wu X, Zhang X, Li P, Duan W, Wei X. Biomechanical properties of articular cartilage in different regions and sites of the knee joint: acquisition of osteochondral allografts. Cell Tissue Bank 2024; 25:633-648. [PMID: 38319426 PMCID: PMC11143059 DOI: 10.1007/s10561-024-10126-3] [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: 04/20/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
Osteochondral allograft (OCA) transplantation involves grafting of natural hyaline cartilage and supporting subchondral bone into the cartilage defect area to restore its biomechanical and tissue structure. However, differences in biomechanical properties and donor-host matching may impair the integration of articular cartilage (AC). This study analyzed the biomechanical properties of the AC in different regions of different sites of the knee joint and provided a novel approach to OCA transplantation. Intact stifle joints from skeletally mature pigs were collected from a local abattoir less than 8 h after slaughter. OCAs were collected from different regions of the joints. The patella and the tibial plateau were divided into medial and lateral regions, while the trochlea and femoral condyle were divided into six regions. The OCAs were analyzed and compared for Young's modulus, the compressive modulus, and cartilage thickness. Young's modulus, cartilage thickness, and compressive modulus of OCA were significantly different in different regions of the joints. A negative correlation was observed between Young's modulus and the proportion of the subchondral bone (r = - 0.4241, P < 0.0001). Cartilage thickness was positively correlated with Young's modulus (r = 0.4473, P < 0.0001) and the compressive modulus (r = 0.3678, P < 0.0001). During OCA transplantation, OCAs should be transplanted in the same regions, or at the closest possible regions to maintain consistency of the biomechanical properties and cartilage thickness of the donor and recipient, to ensure smooth integration with the surrounding tissue. A 7 mm depth achieved a higher Young's modulus, and may represent the ideal length.
Collapse
Affiliation(s)
- Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xiangyang Yu
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Yuanyu Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Li Guo
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xiaogang Wu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Xiangyu Zhang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Pengcui Li
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China.
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China.
| | - Xiaochun Wei
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| |
Collapse
|
11
|
Crisol M, Wu K, Congdon B, Skene-Arnold TD, Laouar L, Elliott JA, 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 PMCID: PMC11368895 DOI: 10.1177/19476035221118656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [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.
Collapse
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
| |
Collapse
|
12
|
Rucinski K, Cook JL, Schweser KM, Crist BD. Short-Term Outcomes After Bipolar Osteochondral Allograft Transplantation (OCAT) in the Ankle. J Foot Ankle Surg 2024; 63:207-213. [PMID: 37972816 DOI: 10.1053/j.jfas.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Treatment options for symptomatic cartilage loss in the ankle are not consistently effective. This study documents initial outcomes for patients undergoing bipolar OCAT in the ankle after advances in tissue preservation, transplantation techniques, and patient management strategies were implemented. Patients were prospectively enrolled into a registry designed to follow outcomes after OCAT in the ankle. Fourteen patients were included for analyses (12 primary OCAT, 2 revision OCAT). Four patients underwent Bipolar OCAT (tibia, talus) and 10 Bipolar+ OCAT (tibia, talus, fibula). Short-term (median follow-up 43, range 13-73 months) success was documented for 13 patients. Radiographic assessments indicated OCA integration and maintenance of joint space in 12 patients. Statistically significant (p < .030) and clinically meaningful improvements in AAOS and VAS pain scores were noted at 3 months, 6 months, 1 year, and 2 years following OCA transplantation when compared to preoperative measures. For patients that were nonadherent to postoperative restriction and rehabilitation protocols, all 1-year postoperative PROs were significantly lower (p < .050) than for patients who were adherent. The successful outcomes documented in 13 of 14 patients in conjunction with significant and clinically meaningful improvements in patient-reported measures of pain and function support OCA transplantation as an appropriate treatment option in indicated patients. These improvements in outcomes were associated with advances in OCA preservation, preimplantation treatment, transplantation techniques, and patient management strategies, suggesting this shift in practice be considered for OCA transplantation in the ankle.
Collapse
Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Kyle M Schweser
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Brett D Crist
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO.
| |
Collapse
|
13
|
Struijk C, Lydon KL, Husen M, Verdonk P, Michielsen J, van Wijnen AJ, Krych AJ, Saris DBF. Cellular Enhancement of Frozen Meniscus Allograft Combining Native Meniscus and Mesenchymal Stromal Cell Injections. Cartilage 2024:19476035231224802. [PMID: 38321966 DOI: 10.1177/19476035231224802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This proof-of-concept study investigated an improved cell-based injection therapy combining mesenchymal stem cells (MSCs) and meniscus cells (MCs) to support superior meniscus allograft repopulation and early revival compared to injecting MSCs alone. DESIGN In this controlled laboratory study, frozen meniscus allograft samples were injected vertically with a cell suspension containing different ratios of MSCs and MCs or control (lactated ringers) and cultured for 28 days. Samples were analyzed weekly for cell viability, migration, and metabolism using histological and biochemical assays. Tissue medium was analyzed for matrix metalloproteinase (MMP) expression using zymography. RESULTS Cellular repopulation of frozen allografts injected with different cell suspensions was validated by immunohistochemistry. Significant higher DNA content was evidenced in grafts treated with suspensions of MCs or MC:MSC (1:4 ratio). Cell metabolic activity was significantly different between all treated groups and control group after 1 week. Allografts injected with MCs showed significantly more cell proliferation than injections with MSCs. MMP2 activity was detected in medium of all grafts cellularized with MCs with or without MSCs. Scanning electron microscopy (SEM) analysis showed resolution of the needle puncture, but not in the control group. Cell labeling of MCs upon injection of mixed MC:MSC suspensions revealed a gradual increase in the cell ratio. CONCLUSIONS The findings of this study establish that injection of MCs with or without MSCs enhances the cellularity of meniscus allograft to support early graft revival and remodeling.
Collapse
Affiliation(s)
- Caroline Struijk
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, University of Antwerp, Antwerp, Belgium
| | | | - Martin Husen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Verdonk
- Department of Orthopedic Surgery, University of Antwerp, Antwerp, Belgium
- Orthoca, Antwerp, Belgium
| | - Jozef Michielsen
- Department of Orthopedic Surgery, University of Antwerp, Antwerp, Belgium
| | - Andre J van Wijnen
- Department of Biochemistry, The University of Vermont, Burlington, VT, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
14
|
Luk J, Troyer L, Guess TM, Teixeiro E, Stannard JP, Cook JL. Characterizing Osteochondral Allograft Biomechanics for Optimizing Transplant Success: A Systematic Review. J Knee Surg 2024; 37:227-237. [PMID: 36940706 DOI: 10.1055/s-0043-1764403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Osteochondral allograft (OCA) transplantation has been largely successful in treating symptomatic articular cartilage lesions; however, treatment failures persist. While OCA biomechanics have been consistently cited as mechanisms of treatment failure, the relationships among mechanical and biological variables that contribute to success after OCA transplantation have yet to be fully characterized. The purpose of this systematic review was to synthesize the clinically relevant peer-reviewed evidence targeting the biomechanics of OCAs and the impact on graft integration and functional survival toward developing and implementing strategies for improving patient outcomes. The Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, and EMBASE were searched to identify articles for systematic review. This review of relevant peer-reviewed literature provided evidence that the biomechanics related to OCA transplantation in the knee have direct and indirect effects on functional graft survival and patient outcomes. The evidence suggests that biomechanical variables can be optimized further to enhance benefits and mitigate detrimental effects. Each of these modifiable variables should be considered regarding indications, patient selection criteria, graft preservation methodology, graft preparation, transplantation, fixation techniques, and prescribed postoperative restriction and rehabilitation protocols. Criteria, methods, techniques, and protocols should target OCA quality (chondrocyte viability, extracellular matrix integrity, material properties), favorable patient and joint characteristics, rigid fixation with protected loading, and innovative ways to foster rapid and complete OCA cartilage and bone integration to optimize outcomes for OCA transplant patients.
Collapse
Affiliation(s)
- Josephine Luk
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Luke Troyer
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- School of Medicine, University of Missouri, Columbia, Missouri
- University of Missouri, Molecular Microbiology & Immunology, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
15
|
Cook JL, Rucinski K, Crecelius CR, Kfuri M, Stannard JP. Treatment failures (revision or arthroplasty) after knee osteochondral allograft transplantation with minimum two-year follow-up. Knee 2024; 46:128-135. [PMID: 38128151 DOI: 10.1016/j.knee.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Knee osteochondral allograft transplantation (OCAT) has been associated with good short- to mid-term outcomes, however, treatment failures occur more frequently than desired. This study used data from a lifelong outcomes registry to analyze knee OCAT treatment failure rates, variables associated with knee OCAT treatment failures, and outcomes after revision or arthroplasty surgery for knee OCAT treatment failures. METHODS Patient outcomes were followed after knee OCAT performed using standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS®) allografts. The study population consisted of patients undergoing primary OCAT with ≥ 2-year follow-up. For comparisons, the treatment failure population was defined by patients in the study population with documented treatment failure (revision or arthroplasty) with ≥ 2-year follow-up after failure. Functional graft survival was defined as no further need for revision surgery after primary or revision OCAT. RESULTS A total of 262 patients (n = 136 males; 51.9%) were analyzed. SP grafts were used for 59 cases and MOPS grafts were used for 203 cases. Treatment failure was documented in 61 cases (23.3%). MOPS grafts were 3.3 times more likely to be associated with functional graft survival. SP grafts, older patient age, higher BMI, tibiofemoral bipolar OCAT and non-adherence to the postoperative rehabilitation protocol were significantly associated with treatment failure. CONCLUSIONS Knee OCAT resulted in functional graft survival at short- to mid-term follow-up in the majority (70-88%) of cases. In addition, revision of primary OCAT resulted in functional graft survival for at least 2 years after revision surgery in the majority (66%) of patients. LEVEL OF EVIDENCE 2, prospective cohort study.
Collapse
Affiliation(s)
- James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA.
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Cory R Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| |
Collapse
|
16
|
Royse LA, Strother S, Trachsel M, Mehr DR, Hoffman K, Cook JL. Engaging Patients and Caregivers to Develop a Patient-Centered Agenda for Comparative Effectiveness Research Focused on the Treatment of Complex Knee Problems. J Knee Surg 2023; 36:1422-1437. [PMID: 37604174 DOI: 10.1055/s-0043-1772608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Complex articular cartilage loss in the knee is being diagnosed more frequently and earlier in life, and patients are faced with major decisions regarding invasive surgical interventions at increasingly younger ages. There is a critical unmet need to provide patient-centered comparative effectiveness research for the hundreds of thousands of patients faced with these treatment decisions each year. Toward filling the need, we developed the Patient AdvisoR Team iN Orthopaedic ReSearch (PARTNORS) program. We recruited a diverse group of patients and caregivers with lived experiences in dealing with complex knee problems to define patient-centered research priorities for comparative biological and artificial knee surgery research for middle-aged adults. Adapting the Stakeholder Engagement in Question Development and Prioritization Method, PARTNORS defined a 20-question list of patient-centered research questions of factors influencing a patients' choice between biological and artificial knee surgeries. The highest prioritized research question related to functional level postsurgery as it relates to daily activities and recreational activities. The second highest prioritized research questions related to insurance coverage and financial costs. Other prioritized research areas included caregiving needs, implant longevity, recovery and rehabilitation time, patient satisfaction and success rates, individual characteristics, and risks. By engaging a group of patients and caregivers and including them as members of a multidisciplinary research team, comparative effectiveness research that includes patient-centered factors that go beyond typical clinical success indicators for knee surgery can be designed to allow physicians and patients to work together toward evidence-based shared decisions. This shared decision-making process helps to align patients' and health care team's goals and expectations to improve outcomes.
Collapse
Affiliation(s)
- Lisa A Royse
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Sandi Strother
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Matt Trachsel
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Kimberly Hoffman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
17
|
Jin YJ, Park DY, Noh S, Kwon H, Shin DI, Park JH, Min BH. Effects of glycosaminoglycan content in extracellular matrix of donor cartilage on the functional properties of osteochondral allografts evaluated by micro-CT non-destructive analysis. PLoS One 2023; 18:e0285733. [PMID: 37220126 DOI: 10.1371/journal.pone.0285733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Osteochondral allograft (OCA) is an important surgical procedure used to repair extensive articular cartilage damage. It is known that chondrocyte viability is crucial for maintaining the biochemical and biomechanical properties of OCA, which is directly related to the clinical success of the operation and is the only standard for preoperative evaluation of OCA. However, there is a lack of systematic research on the effect of the content of cellular matrix in OCA cartilage tissue on the efficacy of transplantation. Therefore, we evaluated the effect of different GAG contents on the success of OCA transplantation in a rabbit animal model. Each rabbit OCA was treated with chondroitinase to regulate glycosaminoglycan (GAG) content in the tissue. Due to the different action times of chondroitinase, they were divided into 4 experimental groups (including control group, 2h, 4h, and 8h groups). The treated OCAs of each group were used for transplantation. In this study, transplant surgery effects were assessed using micro-computed tomography (μCT) and histological analysis. Our results showed that tissue integration at the graft site was poorer in the 4h and 8h groups compared to the control group at 4 and 12 weeks in vivo, as were the compressive modulus, GAG content, and cell density reduced. In conclusion, we evaluated the biochemical composition of OCAs before and after surgery using μCT analysis and demonstrated that the GAG content of the graft decreased, it also decreased during implantation; this resulted in decreased chondrocyte viability after transplantation and ultimately affected the functional success of OCAs.
Collapse
Affiliation(s)
- Yong Jun Jin
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Sujin Noh
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Republic of Korea
| | - HyeonJae Kwon
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Dong Il Shin
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Jin Ho Park
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| |
Collapse
|
18
|
Trofa DP, Hong IS, Lopez CD, Rao AJ, Yu Z, Odum SM, Moorman CT, Piasecki DP, Fleischli JE, Saltzman BM. Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:812-824. [PMID: 35139311 DOI: 10.1177/03635465211053594] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce. PURPOSE To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 2. METHODS A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non-English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses. RESULTS The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively (P = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively (P = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft (P = .97) and a coefficient of 0.033 (95% CI, -1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences (P = .66) and a coefficient of 0.114 (95% CI, -0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft. CONCLUSION Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.
Collapse
Affiliation(s)
- David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Cesar D Lopez
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Allison J Rao
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
| | - Ziqing Yu
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Susan M Odum
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
| | - Claude T Moorman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Dana P Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| |
Collapse
|
19
|
Chan C, Liu L, Dharmadhikari S, Shontz KM, Tan ZH, Bergman M, Shaffer T, Tram NK, Breuer CK, Stacy MR, Chiang T. A Multimodal Approach to Quantify Chondrocyte Viability for Airway Tissue Engineering. Laryngoscope 2023; 133:512-520. [PMID: 35612419 PMCID: PMC9691794 DOI: 10.1002/lary.30206] [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: 01/05/2022] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Partially decellularized tracheal scaffolds have emerged as a potential solution for long-segment tracheal defects. These grafts have exhibited regenerative capacity and the preservation of native mechanical properties resulting from the elimination of all highly immunogenic cell types while sparing weakly immunogenic cartilage. With partial decellularization, new considerations must be made about the viability of preserved chondrocytes. In this study, we propose a multimodal approach for quantifying chondrocyte viability for airway tissue engineering. METHODS Tracheal segments (5 mm) were harvested from C57BL/6 mice, and immediately stored in phosphate-buffered saline at -20°C (PBS-20) or biobanked via cryopreservation. Stored and control (fresh) tracheal grafts were implanted as syngeneic tracheal grafts (STG) for 3 months. STG was scanned with micro-computed tomography (μCT) in vivo. STG subjected to different conditions (fresh, PBS-20, or biobanked) were characterized with live/dead assay, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and von Kossa staining. RESULTS Live/dead assay detected higher chondrocyte viability in biobanked conditions compared to PBS-20. TUNEL staining indicated that storage conditions did not alter the proportion of apoptotic cells. Biobanking exhibited a lower calcification area than PBS-20 in 3-month post-implanted grafts. Higher radiographic density (Hounsfield units) measured by μCT correlated with more calcification within the tracheal cartilage. CONCLUSIONS We propose a strategy to assess chondrocyte viability that integrates with vivo imaging and histologic techniques, leveraging their respective strengths and weaknesses. These techniques will support the rational design of partially decellularized tracheal scaffolds. LEVEL OF EVIDENCE N/A Laryngoscope, 133:512-520, 2023.
Collapse
Affiliation(s)
- Coreena Chan
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Lumei Liu
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Sayali Dharmadhikari
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Kimberly M Shontz
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Zheng Hong Tan
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Maxwell Bergman
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, Ohio, U.S.A
| | - Terri Shaffer
- Small Animal Imaging Facility, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Nguyen K Tram
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Mitchel R Stacy
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Tendy Chiang
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| |
Collapse
|
20
|
Buyuk AF, Stannard JP, Rucinski K, Crecelius CR, Cook JL. The Missouri Osteochondral Preservation System Is Associated With Better Short-Term Outcomes Than Standard Preservation Methods When Performing Osteochondral Allograft Transplantation Using Shell Grafts for Patellofemoral Lesions. Arthroscopy 2023; 39:650-659. [PMID: 36306891 DOI: 10.1016/j.arthro.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To compare outcomes after whole-surface osteochondral allograft (OCA) transplantation using shell grafts for treatment of patellofemoral joint lesions with respect to surfaces treated and OCA preservation method. METHODS With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients who received patellofemoral shell OCA to treat the entire articular surface of the patella, trochlea, or both, and with a minimum of 2-year follow-up data, including patient-reported outcome measures (PROMs), failures, and complications, were included. Functional graft survival was determined based on patients returning to functional activities without need for OCA revision or arthroplasty surgery and calculated using the formula: 100% - (%revision + %failure). Minimum clinically important differences were determined based on previously validated data. Outcomes were compared based on differences in graft preservation methodology (Missouri Osteochondral Preservation System [MOPS] or standard preservation [SP]) and based on surfaces treated (patella, trochlea, or both). RESULTS Fifty-eight patients met inclusion criteria. Mean age was 36.7 years (range 15-60 years) and mean body mass index was 28.9 (range 18-42). OCAs stored using SP methods were transplanted in 12 patients, mean follow-up was (66.1 months; range 54-70 months): OCAs stored using MOPS methods were transplanted in 46 patients, mean follow-up was (44.8 months; range 24-60 months). Graft survival rate at final follow-up was significantly greater (P = .025) for MOPS OCAs (98%) compared with SP OCAs (75%), whereas 2-year functional graft survival rates (MOPS 98% vs SP 83%; P = .1) were not. Reoperation rate was significantly greater (P = .0014) for SP cases compared with MOPS cases. PROMs showed statistically significant and clinically meaningful improvements through 4 years after unipolar patella, unipolar trochlea, and bipolar patellofemoral OCA transplantation using MOPS grafts. Unipolar patella OCA transplantations were associated with significantly more reduction in pain and significantly better PROMs at 1-year compared with unipolar trochlea and bipolar patellofemoral OCAs. CONCLUSIONS OCA transplantation using MOPS shell grafts for unipolar and bipolar patellofemoral resurfacing was associated with statistically significant and clinically meaningful improvements from preoperative levels of pain and function. The 2-year functional graft survival rate was 83% in the SP group and 98% in the MOPS group, such that MOPS was associated with better short-term outcomes than SP methods when performing OCA transplantation using shell grafts for patellofemoral lesions. Patients who received unipolar patella allografts reported the best outcomes in terms of pain and function. LEVEL OF EVIDENCE Level III, retrospective analysis of registry data.
Collapse
Affiliation(s)
- Abdul Fettah Buyuk
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Cory R Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.
| |
Collapse
|
21
|
Paul KD, Patel RK, Arguello AM, Kwapisz A, Brabston EW, Stannard JP, Ponce BA, Momaya AM. Variability in the Processing of Fresh Osteochondral Allografts. J Knee Surg 2023; 36:450-455. [PMID: 34600436 DOI: 10.1055/s-0041-1736148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The indications for fresh osteochondral allograft continue to increase. As a result, variations in graft processing and preservation methods have emerged. An understanding of these techniques is important when evaluating the optimal protocol for processing fresh osteochondral allografts prior to surgical implantation. The aim of this study is to review the literature and understand various tissue processing protocols of four leading tissue banks in the United States. Donor procurement, serological and microbiological testing, and storage procedures were compared among companies of interest. Similarities between the major tissue banks include donor screening, aseptic processing, and testing for microorganisms. Variability exists between these companies with relation to choice of storage media, antibiotic usage, storage temperature, and graft expiration dates. Potential exists for increased chondrocyte viability and lengthened time-to-expiration of the graft through a protocol of delicate tissue handling, proper choice of storage medium, adding hormones and growth factors like insulin growth factor-1 (IGF-1) to serum-free nutrient media, and storing these grafts closer to physiologic temperatures.
Collapse
Affiliation(s)
- Kyle D Paul
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Romil K Patel
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Alexandra M Arguello
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Lodzkie, Poland
| | - Eugene W Brabston
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri Columbia, Missouri Orthopaedic Institute, Columbia, Missouri.,Department of Thompson Laboratory for Regenerative Orthopaedics, University of Missouri Columbia, Missouri Orthopaedic Institute, Columbia, Missouri
| | - Brent A Ponce
- Department of Orthopaedics, Hughston Clinic, Columbus, Georgia
| | - Amit M Momaya
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
22
|
Mehta VM, Mehta S, Santoro S, Shriver R, Mandala C, Weess C. Short term clinical outcomes of a Prochondrix® thin laser-etched osteochondral allograft for the treatment of articular cartilage defects in the knee. J Orthop Surg (Hong Kong) 2022; 30:10225536221141781. [PMID: 36527357 DOI: 10.1177/10225536221141781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: The purpose of this study is to evaluate the short-term clinical outcomes of Prochondrix® novel thin, laser-etched osteochondral allograft on isolated articular cartilage defects. Methods: Eighteen patients with isolated, symptomatic, full-thickness articular cartilage lesions were treated with marrow stimulation followed by placement of a T-LE allograft. Demographic and intra-operative data was recorded as well as pre- and post-operative International Knee Documentation Committee (IKDC), Short Form-36 (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS) and Tegner scores. Pre- and post-operative data was compared at 6, 12, 24 and 36 months post operatively. Failures requiring reoperation were also recorded. Results: At a mean follow-up of 2.5 years (6-43 months), VAS decreased from 6.55 to 2.55 (p = .02) and subjective IKDC scores increased from 37.61 to 59.65 (p = .02). Statistically significant increases were also seen in KOOS Function-Sports and Recreational Activities (+26.04, p = .04) and KOOS QOL (+18.76, p = .007) as well as in SF-36 Physical Functioning (+25.20, p = .04), Energy/Fatigue (+16.50, p = .02), Social Functioning (+11.79, p = .04), and Bodily Pain (+25.18, p = .04). There were two failures requiring reoperation: one conversion to a patellofemoral arthroplasty (PFA), and one graft dislodgement which required removal. Conclusion: Treatment of articular cartilage lesions of the knee with ProChondrix® has demonstrated sustained positive results out to a mean follow-up of two and a half years in this prospective case series with a low failure rate that required reoperation (2 patients) in this series. These results are comparable to the short-term results of other cartilage restoration procedures currently in use today. A meta-analysis of osteochondral allografting demonstrated a mean 86.7% survival rate at 5 years with significant improvements in clinical outcome scores reaching MCID values.
Collapse
Affiliation(s)
| | - Shaan Mehta
- 158277Fox Valley Orthopedics Institute, Geneva, IL, USA
| | | | - Ryan Shriver
- 158277Fox Valley Orthopedics Institute, Geneva, IL, USA
| | | | - Cameron Weess
- 158277Fox Valley Orthopedics Institute, Geneva, IL, USA
| |
Collapse
|
23
|
Du PZ, Barton D, Bridge N, Ganapathy V. Cervical fracture patterns associated with blunt cerebrovascular injures when utilizing computed tomographic angiography: a systematic review and meta-analysis. Spine J 2022; 22:1716-1725. [PMID: 35671944 DOI: 10.1016/j.spinee.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/04/2022] [Accepted: 05/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prior studies have demonstrated an association between cervical spine fractures and blunt cerebrovascular injuries (BCVI) due to the intimate anatomic relationship between the cervical spine and the vertebral arteries. Digital subtraction angiography (DSA) has historically been the gold standard, but computed tomography angiography (CTA) is commonly used to screen for BCVI in the trauma setting. However, there is no consensus regarding which fracture patterns mandate screening. Over aggressive screening may lead to increased radiation, increased false positives, and overtreatment of patients which can cause unnecessary patient harm, and increased healthcare costs. PURPOSE The aim of this meta-analysis is to analyze which cervical spine fracture patterns are most predictive of BCVI when utilizing CTA. STUDY DESIGN/SETTING Systematic review and meta-analysis. OUTCOME MEASURES Odds ratios for specific cervical fracture patterns and risk of developing a BCVI. METHODS A systematic literature review of all English language studies from 2000-2020 was conducted. The year 2000 was chosen as the cut-off because use of CTA prior to 2000 was rare. Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, Global Index Medicus, and ClinicalTrials.gov were queried. Studies were included if they met the following criteria: (1) the diagnostic imaging modality was CTA; (2) investigated blunt cervical trauma; (3) noted specific cervical spine fracture patterns associated with BCVI; (4) odds ratios for specific cervical spine fracture patterns or the odds ratio could be calculated; (5) subjects were 18 years old or older. Studies were excluded if they: (1) included DSA or magnetic resonance imaging; (2) included penetrating cervical trauma; (3) included pediatric patients less than 18 years of age; (4) were not written in English. All statistical analysis was performed using R Studio (RStudio, Boston, MA, USA). RESULTS The initial search, after duplicates were removed, resulted in 10,940 articles for independent review. Six studies met the criteria for inclusion in the meta-analysis. Specific fracture patterns mentioned are isolated C1, C2, C3 fractures, any C1-C3 fracture, any C4-C7 fracture, two-level fractures, subluxation/dislocations, and transverse foramen (TF) fractures. Three studies were included in the meta-analysis for C1, C2, C1-C3, subluxations/dislocations, and TF fractures. Two studies were included in the meta-analysis for C3, C4-C7, and two-level fractures. The pooled odds ratio with 95% confidence interval for: C1 fractures and BCVI is 1.3 (0.8-2.1); C2: 1.6 (0.9-2.8); C3: 1.8 (0.9-3.6); C1-C3: 2.2 (1.1-4.2); C4-C7: 0.7 (0.3-1.7); Two-level: 2.5 (1.4-4.6); Subluxation/Dislocation: 2.9 (1.8-4.5); TF: 3.6 (1.4-8.9). DISCUSSION/CONCLUSION This study found that when utilizing CTA for screening of BCVI only fractures in the C1-C3 region, two-level fractures, subluxations/dislocations, and transverse foramen fractures were associated with increased incidence of a BCVI. Further refinement of protocols for CTA in the setting of blunt cervical trauma may help limit unnecessary patient harm from overtreatment and reduce healthcare costs.
Collapse
Affiliation(s)
- Peter Z Du
- University of Arizona - Department of Orthopaedic Surgery, 1501 N Campbell Avenue, 8th Floor Room 8401, Tucson, AZ 85724, USA.
| | - Dane Barton
- University of Arizona - Department of Orthopaedic Surgery, 1501 N Campbell Avenue, 8th Floor Room 8401, Tucson, AZ 85724, USA
| | - Nathaniel Bridge
- University of Arizona - College of Medicine, 1501 N Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA
| | - Venkat Ganapathy
- University of Arizona - Department of Orthopaedic Surgery, 1501 N Campbell Avenue, 8th Floor Room 8401, Tucson, AZ 85724, USA
| |
Collapse
|
24
|
Lai WC, Bohlen HL, Fackler NP, Wang D. Osteochondral Allografts in Knee Surgery: Narrative Review of Evidence to Date. Orthop Res Rev 2022; 14:263-274. [PMID: 35979427 PMCID: PMC9377395 DOI: 10.2147/orr.s253761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.
Collapse
Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Hunter L Bohlen
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Nathan P Fackler
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| |
Collapse
|
25
|
Biomaterial composition and stiffness as decisive properties of 3D bioprinted constructs for type II collagen stimulation. Acta Biomater 2022; 152:221-234. [DOI: 10.1016/j.actbio.2022.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
|
26
|
Abusara Z, Haider I, Moo EK, Miller S, Timmermann S, Herzog W. Chondrocyte morphology as an indicator of collagen network integrity. Connect Tissue Res 2022; 63:319-328. [PMID: 34006162 DOI: 10.1080/03008207.2021.1922398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteochondral allograft (OCA) transplantation offers an attractive treatment option as it can be used to repair large cartilage defects that otherwise would not heal. The currently accepted criterion for OCA selection for joint reconstruction is the percentage of viable chondrocytes, but this criterion alone may not be sufficient to ensure structural integrity and functional performance of allografts following transplantation. We sought to determine an additional parameter that indicates matrix integrity. We used multi-photon microscopy to quantitatively assess chondrocyte viability, chondrocyte shape, and collagen structure of articular cartilage of OCAs. Chondrocyte shape varied considerably in otherwise macroscopically healthy-looking OCAs with good (>90%) cell viability. Shape varied from the expected ellipsoidal form found in healthy cartilage, to excessively elongated and flattened cells that often contained multiple cytoplasmic processes reminiscent of those observed in fibroblasts. Chondrocytes with abnormal morphology were associated with degradation of their pericellular matrix and disruption of the collagen fiber orientation, reflected by an increase in heterogeneity of second harmonic signal intensity. Cell shape may be an important marker for collagen network integrity in articular cartilage in general and OCAs specifically. We propose that, aside from cell viability, cell shape may be used as an additional criterion measure for the selection of OCAs. OCAs selected for transplantation based on these criteria showed good graft-host integration post-operation. In view of the rapid and nondestructive nature of the current approach, it may be suitable for clinical application in the future.
Collapse
Affiliation(s)
- Ziad Abusara
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Advanced Imaging and Histopathology Core, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Ifaz Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Eng Kuan Moo
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Department of Applied Physics, University of Eastern Finland
| | - Sue Miller
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Section of Orthopaedic Surgery, Department of Surgery, University of Calgary.,Taylor Institute for Teaching and Learning, University of Calgary
| | - Scott Timmermann
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Section of Orthopaedic Surgery, Department of Surgery, University of Calgary
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| |
Collapse
|
27
|
Cook JL, Rucinski K, Crecelius C, Fenkell B, Stannard JP. Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee. Orthop J Sports Med 2022; 10:23259671221102452. [PMID: 35722176 PMCID: PMC9201314 DOI: 10.1177/23259671221102452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Treatment of multisurface articular cartilage lesions of the knee is a challenging problem. Hypothesis Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function. Study Design Cohort study; Level of evidence, 3. Methods Patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. The study included patients who received OCA transplantation for multisurface unipolar defects in 1 knee and had minimum 2-year follow-up data, including patient-reported outcome measures, failures, reoperations, and complications. The OCA transplants had been stored using 2 methods: standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS). Preoperative data were compared with outcomes at 1 year and final follow-up, and risk factors for revision surgery or failure (total knee arthroplasty) were analyzed. Results The sample included 25 patients with a mean age of 37.2 years (range, 13-51 years), body mass index of 27.7 (range, 18-38), and follow-up of 45.1 months (median, 49 months; range, 24-68 months). OCAs stored using SP were transplanted into 6 patients, and those stored using MOPS were transplanted into 19 patients. The initial success rate was significantly higher for MOPS OCAs (94.7%) than SP OCAs (33.3%). There were statistically significant improvements in all patient-reported outcomes at 1 year and final follow-up in the MOPS cohort (P < .0001 for all). Revision surgery/failure was significantly associated with patients who were nonadherent to the prescribed postoperative restrictions and rehabilitation protocols (P = .038; odds ratio = 13.5) and with OCAs that had a viable chondrocyte density <70% of the established reference range mean at transplantation (P = .0037; odds ratio = 76). Conclusion OCA transplantation for treatment of large multisurface cartilage defects in the knee resulted in a 94.7% initial success rate when grafts with high viable chondrocyte density (≥70%) were used and when patients strictly adhered to prescribed postoperative rehabilitation protocols. Successful outcomes were associated with statistically significant improvements in patient-reported outcome measures of pain and function.
Collapse
Affiliation(s)
- James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Kylee Rucinski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Cory Crecelius
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Blake Fenkell
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
28
|
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.
Collapse
Affiliation(s)
- Suzanne M Tabbaa
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | |
Collapse
|
29
|
Zhao G, Jiang H. Beneficial effects of Aucubin on restoration of rabbits with cartilage defect. Cell Tissue Bank 2022; 23:887-897. [PMID: 35384569 DOI: 10.1007/s10561-022-10004-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 11/02/2022]
Abstract
Osteochondral grafts are suitable materials for repair of articular cartilage defect and plastic and reconstructive surgery. In our study, osteochondral allografts from rabbits were preserved in vitro for 28 days, and chondrocyte death, degradation of collagen and proteoglycan, morphological alterations, and inflammatory reaction were observed in the grafts. Supplementing of Aucubin with 10 or 20 μM in the preservation solution inhibited chondrocyte death, matrix degradation, pathological alterations and inflammation in allografts preserved in vitro, compared with that preserved in standard preservation solution. In addition, after transplantation of 20 μM Aucubin-treated allografts, the osteochondral repair and regeneration of rabbits with knee joint defect were accelerated. In conclusion, Aucubin was beneficial for maintaining chondrocyte viability and normal morphology, and inhibiting inflammatory occurrence in rabbit osteochondral grafts preserved in vitro, and facilitated osteochondral repair and regeneration of rabbits with knee defect. These findings might provide novel insights for preservation of grafts for clinical articular cartilage repair and plastic surgery.
Collapse
Affiliation(s)
- Gaofeng Zhao
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Badachu Road, Shijingshan District, Beijing, 100144, China.
| |
Collapse
|
30
|
Cook JL, Stannard JP, Stoker AM, Rucinski K, Crist BD, Cook CR, Crecelius C, Smith MJ, Stucky R. Biologic Joint Restoration: A Translational Research Success Story. MISSOURI MEDICINE 2022; 119:115-121. [PMID: 36036037 PMCID: PMC9339389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment options that result in consistently successful outcomes for young and active patients with joint disorders are needed. This article summarizes two decades of rigorous research using a bedside-to-bench- to-bedside translational approach based on the One Health - One Medicine concept that culminated in successful clinical use of biologic joint restoration options for treatment of knee, hip, ankle, and shoulder problems in this growing patient population.
Collapse
Affiliation(s)
- James L Cook
- William and Kathryn Allen Distinguished Chair in Orthopaedic Surgery; Director, Thompson Laboratory for Regenerative Orthopaedics (TLRO) and Mizzou BioJoint® Center; and Vice Chair, Orthopaedic Research Division, University of Missouri - Columbia, Columbia, Missouri
| | - James P Stannard
- TLRO and Department of Orthopaedic Surgery (DOS), University of Missouri - Columbia, Columbia, Missouri
| | - Aaron M Stoker
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Kylee Rucinski
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Brett D Crist
- TLRO and DOS, University of Missouri - Columbia, Columbia, Missouri
| | - Cristi R Cook
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Cory Crecelius
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | | | - Renee Stucky
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| |
Collapse
|
31
|
Franklin SP, Stoker AM, Murphy SM, Kowaleski MP, Gillick M, Kim SE, Karlin M, Cross A, Cook JL. Outcomes Associated With Osteochondral Allograft Transplantation in Dogs. Front Vet Sci 2022; 8:759610. [PMID: 35004920 PMCID: PMC8739896 DOI: 10.3389/fvets.2021.759610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to retrospectively characterize outcomes and complications associated with osteochondral allograft transplantation for treating chondral and osteochondral lesions in a group of client-owned dogs with naturally-occurring disease. Records were reviewed for information on signalment, treated joint, underlying pathology (e.g., osteochondritis dissecans; OCD), and type, size, and number of grafts used. Complications were classified as “trivial” if no treatment was provided, “non-surgical” if non-surgical treatment were needed, “minor surgical” if a minor surgical procedure such as pin removal were needed but the graft survived and function was acceptable, or “major” if the graft failed and revision surgery were needed. Outcomes were classified as unacceptable, acceptable, or full function. Thirty-five joints in 33 dogs were treated including nine stifles with lateral femoral condyle (LFC) OCD and 10 stifles with medial femoral condyle (MFC) OCD treated with osteochondral cylinders or “plugs.” There were 16 “complex” procedures of the shoulder, elbow, hip, stifle, and tarsus using custom-cut grafts. In total there were eight trivial complications, one non-surgical complication, two minor surgical complications, and five major complications for a total of 16/35 cases with complications. Accordingly, there were five cases with unacceptable outcomes, all of whom had major complications while the other 30 cases had successful outcomes. Of the 30 cases with successful outcomes, 15 had full function and 15 had acceptable function. Based on these subjective outcome assessments, it appears osteochondral allograft transplantation is a viable treatment option in dogs with focal or complex cartilage defects. However, no conclusions can be made regarding the inferiority or superiority of allograft transplantation in comparison to other treatment options based upon these data.
Collapse
Affiliation(s)
- Samuel P Franklin
- Colorado Canine Orthopedics and Rehab, Colorado Springs, CO, United States
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
| | - Sean M Murphy
- WestVet Animal Emergency and Specialty Center, Garden City, ID, United States
| | - Michael P Kowaleski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Mitchell Gillick
- Toronto Veterinary Emergency and Referral Hospital, Toronto, ON, Canada
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Michael Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Alan Cross
- BluePearl Pet Hospital, Atlanta, GA, United States
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
| |
Collapse
|
32
|
Liu Y, Shah KM, Luo J. Strategies for Articular Cartilage Repair and Regeneration. Front Bioeng Biotechnol 2022; 9:770655. [PMID: 34976967 PMCID: PMC8719005 DOI: 10.3389/fbioe.2021.770655] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/01/2021] [Indexed: 12/19/2022] Open
Abstract
Articular cartilage is an avascular tissue, with limited ability to repair and self-renew. Defects in articular cartilage can induce debilitating degenerative joint diseases such as osteoarthritis. Currently, clinical treatments have limited ability to repair, for they often result in the formation of mechanically inferior cartilage. In this review, we discuss the factors that affect cartilage homeostasis and function, and describe the emerging regenerative approaches that are informing the future treatment options.
Collapse
Affiliation(s)
- Yanxi Liu
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, China
| | - Karan M Shah
- Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Jian Luo
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, China.,Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
33
|
Voga M, Majdic G. Articular Cartilage Regeneration in Veterinary Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1401:23-55. [DOI: 10.1007/5584_2022_717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
34
|
Ackermann J, Duerr RA, Barbieri Mestriner A, Shah N, Gomoll AH. Effect of Graft-Host Interference Fit on Graft Integration after Osteochondral Allograft Transplantation: A Comparative MRI Analysis of Two Instrumentation Sets. Cartilage 2021; 13:920S-927S. [PMID: 31375032 PMCID: PMC8808806 DOI: 10.1177/1947603519865314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Precise graft-host interference fit is a potentially import factor for the successful incorporation of osteochondral allograft (OCA) transplants for the treatment of symptomatic focal cartilage defects. It was hypothesized that selection of OCA plug instrumentation set has a significant effect on graft integration and morphology after OCA transplantation. METHODS Thirty-one patients who underwent OCA transplantation between July 2013 and July 2016 were identified for this comparative magnetic resonance imaging (MRI) analysis. Patients were stratified into two groups based on the treatment with the Arthrex Allograft OATS Instrument Set or the JRF Ortho Osteochondral Allograft Plug Instrumentation. MRI was obtained at 12 months postoperatively. All grafts were assessed for integration using the Osteochondral Allograft MRI Scoring System (OCAMRISS), host marrow edema size, graft-host interface distance, graft cartilage integrity, cyst size, graft contour and presence of effusion. RESULTS At a mean follow-up of 11.39 ± 1.98 months, 95.5% of all grafts showed osseous integration into the recipient bone with 68.2% presenting without cystic changes of the graft or host-graft junction. No differences were seen in any OCAMRISS subscale besides cartilage signal, which demonstrated minimal differences (P = 0.046). CONCLUSION OCAs show excellent osseous integration at the graft-host junction at 12 months postoperatively. The comparative MRI analysis of two instrumentation sets yielded no significant differences in terms of graft integration, bone marrow edema, or cystic formation. Hence, this study cannot recommend one instrumentation set over the other. Consequently, the individual preference should guide the surgeon's selection of instrumentation for OCA transplantation.
Collapse
Affiliation(s)
- Jakob Ackermann
- Sports Medicine Center, Massachusetts
General Hospital, Boston, MA, USA,Jakob Ackermann, Sports Medicine Center,
Department of Orthopaedic Surgery, Massachusetts General Hospital, 175 Cambridge
Street, Sports Medicine Center, Floor 4, Boston, MA 02114, USA.
| | - Robert A. Duerr
- Jameson Crane Sports Medicine Institute,
Ohio State University, Columbus, OH, USA
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center and Center for
Regenerative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard
University, Boston, MA, USA,Universidade Federal de São Paulo, São
Paulo, Brazil
| | - Nehal Shah
- Brigham and Women’s Hospital, Boston,
MA, USA
| | | |
Collapse
|
35
|
Hevesi M, Denbeigh JM, Paggi CA, Galeano-Garces C, Bagheri L, Larson AN, Stuart MJ, Saris DBF, van Wijnen AJ, Krych AJ. Fresh Osteochondral Allograft Transplantation in the Knee: A Viability and Histologic Analysis for Optimizing Graft Viability and Expanding Existing Standard Processed Graft Resources Using a Living Donor Cartilage Program. Cartilage 2021; 13:948S-956S. [PMID: 31617404 PMCID: PMC8808912 DOI: 10.1177/1947603519880330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aims to (1) determine and validate living cartilage allograft transplantation as a novel source for viable osteochondral allograft (OCA) tissues and (2) perform histologic and viability comparisons of living donor cartilage tissues to currently available clinical-grade standard processed grafts. DESIGN Using healthy cartilage from well-preserved contralateral compartments in 27 patients undergoing total knee arthroplasty (TKA) and 10 clinical-grade OCA specimens obtained immediately following operative implantation, standard and living donor OCA quality was evaluated at the time of harvest and following up to 3 weeks of storage on the basis of macroscopic International Cartilage Repair Society grade, histology, and viability. RESULTS Osteochondral samples demonstrated a consistent decrease in viability and histologic quality over the first 3 weeks of storage at 37°C, supporting the utility of an OCA paradigm shift toward early implantation, as was the clinical standard up until recent adoption of transplantation at 14 to 35 days following donor procurement. Samples from the 10 clinical-grade OCAs, implanted at an average of 23 days following graft harvest demonstrated a mean viable cell density of 45.6% at implantation, significantly lower (P < 0.01) than the 93.6% viability observed in living donor allograft tissues. CONCLUSIONS Osteochondral tissue viability and histologic quality progressively decreases with ex vivo storage, even when kept at physiologic temperatures. Currently available clinical OCAs are stored for 2 to 5 weeks prior to implantation and demonstrate inferior viability to that of fresh osteochondral tissues that can be made available through the use of a living donor cartilage program.
Collapse
Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | - Janet M. Denbeigh
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Radiation Oncology,
Mayo Clinic, Rochester, MN, USA
| | - Carlo A. Paggi
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Regenerative
Medicine, University of Twente, Enschede, Netherlands
| | | | - Leila Bagheri
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | | | - Daniel B. F. Saris
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Regenerative
Medicine, University of Twente, Enschede, Netherlands,Department of Orthopedics,
University Medical Center Utrecht, Utrecht, Netherlands
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Andre J. van Wijnen, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
55905, USA.
| | - Aaron J. Krych
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
36
|
Denbeigh JM, Hevesi M, Paggi CA, Resch ZT, Bagheri L, Mara K, Arani A, Zhang C, Larson AN, Saris DB, Krych AJ, van Wijnen AJ. Modernizing Storage Conditions for Fresh Osteochondral Allografts by Optimizing Viability at Physiologic Temperatures and Conditions. Cartilage 2021; 13:280S-292S. [PMID: 31777278 PMCID: PMC8808875 DOI: 10.1177/1947603519888798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective. Osteochondral allograft (OCA) transplantation has demonstrated good long-term outcomes in treatment of cartilage defects. Viability, a key factor in clinical success, decreases with peri-implantation storage at 4°C during pathogen testing, matching logistics, and transportation. Modern, physiologic storage conditions may improve viability and enhance outcomes. Design. Osteochondral specimens from total knee arthroplasty patients (6 males, 5 females, age 56.4 ± 2.2 years) were stored in media and incubated at normoxia (21% O2) at 22°C or 37°C, and hypoxia (2% O2) at 37°C. Histology, live-dead staining, and quantitative polymerase chain reaction (qPCR) was performed 24 hours after harvest and following 7 days of incubation. Tissue architecture, cell viability, and gene expression were analyzed. Results. No significant viability or gene expression deterioration of cartilage was observed 1-week postincubation at 37°C, with or without hypoxia. Baseline viable cell density (VCD) was 94.0% ± 2.7% at day 1. At day 7, VCD was 95.1% (37°C) with normoxic storage and 92.2% (37°C) with hypoxic storage (P ≥ 0.27). Day 7 VCD (22°C) incubation was significantly lower than both the baseline and 37°C storage values (65.6%; P < 0.01). COL1A1, COL1A2, and ACAN qPCR expression was unchanged from baseline (P < 0.05) for all storage conditions at day 7, while CD163 expression, indicative of inflammatory macrophages and monocytes, was significantly lower in the 37°C groups (P < 0.01). Conclusion. Physiologic storage at 37°C demonstrates improved chondrocyte viability and metabolism, and maintained collagen expression compared with storage at 22°C. These novel findings guide development of a method to optimize short-term fresh OCA storage, which may lead to improved clinical results.
Collapse
Affiliation(s)
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Carlo A. Paggi
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Zachary T. Resch
- Center for Regenerative Medicine, Mayo
Clinic, Rochester, MN, USA
| | - Leila Bagheri
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristin Mara
- Department of Biomedical Statistics and
Informatics, Mayo Clinic, Rochester, MN, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Chenghao Zhang
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Daniel B.F. Saris
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Department of Orthopedics, University
Medical Center Utrecht, Utrecht, Netherlands,Reconstructive Medicine, University of
Twente, Enschede, Netherlands
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic,
Rochester, MN, USA
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Andre J. van Wijnen PhD, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
37
|
Langhans MT, Strickland SM, Gomoll AH. Management of Chondral Defects Associated with Patella Instability. Clin Sports Med 2021; 41:137-155. [PMID: 34782070 DOI: 10.1016/j.csm.2021.07.005] [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: 11/03/2022]
Abstract
Cartilage defects of the patellofemoral joint are commonly found in association with patellar instability owing to abnormal biomechanics. Strategies to address chondral defects of the patellofemoral joint secondary to instability should first address causes of recurrent instability. Most patellofemoral chondral defects associated with instability are less than 2 cm2 and do not generally require intervention beyond chondroplasty. Larger defects of the patella and/or the trochlea can be repaired with osteochondral or surface cartilage repair.
Collapse
Affiliation(s)
- Mark T Langhans
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | | | - Andreas H Gomoll
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Schreiner AJ, Stannard JP, Stoker AM, Bozynski CC, Kuroki K, Cook CR, Cook JL. Unicompartmental bipolar osteochondral and meniscal allograft transplantation is effective for treatment of medial compartment gonarthrosis in a canine model. J Orthop Res 2021; 39:1093-1102. [PMID: 32672863 DOI: 10.1002/jor.24801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Osteochondral allograft (OCA) transplantation can restore large articular defects in the knee. Bipolar OCA transplantations for partial and whole joint resurfacing often have less favorable results than single-surface transplants. This study was designed to use a large animal model to test the hypothesis that unicompartmental bipolar osteochondral and meniscal allograft transplantation (BioJoint) would be as or more effective for treatment of medial compartment osteoarthritis (OA) compared to standard-of-care nonoperative treatment. OA was induced in one knee of each research hound (n = 8) using a meniscal release model and pretreatment assessments were performed. After 3 months, dogs were randomly assigned to either the control group (n = 4, no surgical intervention, daily nonsteroidal antiinflammatory drugs [NSAIDs]) or the BioJoint group (n = 4). Clinical, radiographic, and arthroscopic assessments were performed longitudinally and histopathology was evaluated at the 6-month endpoint. At study endpoint, functional, pain, and total pressure index measures, as well as radiographic and arthroscopic grading of graft appearance and joint health, demonstrated superior outcomes for BioJoints compared to NSAID controls. Furthermore, histologic assessments showed that osteochondral and meniscal transplants maintain integrity and integrated into host tissues. Clinical significance: The results support the safety and efficacy of unicompartmental bipolar osteochondral and meniscal allograft transplantation in a preclinical model with highly functional outcomes without early OA progression.
Collapse
Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Trauma and Reconstructive Surgery, BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, Orthopaedic Research Division, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
40
|
Espinosa MG, Otarola GA, Hu JC, Athanasiou KA. Cartilage Assessment Requires a Surface Characterization Protocol: Roughness, Friction, and Function. Tissue Eng Part C Methods 2021; 27:276-286. [PMID: 33678002 DOI: 10.1089/ten.tec.2020.0367] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The surface of articular cartilage is integral to smooth, low-friction joint articulation. However, the majority of cartilage literature rarely includes measurements of surface characteristics and function. This may, in part, be due to a shortage of or unfamiliarity with fast, nondestructive, and, preferably, noncontact methods that can be applied to large cartilage surfaces for evaluating cartilage surface characteristics. A comprehensive methodology for characterizing cartilage surfaces is useful in determining changes in tissue function, as for example, in cases where the quality of cartilage grafts needs to be assessed. With cartilage storage conditions being an area of ongoing and active research, this study used interferometry and tribology methods as efficient and nondestructive ways of evaluating changes in cartilage surface topography, roughness, and coefficient of friction (CoF) resulting from various storage temperatures and durations. Standard, destructive testing for bulk mechanical and biochemical properties, as well as immunohistochemistry, were also performed. For the first time, interferometry was used to show cartilage topographical anisotropy through an anterior-posterior striated pattern in the same direction as joint articulation. Another novel observation enabled by tribology was frictional anisotropy, illustrated by a 53% increase in CoF in the medial-lateral direction compared to the anterior-posterior direction. Of the storage conditions examined, 37°C, 4°C, -20°C, and -80°C for 1 day, 1 week, and 1 month, a 49% decrease in CoF was observed at 1 week in -80°C. Interestingly, prolonged storage at 37°C resulted in up to an 83% increase in the compressive aggregate modulus by 1 month, with a corresponding increase in the glycosaminoglycan (GAG) bulk content. This study illustrates the differential effects of storage conditions on cartilage: freezing tends to target surface properties, while nonfreezing storage impacts the tissue bulk. These data show that a bulk-only analysis of cartilage function is not sufficient or representative. The nondestructive surface characterization assays described here enable improvement in cartilage functionality assessment by considering both surface and bulk cartilage properties; this methodology may thus provide a new angle to explore in future cartilage research and tissue engineering endeavors.
Collapse
Affiliation(s)
- M Gabriela Espinosa
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Gaston A Otarola
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| |
Collapse
|
41
|
Görtz S, Tabbaa SM, Jones DG, Polousky JD, Crawford DC, Bugbee WD, Cole BJ, Farr J, Fleischli JE, Getgood A, Gomoll AH, Gross AE, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Mirzayan R, Mologne TS, Provencher MT, Rodeo SA, Safir O, Strauss ED, Wahl CJ, Williams RJ, Yanke AB. Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft. Orthop J Sports Med 2021; 9:2325967120983604. [PMID: 34250153 PMCID: PMC8237219 DOI: 10.1177/2325967120983604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line
treatment for large chondral and osteochondral defects, aided by
advancements in storage protocols and a growing body of clinical evidence
supporting successful clinical outcomes and long-term survivorship. Despite
the body of literature supporting OCAs, there still remains controversy and
debate in the surgical application of OCA, especially where high-level
evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and
scientific experience in OCA, addressing controversies in the treatment of
chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated
in a 3-round modified Delphi process to generate a list of statements and
establish consensus. Questions and statements were initially developed on
specific topics that lack scientific evidence and lead to debate and
controversy in the clinical community. In-person discussion occurred where
statements were not agreed on after 2 rounds of voting. After final voting,
the percentage of agreement and level of consensus were characterized. A
systematic literature review was performed, and the level of evidence and
grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching,
indications, and rehabilitation reached consensus after the final round of
voting. Of the 17 statements that reached consensus, 11 received unanimous
(100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements
that provide guidance on surgical and perioperative management of OCAs. The
findings also provided insights on topics requiring more research or
high-quality studies to further establish consensus and provide stronger
evidence.
Collapse
Affiliation(s)
- Simon Görtz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Suzanne M Tabbaa
- University of California-San Francisco, San Francisco, California, USA
| | - Deryk G Jones
- Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA
| | - John D Polousky
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA
| | | | | | - William D Bugbee
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Brian J Cole
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Jack Farr
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - James E Fleischli
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Alan Getgood
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Andreas H Gomoll
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Allan E Gross
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Aaron J Krych
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Christian Lattermann
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Bert R Mandelbaum
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Peter R Mandt
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Raffy Mirzayan
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Timothy S Mologne
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Matthew T Provencher
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Scott A Rodeo
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Oleg Safir
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Eric D Strauss
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Christopher J Wahl
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Riley J Williams
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Adam B Yanke
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| |
Collapse
|
42
|
De Armond CC, Kim SE, Lewis DD, Biedryzcki AH, Banks SA, Cook JL, Keister JD. Three-dimensional-printed custom guides for bipolar coxofemoral osteochondral allograft in dogs. PLoS One 2021; 16:e0244208. [PMID: 33561146 PMCID: PMC7872253 DOI: 10.1371/journal.pone.0244208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Abstract
The objective of this experimental study was to develop and evaluate a three-dimensionally printed custom surgical guide system for performing bipolar coxofemoral osteochondral allograft transplantation in dogs. Five cadaver dogs, weighing 20–38 kg were used in the study. Custom surgical guides were designed and three-dimensionally printed to facilitate accurate execution of a surgical plan for bipolar coxofemoral osteochondral allograft transplantation. Guide-assisted technique was compared to freehand technique in each cadaver. Surgical time was recorded and postoperative computed tomography and three-dimensional segmentation was performed. Femoral version and inclination angles, femoral neck length, and gap present at the femoral and acetabular donor-recipient interface was compared between the virtual surgical plan and postoperative outcome for both techniques. One-tailed paired t-test (P < .05) was used for statistical analysis. When compared to free-hand preparation, mean donor femoral preparation time was 10 minutes longer and mean recipient preparation time was 2 minutes longer when using guides (p = 0.011 and p = 0.001, respectively). No difference in acetabular preparation time was noted between groups. Gap volume at the acetabular and femoral donor-recipient interface was not different between groups. Mean difference between the planned and postoperative version angle was 6.2° lower for the guide group when compared to the freehand group (p = 0.025). Mean femoral neck length was 2 mm closer to the plan when using guides than when performing surgery freehand (p = 0.037). Accuracy for femoral angle of inclination was not different between groups. Custom surgical guides warrants consideration in developing bipolar coxofemoral osteochondral allograft transplantation as an alternative surgical technique for managing hip disorders in dogs.
Collapse
Affiliation(s)
- Christina C. De Armond
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Stanley E. Kim
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
- * E-mail:
| | - Daniel D. Lewis
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Adam H. Biedryzcki
- Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Scott A. Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, United States of America
| | - James L. Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics & Mizzou BioJoint Center, University of Missouri, Columbia, Missouri, United States of America
| | - Justin D. Keister
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, United States of America
| |
Collapse
|
43
|
Schreiner AJ, Stannard JP, Cook CR, Bozynski CC, Kuroki K, Stoker AM, Smith PA, Cook JL. Comparison of meniscal allograft transplantation techniques using a preclinical canine model. J Orthop Res 2021; 39:154-164. [PMID: 32198782 DOI: 10.1002/jor.24668] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 02/04/2023]
Abstract
Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with menisco-capsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibial-osteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with menisco-tibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.
Collapse
Affiliation(s)
- Anna J Schreiner
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Traumatology and Reconstructive Surgery, BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Division of Sports Medicine, Columbia Orthopaedic Group, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
44
|
Luk J, Stoker AM, Teixeiro E, Kuroki K, Schreiner AJ, Stannard JP, Wissman R, Cook JL. Systematic Review of Osteochondral Allograft Transplant Immunology: How We Can Further Optimize Outcomes. J Knee Surg 2021; 34:30-38. [PMID: 33389738 DOI: 10.1055/s-0040-1721670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the growing success for osteochondral allograft (OCA) transplantation in treating large articular cartilage lesions in multiple joints, associated revision and failure rates are still higher than desired. While immunorejection responses have not been documented, the effects of the host's immune responses on OCA transplantation failures have not been thoroughly characterized. The objective of this study was to systematically review clinically relevant peer-reviewed evidence pertaining to the immunology of OCAs to elucidate theragnostic strategies for improving functional graft survival and outcomes for patients undergoing OCA transplantation. This systematic review of Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, and EMBASE suggests that host immune responses play key roles in incorporation and functional survival of OCA transplants. OCA rejection has not been reported; however, graft integration through creeping substitution is reliant on host immune responses. Prolonged inflammation, diminished osteogenic potential for healing and incorporation, and relative bioburden are mechanisms that may be influenced by the immune system and contribute to undesirable outcomes after OCA transplantation. Based on the safety and efficacy of OCA transplantation and its associated benefits to a large and growing patient population, basic, preclinical, and clinical osteoimmunological studies on OCA transplantation that comprehensively assess and correlate cellular, molecular, histologic, biomechanical, biomarkers, diagnostic imaging, arthroscopic, functional, and patient-reported outcome measures are of high interest and importance.
Collapse
Affiliation(s)
- Josephine Luk
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Robert Wissman
- Department of Radiology, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
45
|
Schreiner AJ, Stannard JP, Cook CR, Oladeji LO, Smith PA, Rucinski K, Cook JL. Initial clinical outcomes comparing frozen versus fresh meniscus allograft transplants. Knee 2020; 27:1811-1820. [PMID: 33197821 DOI: 10.1016/j.knee.2020.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/18/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate initial clinical outcomes using fresh meniscal allografts with high cell viability at transplantation time and meniscotibial ligament (MTL) reconstruction (Fresh) in comparison to standard fresh-frozen (Frozen) meniscus allograft transplantation (MAT). METHODS Patients treated for medial and/or lateral meniscal deficiency using either Fresh or Frozen MAT with minimum of 1-year follow-up were identified from a prospective registry. Patient demographics, prior surgeries, MAT surgery data, complications, revisions, and failures were documented. Functional outcome scores were collected preoperatively, and 6 months and yearly after surgery and radiographic joint space measurements were performed. Treatment cohorts were compared for statistically significant (P < 0.005) differences using t-Tests and Fisher's exact tests. RESULTS Twenty-seven patients (14 Fresh, 13 Frozen) met inclusion criteria and showed comparable characteristics. For Fresh MAT + MTL, 10 medial, two lateral, and two medial + lateral MAT were performed. For Frozen MAT, nine medial, and four lateral MAT were performed. There was significantly more improvement in the Fresh cohort compared to the Frozen cohort for VAS pain (P = 0.014), PROMIS Physical Function (P = 0.036) and Single Assessment Numeric Evaluation (P = 0.033) from preoperatively to 2 years postoperatively. Tegner Activity Scale and PROMIS Mobility score showed no significant differences. The International Knee Documentation Committee score revealed a clinically meaningful change for the Fresh group. Radiographic measurements showed no significant differences between groups. There were two Fresh MAT + MTL revisions and one conversion to TKA in each cohort. CONCLUSIONS Fresh MAT + MTL is safe and associated with potential advantages with respect to initial pain relief and function compared to standard frozen MAT.
Collapse
Affiliation(s)
- Anna J Schreiner
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA
| | - Cristi R Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA
| | - Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Columbia Orthopaedic Group, Columbia, MO, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA.
| |
Collapse
|
46
|
Rorick CB, Mitchell JA, Bledsoe RH, Floren ML, Wilkins RM. Cryopreserved, Thin, Laser-Etched Osteochondral Allograft maintains the functional components of articular cartilage after 2 years of storage. J Orthop Surg Res 2020; 15:521. [PMID: 33176819 PMCID: PMC7659100 DOI: 10.1186/s13018-020-02049-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite improvements in treatment options and techniques, articular cartilage repair continues to be a challenge for orthopedic surgeons. This study provides data to support that the 2-year Cryopreserved, Thin, Laser-Etched Osteochondral Allograft (T-LE Allograft) embodies the necessary viable cells, protein signaling, and extracellular matrix (ECM) scaffold found in fresh cartilage in order to facilitate a positive clinical outcome for cartilage defect replacement and repair. METHODS Viability testing was performed by digestion of the graft, and cells were counted using a trypan blue assay. Growth factor and ECM protein content was quantified using biochemical assays. A fixation model was introduced to assess tissue outgrowth capability and cellular metabolic activity in vitro. Histological and immunofluorescence staining were employed to confirm tissue architecture, cellular outgrowth, and presence of ECM. The effects of the T-LE Allograft to signal bone marrow-derived mesenchymal stem cell (BM-MSC) migration and chondrogenic differentiation were evaluated using in vitro co-culture assays. Immunogenicity testing was completed using flow cytometry analysis of cells obtained from digested T-LE Allografts and fresh articular cartilage. RESULTS Average viability of the T-LE Allograft post-thaw was found to be 94.97 ± 3.38%, compared to 98.83 ± 0.43% for fresh articular cartilage. Explant studies from the in vitro fixation model confirmed the long-term viability and proliferative capacity of these chondrocytes. Growth factor and ECM proteins were quantified for the T-LE Allograft revealing similar profiles to fresh articular cartilage. Cellular signaling of the T-LE Allograft and fresh articular cartilage both exhibited similar outcomes in co-culture for migration and differentiation of BM-MSCs. Flow cytometry testing confirmed the T-LE Allograft is immune-privileged as it is negative for immunogenic markers and positive for chondrogenic markers. CONCLUSIONS Using our novel, proprietary cryopreservation method, the T-LE Allograft, retains excellent cellular viability, with native-like growth factor and ECM composition of healthy cartilage after 2 years of storage at - 80 °C. The successful cryopreservation of the T-LE Allograft alleviates the limited availably of conventionally used fresh osteochondral allograft (OCA), by providing a readily available and simple to use allograft solution. The results presented in this paper supports clinical data that the T-LE Allograft can be a successful option for repairing chondral defects.
Collapse
Affiliation(s)
- Carolyn B Rorick
- Innovation Department, AlloSource, 6278 S Troy Circle, Centennial, CO, 80111, USA.
| | - Jordyn A Mitchell
- Innovation Department, AlloSource, 6278 S Troy Circle, Centennial, CO, 80111, USA
| | - Ruth H Bledsoe
- Innovation Department, AlloSource, 6278 S Troy Circle, Centennial, CO, 80111, USA
| | - Michael L Floren
- Innovation Department, AlloSource, 6278 S Troy Circle, Centennial, CO, 80111, USA
| | - Ross M Wilkins
- Innovation Department, AlloSource, 6278 S Troy Circle, Centennial, CO, 80111, USA
| |
Collapse
|
47
|
Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
Collapse
Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
48
|
Zhang C, Ao Y, Cao J, Yang L, Duan X. Donor Cell Fate in Particulated Juvenile Allograft Cartilage for the Repair of Articular Cartilage Defects. Am J Sports Med 2020; 48:3224-3232. [PMID: 32966105 DOI: 10.1177/0363546520958700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Particulated juvenile allograft cartilage (PJAC) has demonstrated good clinical efficacy in repairing articular cartilage defects, but the related repair mechanism after transplant and the biological characteristics of the transplanted cells are still unclear. PURPOSE To study the efficacy of PJAC in repairing full-thickness cartilage defects and the specific fate of donor cells to provide experimental evidence for its clinical application. STUDY DESIGN Controlled laboratory study. METHODS Twenty female Guizhou minipigs were randomly divided into an experimental group and a control group. An 8-mm cylindrical full-thickness cartilage defect was created in the femoral trochlea of 1 knee in all minipigs. The experimental group received transplant of PJAC from 5 male juvenile Guizhou minipigs (PJAC group; n = 10) and the control group received autologous cartilage chips (ACC group; n = 10). Follow-up assessments were conducted at 1 month and 3 months to track the transplanted cells by the male-specific sex-determining region Y-linked (SRY) gene; tissue sections were hybridized in situ, and O'Driscoll histological scoring was performed according to hematoxylin and eosin staining, safranin O and fast green staining, and toluidine blue O staining, as well as immunohistochemical evaluation of aggrecan and Sry-type HMG-box 9 (SOX9). RESULTS All 20 Guizhou minipigs were followed; no infection or incision healing disorder occurred after the operation. By SRY in situ hybridization, the SRY signal of the transplanted cells was positive in the repaired tissue of the defect, and the SRY positive signal could still be detected in repaired tissue at 3 months postoperatively. The average number of positive cells was 68.6 ± 11.91 at 1 month and 32.6 ± 3.03 at 3 months (confocal microscope: ×400), and the difference was statistically significant. The O'Driscoll histological scores were 14 ± 0.71 in the ACC group and 9.8 ± 0.84 in the PJAC group at 1 month, and 18 ± 1.20 in the ACC group and 17.4 ± 1.14 in the PJAC group at 3 months. The scores were statistically significant between the ACC group and PJAC group at 1 month. The positive rates of SOX9 in the PJAC and ACC groups at 1 month were 67.6% ± 3.78% and 63.4% ± 5.30%, respectively, and the difference was not statistically significant (P > .05). The positive rates of SOX9 in the PJAC and ACC groups at 3 months were 68.8% ± 2.69% and 17.1% ± 1.26%, respectively, and the difference was statistically significant (P < .05). The positive rates of aggrecan in the PJAC and ACC groups at 1 month were 40.5% ± 2.78% and 42.4% ± 0.54% respectively, and the difference was not statistically significant (P > .05). The positive rates of aggrecan in the PJAC and ACC groups at 3 months were 40.8% ± 1.50% and 30.1% ± 2.44%, respectively, and the difference was not statistically significant (P > .05). CONCLUSION An animal model was established with Guizhou minipigs, and the cartilage defect was repaired with PJAC from male minipigs. The SRY gene positive signal could be detected from the repaired tissue by in situ hybridization, indicating that the transplanted cells survived at least 3 months. The key genes of cartilage formation, SOX9 and aggrecan, were expressed at 1 month and 3 months, and SOX9 expression was stronger in the PJAC group than the ACC group at 3 months. CLINICAL RELEVANCE This study suggests that it is feasible to study the biological characteristics of transplanted cells in the cartilage region by the sex-determining gene.
Collapse
Affiliation(s)
- Changgui Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yunong Ao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jin Cao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| |
Collapse
|
49
|
Merkely G, Ackermann J, Farina EM, VanArsdale C, Lattermann C, Gomoll AH. Shorter Storage Time Is Strongly Associated With Improved Graft Survivorship at 5 Years After Osteochondral Allograft Transplantation. Am J Sports Med 2020; 48:3170-3176. [PMID: 32941057 DOI: 10.1177/0363546520956311] [Citation(s) in RCA: 8] [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]
Abstract
BACKGROUND Current regulations surrounding the use of osteochondral allografts (OCAs) in the United States require delayed graft release after 14 days to complete infectious disease screening. With a generally accepted expiration time of 28 days in storage, a limited window from 14 to 28 days remains for implantation. Yet, the rates of graft survival and thus optimal time for transplantation within this window remain largely unknown. HYPOTHESIS OCAs transplanted within 19 to 24 days would have lower failure rates at 5 years than those transplanted at 25 to 27 days. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In this retrospective case series, we analyzed data from patients who underwent OCA transplantation (N = 111) by a single surgeon between February 2014 and December 2016 with at least 2-year follow-up. In total, 56 patients received early transplant grafts (storage time, 19-24 days), and 55 received late transplant grafts (storage time, 25-27 days). Survival analysis with Kaplan-Meier curves was performed using log-rank analysis to compare the groups. Multivariable Cox regression analysis was used to assess the influence of OCA storage duration on graft survival while adjusting for age and defect size. Optimal storage time cutoff associated with graft failure was identified by performing receiver operating characteristic curve analysis and calculating the area under the curve. RESULTS Patients in the late transplant group had a significantly lower rate of graft survival at 5 years postoperatively (70.4%) as compared with patients in the early transplant group (93.1%; P = .027). When correcting for patient age and defect size, late transplant OCAs demonstrated a 3.4-times greater likelihood of failure versus early transplant OCAs. Receiver operating characteristic analysis suggested that OCA transplantation should ideally occur before 25 days of graft storage. CONCLUSION OCA transplantation is a safe and successful treatment option for large osteochondral defects of the knee, with excellent rates of in situ graft survival at 5 years. Prioritizing early transplantation of OCAs to <25 days in storage improves rates of graft survival.
Collapse
Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Evan M Farina
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney VanArsdale
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Lattermann
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
50
|
Stannard JP, Cook JL. Prospective Assessment of Outcomes After Primary Unipolar, Multisurface, and Bipolar Osteochondral Allograft Transplantations in the Knee: A Comparison of 2 Preservation Methods. Am J Sports Med 2020; 48:1356-1364. [PMID: 32134685 DOI: 10.1177/0363546520907101] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage lesions in the knee remain a challenging clinical problem. HYPOTHESIS A novel graft preservation method combined with surgical technique and patient management improvements would lead to consistently successful outcomes after osteochondral allograft (OCA) transplantation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients were included when ≥1-year follow-up data were available, including complications and reoperations, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures. RESULTS For patients meeting inclusion criteria (N = 194), mean ± SD age was 37.9 ± 12.2 years and mean BMI was 28.9 ± 5; 38% received unipolar transplants (44% multisurface) and 62% received bipolar transplants. OCAs were preserved by standard tissue bank methods (standard preservation [SP]; 29%) or the novel method (Missouri Osteochondral Preservation System [MOPS]; 71%). Initial success rates were 79% for all cases combined, 60% for SP, and 84% for MOPS. MOPS cases were significantly (P = .028) more likely to be associated with successful outcomes when compared with SP cases. PROMs improved significantly (P < .05) for all cohorts through 3 to 4 years of follow-up. Revisions were performed in 19 cases (10%). MOPS grafts were associated with a significantly (P = .0014) lower revision rate (5%) than SP grafts (21%). Failures occurred in 26 patients (13%), with all undergoing total knee arthroplasty. Bipolar cases were significantly (P = .008) more likely to be associated with failure. MOPS grafts were associated with a significantly (P = .048) lower failure rate (11%) than were SP grafts (19%). Noncompliance with the prescribed rehabilitation protocol was significantly (P = .00008) more likely to be associated with failure. CONCLUSION Prospective data for 194 cases revealed that OCA transplantation for unipolar, multisurface, and bipolar cartilage restoration can be associated with consistently successful outcomes. The 5% revision rate, 11% failure rate, 82%-94% survival probability estimates, and continually improving PROMs through postoperative 3 to 4 years underscore major advances in outcomes as compared with previous reports. These encouraging results were realized with the use of a novel graft preservation method; autogenous bone marrow concentrate pretreatment of donor bone; advancements in graft cutting, implantation, and stabilization techniques; and procedure-specific rehabilitation protocols.
Collapse
Affiliation(s)
- James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|