Variability in the Processing of Fresh Osteochondral Allografts

AbstractThe 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.

Download Full-text

Development of a Fresh Osteochondral Allograft Program Outside North America

Cartilage ◽

10.1177/1947603515618484 ◽

2015 ◽

Vol 7 (3) ◽

pp. 222-228 ◽

Cited By ~ 10

Author(s):

Luís Eduardo Passarelli Tírico ◽

Marco Kawamura Demange ◽

Luiz Augusto Ubirajara Santos ◽

Márcia Uchoa de Rezende ◽

Camilo Partezani Helito ◽

...

Keyword(s):

Culture Media ◽

International Knee Documentation Committee ◽

Osteochondral Allograft ◽

Tissue Banks ◽

Transplant Program ◽

Process Modification ◽

Fresh Osteochondral Allograft ◽

Tissue Contamination ◽

Osteochondral Allografts

Objective To standardize and to develop a fresh osteochondral allograft protocol of procurement, processing and surgical utilization in Brazil. This study describes the steps recommended to make fresh osteochondral allografts a viable treatment option in a country without previous fresh allograft availability. Design The process involves regulatory process modification, developing and establishing procurement, and processing and surgical protocols. Results Legislation: Fresh osteochondral allografts were not feasible in Brazil until 2009 because the law prohibited preservation of fresh grafts at tissue banks. We approved an amendment that made it legal to preserve fresh grafts for 30 days from 2°C to 6°C in tissue banks. Procurement: We changed the protocol of procurement to decrease tissue contamination. All tissues were procured in an operating room. Processing: Processing of the grafts took place within 12 hours of tissue recovery. A serum-free culture media with antibiotics was developed to store the grafts. Surgeries: We have performed 8 fresh osteochondral allografts on 8 knees obtaining grafts from 5 donors. Mean preoperative International Knee Documentation Committee (IKDC) score was 31.99 ± 13.4, improving to 81.26 ± 14.7 at an average of 24 months’ follow-up. Preoperative Knee Injury and Oseoarthritis Outcome Score (KOOS) score was 46.8 ± 20.9 and rose to 85.24 ± 13.9 after 24 months. Mean preoperative Merle D’Aubigne-Postel score was 8.75 ± 2.25 rising to 16.1 ± 2.59 at 24 months’ follow-up. Conclusion To our knowledge, this is the first report of fresh osteochondral allograft transplantation in South America. We believe that this experience may be of value for physicians in countries that are trying to establish an osteochondral allograft transplant program.

Download Full-text

Chondrocyte Viability at Time of Transplantation for Osteochondral Allografts Preserved by the Missouri Osteochondral Preservation System versus Standard Tissue Bank Protocol

The Journal of Knee Surgery ◽

10.1055/s-0037-1608947 ◽

2017 ◽

Vol 31 (08) ◽

pp. 772-780 ◽

Cited By ~ 8

Author(s):

Aaron Stoker ◽

James Stannard ◽

James Cook

Keyword(s):

Femoral Condyle ◽

Tissue Bank ◽

Standard Of Care ◽

Tissue Banks ◽

Complication Rates ◽

Current Standard ◽

Cell Viability Assay ◽

Chondrocyte Viability ◽

Viability Assay ◽

Osteochondral Allografts

AbstractThe Missouri Osteochondral Preservation System (MOPS) has been reported to effectively preserve osteochondral allografts (OCAs) twice as long as current tissue bank protocols in preclinical studies. However, viability of OCAs preserved using the MOPS protocol at the time of clinical implantation compared with the current standard of care (SOC) is not known. Viable chondrocyte density (VCD) at time of transplantation will be significantly higher in OCAs preserved using the MOPS protocol compared with OCAs preserved using the current tissue bank protocol and will significantly affect clinical complication rates. Femoral condyle OCAs were obtained from American Association of Tissue Banks accredited tissue banks for clinical use. The OCAs were stored using the current SOC protocol for each respective tissue bank (n = 26) or the MOPS protocol (n = 50). Nonimplanted femoral condyle OCA tissue normally discarded after surgery was collected and assessed for VCD within 1 hour after surgery. Control OCA samples (n = 34) were obtained from one tissue bank. VCD was determined using a validated cell viability assay. Patients (n = 76) had in-clinic follow-up at least 6 months after OCA transplantation. At the time of clinical implantation, mean storage time for OCAs in the SOC cohort was 20.4 days, and in the MOPS cohort was 44.2 days, after procurement. VCD in OCAs in the MOPS cohort was not significantly different from normal healthy cartilage VCD and 100% were above the desired minimum essential level 70% of control VCD at the time of transplantation. VCD in OCAs in the SOC cohort was significantly (p < 0.001) lower than controls and MOPS, and only 27% were above 70% of control VCD at the time of transplantation. MOPS preserves OCA chondrocyte viability at significantly higher levels than current tissue bank storage protocols for a longer period of time after procurement. All MOPS-preserved OCAs exceeded minimum essential VCD levels for up to 56 days after procurement.

Download Full-text

Improved Osteochondral Allograft Preservation Using Serum-Free Media at Body Temperature

The American Journal of Sports Medicine ◽

10.1177/0363546512458575 ◽

2012 ◽

Vol 40 (11) ◽

pp. 2542-2548 ◽

Cited By ~ 42

Author(s):

Joseph T. Garrity ◽

Aaron M. Stoker ◽

Hannah J. Sims ◽

James L. Cook

Keyword(s):

Biomechanical Properties ◽

Osteochondral Allograft ◽

Window Of Opportunity ◽

Chondrocyte Viability ◽

Serum Free ◽

Defined Media ◽

Collagen Ii ◽

Femoral Condyles ◽

Disease Testing ◽

Osteochondral Allografts

Background: Osteochondral allografts (OCAs) are currently preserved at 4°C and used within 28 days of donor harvest. The window of opportunity for implantation is limited to 14 days due to a 2-week disease testing protocol. Hypothesis: Osteochondral allograft tissues stored at 37°C will have significantly higher chondrocyte viability, as well as superior biochemical and biomechanical properties, than those stored at 4°C. Study Design: Controlled laboratory study. Methods: Osteochondral allografts from 15 adult canine cadavers were aseptically harvested within 4 hours of death. Medial and lateral femoral condyles were stored in Media 1, similar to the current standard, or Media 2, an anti-inflammatory and chondrogenic media containing dexamethasone and transforming growth factor−β3, at 4°C or 37°C for up to 56 days. Chondrocyte viability, glycosaminoglycan (GAG) and collagen (hydroxyproline [HP]) content, biomechanical properties, and collagen II and aggrecan content were assessed at days 28 and 56. Five femoral condyles were stored overnight and assessed the next day to serve as controls. Results: Storage in Media 1 at 37°C maintained chondrocyte viability at significantly higher levels than in any other media-temperature combination and at levels not significantly different from controls. Osteochondral allografts stored in either media at 4°C showed a significant decrease in chondrocyte viability throughout storage. Glycosaminoglycan and HP content were maintained through 56 days of storage in OCAs in Media 1 at 37°C. There were no significant differences in elastic or dynamic moduli among groups at day 56. Qualitative immunohistochemistry demonstrated the presence of collagen II and aggrecan throughout all layers of cartilage. Conclusion: Osteochondral allograft viability, matrix content and composition, and biomechanical properties were maintained at “fresh” levels through 56 days of storage in Media 1 at 37°C. Osteochondral allografts stored at 4°C were unable to maintain viability or matrix integrity through 28 days of storage. These findings suggest that storage of OCAs in a defined media at 37°C is superior to current protocols (4°C) for tissue preservation prior to transplantation. Clinical Relevance: Storage of OCAs in serum-free chemically defined media at 37°C can increase the “window of opportunity” for implantation of optimal tissue from 14 days to 42 days after disease testing clearance.

Download Full-text

Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study

The American Journal of Sports Medicine ◽

10.1177/03635465211003074 ◽

2021 ◽

pp. 036354652110030

Author(s):

Hailey P. Huddleston ◽

Atsushi Urita ◽

William M. Cregar ◽

Theodore M. Wolfson ◽

Brian J. Cole ◽

...

Keyword(s):

Articular Cartilage ◽

Surface Topography ◽

Osteochondral Allograft ◽

Cartilage Defects ◽

Radius Of Curvature ◽

Cartilage Surface ◽

3 Dimensional ◽

Cloud Models ◽

And Cartilage ◽

Osteochondral Allografts

Background: Osteochondral allograft transplantation is 1 treatment option for focal articular cartilage defects of the knee. Large irregular defects, which can be treated using an oblong allograft or multiple overlapping allografts, increase the procedure’s technical complexity and may provide suboptimal cartilage and subchondral surface matching between donor grafts and recipient sites. Purpose: To quantify and compare cartilage and subchondral surface topography mismatch and cartilage step-off for oblong and overlapping allografts using a 3-dimensional simulation model. Study Design: Controlled laboratory study. Methods: Human cadaveric medial femoral hemicondyles (n = 12) underwent computed tomography and were segmented into cartilage and bone components using 3-dimensional reconstruction and modeling software. Segments were then exported into point-cloud models. Modeled defect sizes of 17 × 30 mm were created on each recipient hemicondyle. There were 2 types of donor allografts from each condyle utilized: overlapping and oblong. Grafts were virtually harvested and implanted to optimally align with the defect to provide minimal cartilage surface topography mismatch. Least mean squares distances were used to measure cartilage and subchondral surface topography mismatch and cartilage step-off. Results: Cartilage and subchondral topography mismatch for the overlapping allograft group was 0.27 ± 0.02 mm and 0.80 ± 0.19 mm, respectively. In comparison, the oblong allograft group had significantly increased cartilage (0.62 ± 0.43 mm; P < .001) and subchondral (1.49 ± 1.10 mm; P < .001) mismatch. Cartilage step-off was also found to be significantly increased in the oblong group compared with the overlapping group ( P < .001). In addition, overlapping allografts more reliably provided a significantly higher percentage of clinically acceptable (0.5- and 1-mm thresholds) cartilage surface topography matching (overlapping: 100% for both 0.5 and 1 mm; oblong: 90% for 1 mm and 56% for 0.5 mm; P < .001) and cartilage step-off (overlapping: 100% for both 0.5 and 1 mm; oblong: 86% for 1 mm and 12% for 0.5 mm; P < .001). Conclusion: This computer simulation study demonstrated improved topography matching and decreased cartilage step-off with overlapping osteochondral allografts compared with oblong osteochondral allografts when using grafts from donors that were not matched to the recipient condyle by size or radius of curvature. These findings suggest that overlapping allografts may be superior in treating large, irregular osteochondral defects involving the femoral condyles with regard to technique. Clinical Relevance: This study suggests that overlapping allografts may provide superior articular cartilage surface topography matching compared with oblong allografts and do so in a more reliable fashion. Surgeons may consider overlapping allografts over oblong allografts because of the increased ease of topography matching during placement.

Download Full-text

Prolonged Storage of Osteochondral Allografts -Does the Addition of Fetal Bovine Serum Improve Chondrocyte Viability?

The Journal of Knee Surgery ◽

10.1055/s-0030-1248117 ◽

2010 ◽

Vol 19 (04) ◽

pp. 265-272 ◽

Cited By ~ 42

Author(s):

Andrew Pennock ◽

Ferdinand Wagner ◽

Catherine Robertson ◽

Frederick Harwood ◽

William Bugbee ◽

...

Keyword(s):

Bovine Serum ◽

Fetal Bovine Serum ◽

Prolonged Storage ◽

Chondrocyte Viability ◽

Fetal Bovine ◽

Osteochondral Allografts

Download Full-text

Use of Allografts in Orthopaedic Surgery: Safety, Procurement, Storage, and Outcomes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119891435 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711989143

Author(s):

Adam J. Beer ◽

Tracy M. Tauro ◽

Michael L. Redondo ◽

David R. Christian ◽

Brian J. Cole ◽

...

Keyword(s):

Disease Transmission ◽

Glenohumeral Joint ◽

Tissue Bank ◽

Young Athlete ◽

The United States ◽

Tissue Banks ◽

Orthopaedic Surgeons ◽

Fresh Frozen ◽

Storage Methods ◽

Insurance Approval

The use of allografts has become a vital option for orthopaedic surgeons in the treatment of a variety of musculoskeletal lesions, ranging from osteochondral defects in the glenohumeral joint to meniscal deficiency in the young athlete. Nevertheless, barriers to treating a patient with an allograft-based procedure may arise from concerns over disease transmission, the navigation of tissue banks that supply allografts, the process of obtaining insurance approval, or optimal storage methods. This review serves to support orthopaedic surgeons in the incorporation of allografts into their practice by quelling these potential concerns. Fresh osteochondral allografts, fresh-frozen meniscal allografts, soft tissue allografts, and off-the-shelf cartilage products are the focus of this review amid broad overviews of allograft safety and tissue bank practices in the United States.

Download Full-text

PRESERVATION OF CHONDROCYTE VIABILITY DURING LONG-TERM REFRIGERATED STORAGE OF OSTEOCHONDRAL ALLOGRAFTS

Advances in Tissue Banking ◽

10.1142/9789812816078_0011 ◽

1998 ◽

pp. 175-190

Author(s):

L. CSÖNGE ◽

H. NEWMAN-GAGE ◽

T. RIGLEY ◽

D. BRAVO ◽

E. U. CONRAD ◽

...

Keyword(s):

Refrigerated Storage ◽

Chondrocyte Viability ◽

Osteochondral Allografts

Download Full-text

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

The Journal of Knee Surgery ◽

10.1055/s-0040-1712946 ◽

2020 ◽

Author(s):

Steven F. DeFroda ◽

Steven L. Bokshan ◽

Daniel S. Yang ◽

Alan H. Daniels ◽

Brett D. Owens

Keyword(s):

United States ◽

Sports Medicine ◽

Linear Trend ◽

The United States ◽

Osteochondral Allograft ◽

Osteochondral Autograft ◽

Cartilage Lesions ◽

Average Yearly Incidence ◽

Chondrocyte Implantation ◽

Osteochondral Autograft Transfer

AbstractManagement of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon “gold-standard” management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty) were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing incidence of palliative procedures seen by a significant decrease in the ratio of palliative to microfracture/restorative procedures of 0.2512 each year from 2007 to 2016 (p < 0.001). This decrease followed a linear trend (R 2 = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most commonly performed procedure for cartilage lesions in the United States from 2007 to 2016, as more surgeons opted for microfracture procedures instead. Restorative procedures (ACI, osteochondral autograft transfer system) remained unchanged over the study period, in accordance with the sports medicine literature; however, early functional outcomes studies do show the equivalency and in some cases superiority compared with microfracture. This is Level III study.

Download Full-text