scholarly journals A Method and Mechanism for Harvesting Intact Autograft for Osteochondral Transplantation

2019 ◽  
Author(s):  
Pradipta Biswas ◽  
Sakura Sikander ◽  
Pankaj Kulkarni ◽  
Sang-Eun Song
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Autologous Transplantation ◽  
Removal Mechanism ◽  
Osteochondral Transplantation ◽  
Joint Injury ◽  
Wear And Tear ◽  
Donor Graft ◽  
Graft Removal ◽  
Post Traumatic

Cartilage plays an important role in reducing mechanical stress and assist with smooth limb movement. Osteoarthritis is the degeneration of articular cartilage and bone. This osteochondral region is difficult to heal because of its dissimilar healing capability, so osteochondral transplantation is the most common method to resolve this issue. Post-traumatic osteoarthritis develops after a joint injury and can damage the cartilage and accelerate its wear and tear. Mosaicplasty is the most widely used method involving transplantation of small cylindrical bone cartilage plugs to fill up the affected region. The success of harvesting a larger and complex shaped graft to replace the damaged osteochondral area lies in effective extraction of the cartilage-bone graft from the donor site. Currently, no method exists to perform this procedure for autologous transplantation due to the complexity involved to extract graft without damaging the donor site. In this paper, we propose a novel graft removal mechanism to harvest a personalized autologous graft of virtually any shape and size. Our method involves drilling a profile similar to the effected region on the donor site and slicing off the desired cartilage-bone graft from its root to harvest it. We developed a new graft removal mechanism capable of inserting a flexible saw parallel to the transverse plane and slice the graft parallel to the coronal plane to extract a donor graft for autografting procedures.

scholarly journals Large Osteochondral Lesions of the Talus Treated With Autologous Bone Graft and Periosteum Transfer

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141987403
Author(s):  
Dimitrios Nikolopoulos ◽  
Neoptolemos Sergides ◽  
George Safos ◽  
Konstantinos Moustakas ◽  
Petros Safos ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Autologous Transplantation ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Functional Scores ◽  
Autologous Bone

Background: The treatment of large osteochondral lesions of the talus (OLTs) is challenging due to the poor intrinsic reparative capability of the damaged articular cartilage. Autologous transfer of bone and periosteum has been used successfully in the treatment of large defects in animals, and therefore it was believed that this technique might show similar results in humans. The purpose of this study was to assess the outcome of an innovative technique for autologous transplantation of cancellous tibial graft with periosteal transfer in large OLTs. Methods: Forty-one patients (22 females, 19 males), with a mean age of 34.9 years (range, 18-72 years), with a large OLT (>200 mm2) were treated with autologous bone graft and periosteum transfer. OLTs averaging 310 mm2 were identified on a preoperative computed tomography scan. The procedure consisted of malleolar osteotomy, curettage of sclerotic bone, autologous bone graft from the proximal tibia, and transfixion of periosteum over the graft. Outcome measures, including the pain visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Disability Index (FADI), were compared between preoperative and 1 and 2 years following surgery. Results: There were significant improvements in VAS pain score from 7.7 before surgery to 1.1 at 1 year after surgery and 0.4 at 2 years or more after surgery. The AOFAS and FADI scores were also significantly improved from 40.3 and 53.3 preoperatively to 95 and 93.2 postoperatively at 1 year and 95 and 93.2 at 2 or more years postoperatively, respectively. Postoperative complications included 2 patients who required removal of medial malleolar osteotomy tension bands due to symptomatic hardware. There were no nonunions or malunions of the osteotomies and no donor site complications. Conclusion: Autologous bone graft and periosteum transfer was an effective treatment for large OLTs leading to significant decreases in pain and improvement in functional scores at more than 2 years after surgery. Level of Evidence: Level IV, retrospective case series.

scholarly journals A Robotic Nondestructive Osteochondral Tissue Harvesting for Autograft Transplantation

10.29007/3pxz ◽  
2019 ◽  
Author(s):  
Pradipta Biswas ◽  
Sakura Sikander ◽  
Pankaj Kulkarni ◽  
Sang-Eun Song
Keyword(s):  
Lymphoid Tissue ◽  
Surgical Intervention ◽  
Donor Site ◽  
Osteochondral Lesion ◽  
Robotic Arm ◽  
Removal Mechanism ◽  
Bone Removal ◽  
Healthy Cartilage ◽  
Wire Saw ◽  
Graft Removal

Osteoarthritis is the degeneration of bone-cartilage. Healthy cartilage absorbs mechanical stress and provides smooth limb movement. Cartilage has poor healing capabilities due to the absence of blood, lymphoid tissue, and nerve that makes treatment of the damaged cartilage difficult, making surgical intervention an inevitable solution. Mosaicplasty is a popular surgical practice involving transplantation of small cylindrical bone-cartilage plugs to refill the lesion. A lack of custom-shaped donor harvesting mechanism makes it impossible to fill the lesion with a single graft. The success of transplanting a customized autograft to replace the osteochondral lesion lies in effective extraction of the autograft from the donor site. Currently, no method exists to harvest such grafts since it requires access to the root side of donor. In this paper, we propose a robotic cartilage-bone removal mechanism to harvest a custom-shaped autograft. Our method involves drilling a profile determined from the lesion to be removed and slicing off the desired cartilage-bone graft from the root. We designed a new graft removal mechanism capable of inserting a thin wire saw and slicing through the root of the prepared profile to extract an intact autograft. The device can be attached to a standard 6- DOF robotic arm that can provide profile drilling and gross positioning of the graft removal device.

Distal Tibia Bone Graft for Arthrodesis of the Foot and Ankle

1995 ◽  
Vol 16 (4) ◽  
pp. 187-190 ◽  
Author(s):  
Marc B. Danziger ◽  
Richard V. Abdo ◽  
J. Elliot Decker
Keyword(s):  
Bone Graft ◽  
Disease Transmission ◽  
Donor Site ◽  
Distal Tibia ◽  
Iliac Crest Bone Graft ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Foot And Ankle ◽  
Ankle Motion ◽  
Donor Site Pain

Forty patients since 1988 have had distal tibial bone grafting for 41 arthrodeses of the foot and ankle. Bone graft is obtained through a cortical window made just above the medial metaphyseal distal tibial flare. Average follow-up was 23.3 months. Forty of 41 arthrodesis sites fused; there was only one nonunion. There were no delayed unions. There were no complications at the donor site based on patient examination and radiographs. Ipsilateral ankle motion was not affected by the bone graft procedure. Cited complications from iliac crest bone graft include donor site pain, blood loss, heterotopic bone formation, pelvic instability, iliac hernia, infection, fracture, and deformity. Complications with allografts include disease transmission and immune response. These are avoided by using locally obtained distal tibia autograft for arthrodeses in the foot and ankle.

scholarly journals Monocytes, Macrophages, and Their Potential Niches in Synovial Joints – Therapeutic Targets in Post-Traumatic Osteoarthritis?

2021 ◽  
Vol 12 ◽  
Author(s):  
Patrick Haubruck ◽  
Marlene Magalhaes Pinto ◽  
Babak Moradi ◽  
Christopher B. Little ◽  
Rebecca Gentek
Keyword(s):  
Synovial Fibroblasts ◽  
Cellular Interactions ◽  
Joint Injury ◽  
Synovial Joints ◽  
Joint Disorder ◽  
Hematopoietic Stroma ◽  
Post Traumatic ◽  
Micro Anatomy ◽  
Molecular Signals ◽  
Potential Interactions

Synovial joints are complex structures that enable normal locomotion. Following injury, they undergo a series of changes, including a prevalent inflammatory response. This increases the risk for development of osteoarthritis (OA), the most common joint disorder. In healthy joints, macrophages are the predominant immune cells. They regulate bone turnover, constantly scavenge debris from the joint cavity and, together with synovial fibroblasts, form a protective barrier. Macrophages thus work in concert with the non-hematopoietic stroma. In turn, the stroma provides a scaffold as well as molecular signals for macrophage survival and functional imprinting: “a macrophage niche”. These intricate cellular interactions are susceptible to perturbations like those induced by joint injury. With this review, we explore how the concepts of local tissue niches apply to synovial joints. We introduce the joint micro-anatomy and cellular players, and discuss their potential interactions in healthy joints, with an emphasis on molecular cues underlying their crosstalk and relevance to joint functionality. We then consider how these interactions are perturbed by joint injury and how they may contribute to OA pathogenesis. We conclude by discussing how understanding these changes might help identify novel therapeutic avenues with the potential of restoring joint function and reducing post-traumatic OA risk.

scholarly journals Non-Healing Ulcer Due to Bone Wax in Alveolar Bone Graft Donor Site- A Case Report

2019 ◽  
Vol 3 (35) ◽  
pp. 192-194
Author(s):  
Moumita De ◽  
Rakesh Dawar ◽  
Maneesh Singhal ◽  
Ashish Bichpuriya ◽  
Ravikiran Nalla
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Alveolar Bone ◽  
Donor Site ◽  
Healing Ulcer ◽  
Graft Donor

scholarly journals Inhibition of Early Response Genes Prevents Changes in Global Joint Metabolomic Profiles in Mouse Post-Traumatic Osteoarthritis

2018 ◽  
Author(s):  
Dominik R. Haudenschild ◽  
Alyssa K. Carlson ◽  
Donald L. Zignego ◽  
Jasper H.N. Yik ◽  
Jonathan K. Hilmer ◽  
...  
Keyword(s):  
Transcriptional Activation ◽  
Cellular Responses ◽  
Early Response ◽  
Primary Response ◽  
Response Gene ◽  
Joint Injury ◽  
Non Invasive ◽  
Primary Response Gene ◽  
Post Traumatic ◽  
Early Response Genes

Osteoarthritis (OA) is the most common degenerative joint disease, and joint injury increases the risk of OA by 10-fold. Although the injury event itself damages joint tissues, a substantial amount of secondary damage is mediated by the cellular responses to the injury. Cellular responses include the production and activation of proteases (MMPs, ADAMTSs, Cathepsins), the production of inflammatory cytokines, and we hypothesize, changes to the joint metabolome. The trajectory of cellular responses is driven by the transcriptional activation of early response genes, which requires Cdk9-dependent RNA Polymerase II phosphorylation. Flavopiridol is a potent and selective inhibitor of Cdk9 kinase activity, which prevents the transcriptional activation of early response genes. To model post-traumatic osteoarthritis, we subjected mice to non-invasive ACL-rupture joint injury. Following injury, mice were treated with flavopiridol to inhibit Cdk9-dependent transcriptional activation, or vehicle control. Global joint metabolomics were analyzed 1 hour after injury. We found that injury induced metabolomic changes, including increases in Vitamin D3 metabolism and others. Importantly, we found that inhibition of primary response gene activation at the time of injury largely prevented the global changes in the metabolomics profiles. Cluster analysis of joint metabolomes identified groups of injury-induced and drug-responsive metabolites, which may offer novel targets for cell-mediated secondary joint damage. Metabolomic profiling provides an instantaneous snapshot of biochemical activity representing cellular responses, and these data demonstrate the potential for inhibition of early response genes to alter the trajectory of cell-mediated degenerative changes following joint injury.Significance StatementJoint injury is an excellent predictor of future osteoarthritis. It is increasingly apparent that the acute cellular responses to injury contribute to the initiation and pathogenesis of OA. Although changes to the joint transcriptome have been extensively studied in the context of joint injury, little is known about changes to small-molecule metabolites. Here we use a non-invasive ACL rupture model of joint injury in mice to identify injury-induced changes to the global metabolomic profiles. In one experimental group we prevented the activation of primary response gene transcription using the Cdk9 inhibitor flavopiridol. Through this comparison, we identified two sets of metabolites that change acutely after joint injury: those that require transcription of primary response genes, and those that do not.

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