Chondrogenic Potential and Homogeneity of Cell Populations of Donor and Recipient Cells in a Fresh Osteochondral Allograft

Background: Regulatory concerns and the popularity of fresh osteochondral allograft (OCA) transplantation have led to a need for prolonged viable storage of osteochondral grafts. Tissue culture media allow a longer storage time but lead to chondrocyte death within the tissue. The long-term clinical consequence of prolonged storage is unknown. Hypothesis: Patients transplanted with OCAs with a shorter storage time would have lower failure rates and better clinical outcomes than those transplanted with OCAs with prolonged storage. Study Design: Cohort study; Level of evidence, 3. Methods: A matched-pair study was performed of 75 patients who received early release grafts (mean storage, 6.3 days [range, 1-14 days]) between 1997 and 2002, matched 1:1 by age, diagnosis, and graft size, with 75 patients who received late release grafts (mean storage time, 20.0 days [range, 16-28 days]) from 2002 to 2008. The mean age was 33.5 years, and the median graft size was 6.3 cm2. All patients had a minimum 2-year follow-up. Evaluations included pain, satisfaction, function, failures, and reoperations. Outcome measures included the modified Merle d’Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) form, and Knee Society function (KS-F) scale. Clinical failure was defined as revision OCA transplantation or conversion to arthroplasty. Results: Among patients with grafts remaining in situ, the mean follow-up was 11.9 years (range, 2.0-16.8 years) and 7.8 years (range, 2.3-11.1 years) for the early and late release groups, respectively. OCA failure occurred in 25.3% (19/75) of patients in the early release group and 12.0% (9/75) of patients in the late release group ( P = .036). The median time to failure was 3.5 years (range, 1.7-13.8 years) and 2.7 years (range, 0.3-11.1 years) for the early and late release groups, respectively. The 5-year survivorship of OCAs was 85% for the early release group and 90% for the late release group ( P = .321). No differences in postoperative pain and function were noted between the groups. Ninety-one percent of the early release group and 93% of the late release group reported satisfaction with OCA results. Conclusion: The transplantation of OCA tissue with prolonged storage is safe and effective for large osteochondral lesions of the knee and has similar clinical outcomes and satisfaction to the transplantation of early release grafts.

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Radius of Curvature Measurements to Determine Best Location for Fresh Osteochondral Allograft of the Capitellum v1 (protocols.io.9nmh5c6)

protocols.io ◽

10.17504/protocols.io.9nmh5c6 ◽

2019 ◽

Author(s):

Zachary Goldstein ◽

Michael Robbins ◽

Austin Thompson ◽

Scott Yang ◽

Adam Mirarchi

Keyword(s):

Osteochondral Allograft ◽

Radius Of Curvature ◽

Fresh Osteochondral Allograft ◽

Curvature Measurements

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Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

The American Journal of Sports Medicine ◽

10.1177/0363546517746106 ◽

2018 ◽

Vol 46 (4) ◽

pp. 900-907 ◽

Cited By ~ 15

Author(s):

Luis E.P. Tírico ◽

Julie C. McCauley ◽

Pamela A. Pulido ◽

William D. Bugbee

Keyword(s):

Cartilage Repair ◽

Femoral Condyle ◽

Relative Size ◽

Surgical Techniques ◽

Lesion Size ◽

Osteochondral Allograft ◽

Fresh Osteochondral Allograft ◽

Graft Area ◽

The Mean

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.

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Arthroscopic bullet removal from the hip joint and concurrent treatment of associated full-thickness chondral defects: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x19829670 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1982967

Author(s):

Fernando P Ferro ◽

Felipe S Bessa ◽

Leandro Ejnisman ◽

Henrique MC Gurgel ◽

Alberto T Croci ◽

...

Keyword(s):

Hip Joint ◽

Weight Bearing ◽

Osteochondral Allograft ◽

Concurrent Treatment ◽

Chondral Lesions ◽

Chondral Defects ◽

Arthroscopic Removal ◽

Fresh Osteochondral Allograft ◽

Chondrocyte Implantation

The diagnosis of a bullet inside the hip joint is a rare finding. The usual method to treat this condition has been open surgery, with its associated complications and morbidity. The arthroscopic approach has been increasingly utilized for the diagnosis and treatment of several hip conditions, and the number of indications for this technique has been steadily rising. We report the case of a 35-year-old man who suffered a gunshot wound and was operated on for abdominal perforation. He later presented with groin pain that worsened with weight-bearing on his right leg and then underwent arthroscopic removal of a bullet located inside his right hip joint. After a 2-year follow-up, the patient had an excellent clinical outcome, with no radiologic signs of arthritis. The removal of an intra-articular projectile is necessary to avoid complications such as synovitis, osteoarthritis, septic arthritis, and saturnism. The best access to the hip joint remains a topic of debate. Arthroscopy has the advantage of less soft-tissue damage and quicker recovery. The treatment of associated chondral lesions can be done with several techniques, including microfracture, autologous chondrocyte implantation, mosaicplasty, and fresh osteochondral allograft transplantation. There is no consensus as to the best course of treatment for associated chondral lesions in such cases. Hip arthroscopy can be a safe and effective technique for the removal of intra-articular bullets in the hip.

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Fresh osteochondral allograft with soft tissue reconstruction for open knee trauma: A 20-year follow-up

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0059 ◽

2016 ◽

Vol 98 (2) ◽

pp. e34-e36 ◽

Cited By ~ 2

Author(s):

EW Yates ◽

RA Boden ◽

K Suvarna ◽

I Stockley

Keyword(s):

Soft Tissue ◽

Osteochondral Allograft ◽

Soft Tissue Reconstruction ◽

Fresh Osteochondral Allograft ◽

Tissue Reconstruction ◽

Knee Trauma

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A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00382 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0038

Author(s):

Gregory F. Pereira ◽

John Steele ◽

Amanda N. Fletcher ◽

Samuel B. Adams ◽

Ryan B. Clement

Keyword(s):

Systematic Review ◽

Survival Rate ◽

Graft Survival ◽

Graft Survival Rate ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Cochrane Central Register ◽

Allograft Transplantation ◽

Fresh Osteochondral Allograft

Category: Ankle Introduction/Purpose: The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs. Methods: PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures. Conclusion: The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up. [Table: see text]

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Twenty-five-Year Chondrocyte Viability in Fresh Osteochondral Allograft

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.e.00815 ◽

2007 ◽

Vol 89 (1) ◽

pp. 159-165 ◽

Cited By ~ 36

Author(s):

A.C. Maury ◽

O. Safir ◽

F. Las Heras ◽

K.P.H. Pritzker ◽

A.E. Gross

Keyword(s):

Osteochondral Allograft ◽

Chondrocyte Viability ◽

Fresh Osteochondral Allograft

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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.

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