Allograft Reconstruction of the Knee—Methods and Outcomes

Temple, H. Thomas

doi:10.1055/s-0038-1672123

Cited by 7 publications

(11 citation statements)

References 41 publications

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“… 2 , 3 Osteochondral allografting has proven to be an effective surgical procedure to treat articular cartilage defects. 4 - 6 Depending on the size of the articular cartilage defect, the procedure requires grafts that range from small to large pieces of osteochondral tissue. Fresh articular cartilage grafts are the gold standard used for cartilage repair in orthopedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Vitrification of Intact Porcine Femoral Condyle Allografts Using an Optimized Approach

Laouar

Elliott

et al. 2020

CARTILAGE

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Objective Successful preservation of articular cartilage will increase the availability of osteochondral allografts to treat articular cartilage defects. We compared the effects of 2 methods for storing cartilage tissues using 10-mm diameter osteochondral dowels or femoral condyles at −196°C: (a) storage with a surrounding vitrification solution versus (b) storage without a surrounding vitrification solution. We investigated the effects of 2 additives (chondroitin sulfate and ascorbic acid) for vitrification of articular cartilage. Design Healthy porcine stifle joints ( n = 11) from sexually mature pigs were collected from a slaughterhouse within 6 hours after slaughtering. Dimethyl sulfoxide, ethylene glycol, and propylene glycol were permeated into porcine articular cartilage using an optimized 7-hour 3-step cryoprotectant permeation protocol. Chondrocyte viability was assessed by a cell membrane integrity stain and chondrocyte metabolic function was assessed by alamarBlue assay. Femoral condyles after vitrification were assessed by gross morphology for cartilage fractures. Results There were no differences in the chondrocyte viability (~70%) of 10-mm osteochondral dowels after vitrification with or without the surrounding vitrification solution. Chondrocyte viability in porcine femoral condyles was significantly higher after vitrification without the surrounding vitrification solution (~70%) compared to those with the surrounding vitrification solution (8% to 36%). Moreover, articular cartilage fractures were not seen in femoral condyles vitrified without surrounding vitrification solution compared to fractures seen in condyles with surrounding vitrification solution. Conclusions Vitrification of femoral condyle allografts can be achieved by our optimized approach. Removing the surrounding vitrification solution is advantageous for vitrification outcomes of large size osteochondral allografts.

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Section: Introductionmentioning

confidence: 99%

Vitrification of Intact Porcine Femoral Condyle Allografts Using an Optimized Approach

Laouar

Elliott

et al. 2020

CARTILAGE

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“…Allerdings wird in diesem Bericht nichts über die präoperative Planung und intraoperative Anpassung des Transplantats berichtet. Der Sitz und die Bündigkeit entscheiden jedoch über die Qualität der Osseointegration und damit über die Funktion des Gelenks [15]. Im Jahr 2004 untersuchten Koh et al in einer biomechanischen Studie den Zusammenhang zwischen Transplantathöhen-Mismatch und Kontaktdruck.…”

Section: Diskussionunclassified

“…Um die Patienten vor einem Extremitätenverlust zu bewahren, bieten Allografts eine Möglichkeit, osteochondrale Defekte zu rekonstruieren und so die Extremitätzuerhalten [15].DieVorteiledieses Verfahrens liegen in der unbegrenzten Größe des knöchernen sowie knorpeligen Defekts und damit in der Möglichkeit, auch große subchondrale Knochenverluste zu rekonstruieren [15]. Während Verfahren, welche überwiegend bei großen Knorpeldefekten indiziert sind, wie die "fresh large osteochondral allograft transplantation" (FLOCSAT), den subchondralen Knochen nur als Trägermatrix nutzen [7], kann mithilfe von Allografts auch ein substanzieller Knochendefekt rekonstruiert werden.…”

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“…Somit haben frisch gefrorene Allografts aber auch einen höheren Anteil vitaler Chondrozyten. Aufgrund der genannten Nachteile frischer und kryokonservierter Transplantate stellen frisch gefrorene Allografts die beste Option zur Rekonstruktion großer osteochondraler Defekte dar [8,13,15]. Nichtsdestotrotz sind diese Transplantate in ihrer Anzahl und Verfügbarkeit begrenzt, was auch an der aufwendigen und kostenintensiven Transplantatgewinnung und -lagerung liegt [7].…”

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Rekonstruktion großer osteochondraler Defekte des distalen Femurs und der proximalen Tibia

et al. 2020

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Rekonstruktion großer osteochondraler Defekte des distalen Femurs und der proximalen Tibia Anpassung frisch gefrorener Allografts unter Zuhilfenahme 3D-gedruckter Kunststoffmodelle Hintergrund Offene Frakturen des Kniegelenks mit signifikantem Verlust an osteochondraler Substanz kommen bei jungen Patienten vergleichsweise selten vor, haben jedoch meist fatale Konsequenzen. Aufgrund des hohen Aktivitätslevels und des funktionellen Anspruchs stellt die Behandlung solcher Fälle den Chirurgen vor große Herausforderungen. Obwohl verschiedene Therapieoptionen in der Li-Abb. 1 8 a Intraoperatives Bild des Befunds bei Aufnahme im Universitätsklinikum, Asterisk tibialer, Doppelasterisk femoraler Defekt. b Koronarer CT-Schnitt durch das rechte Knie unter Darstellung der offenen Fraktur mit großen osteochondralen Defekten an der medialen Femurkondyle und dem medialen Tibiaplateau

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“…The osteoarticular allograft and resection arthrodesis reconstruction are common procedures in biological reconstruction around the knee. Osteoarticular allograft reconstruction has many advantages, including reconstruction of the soft tissue (joint capsules, ligaments, and tendons) between the host and allograft that improves joint kinematics and knee extensor function 4 . Osteoarticular allograft reconstruction is suitable for young patients in whom bone stock should be reserved for future revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Wisanuyotin

Paholpak

Sirichativapee

et al. 2021

Asia-Pac J Clncl Oncology

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Aim:The biological reconstruction of the knee with osteoarticular allografts and resection arthrodesis have been reported but there has not yet been a direct comparison between both these procedures. This study aimed to identify the prognostic factors that influence failure of biological reconstruction and compared the results between both procedures.Methods: Between 1994 and 2017, we performed 92 limb-sparing procedures using resection arthrodesis (n = 53) and osteoarticular allograft reconstruction (n = 39) for the management of primary bone tumors around the knee. The minimum follow-up time was 2 years in both groups. Results:The failure rate of reconstruction in the osteoarticular allograft and resection arthrodesis group was 48.7% and 39.6%, respectively (p = 0.75). The mean MSTS score in the osteoarticular allograft and resection arthrodesis group was 23.7 and 21.8, respectively (p = 0.01). The significant risk factor for failure after biological reconstruction was the administration of chemotherapy (p = 0.001; HR = 3.39; 95% CI, 1.60-7.17). Conclusion:Patients who underwent osteoarticular allograft had a better functional outcome than those who underwent resection arthrodesis reconstruction, but clinical outcomes between the groups were comparable. Chemotherapy is a significant adverse prognostic factor for failure of biological reconstruction.

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Allograft Reconstruction of the Knee—Methods and Outcomes

Cited by 7 publications

References 41 publications

Vitrification of Intact Porcine Femoral Condyle Allografts Using an Optimized Approach

Vitrification of Intact Porcine Femoral Condyle Allografts Using an Optimized Approach

Rekonstruktion großer osteochondraler Defekte des distalen Femurs und der proximalen Tibia

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

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