Clinical, Histologic, and Radiographic Outcomes of Distal Femoral Resurfacing with Hypothermically Stored Osteoarticular Allografts

Davidson, Philip A.; Rivenburgh, Dennis W.; Dawson, Patti E.; Rozin, Roman

doi:10.1177/0363546507299529

Cited by 75 publications

(64 citation statements)

References 25 publications

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“…It still remains unclear how fresh-stored graft compares with slow-freezing cryopreserved grafts, which still have some chondrocyte viability [32,50]. In addition, recent clinical studies with fresh-stored allograft with prolonged storage time report good outcomes, which also supports the notion that there may be a critical minimum number of functioning chondrocytes that can maintain the extracellular matrix [22,45,64].…”

Section: Discussionmentioning

confidence: 95%

“…First, we used an ovine animal model, which has limited extrapolations to humans. However, recently published clinical reports on the effect of cold storage on human osteochondral plugs appear to demonstrate a comparable effect on human tissue with cold storage [22,45,64]. Second, in our protocol, storage was in a nutritive medium that was changed sterilely every 48 hours as previously described [65].…”

Section: Discussionmentioning

confidence: 99%

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Material Properties of Fresh Cold-stored Allografts for Osteochondral Defects at 1 Year

Ranawat

Vidal

Chen

et al. 2008

Clin Orthop Relat Res

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Little is known about the long-term properties of fresh cold-stored osteochondral allograft tissue. We hypothesized fresh cold-stored tissue would yield superior material properties in an in vivo ovine model compared to those using freeze-thawed acellular grafts. In addition, we speculated that a long storage time would yield less successful grafts. We created 10-mm defects in medial femoral condyles of 20 sheep. Defects were reconstructed with allograft plugs stored at 4°C for 1, 14, and 42 days; control specimens were freeze-thawed or defect-only. At 52 weeks, animals were euthanized and retrieved grafts were analyzed for cell viability, gross morphology, histologic grade, and biomechanical and biochemical analysis. Explanted coldstored tissue had superior histologic scores over freezethawed and defect-only grafts. Specimens stored for 1 and 42 days had higher equilibrium moduli and proteoglycan content than freeze-thawed specimens. We observed no difference among any of the cold-stored specimens for chondrocyte viability, histology, equilibrium aggregate modulus, proteoglycan content, or hypotonic swelling. Reconstructing cartilage defects with cold-stored allograft resulted in superior histologic and biomechanical properties compared with acellular freeze-thawed specimens; however, storage time did not appear to be a critical factor in the success of the transplanted allograft.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Material Properties of Fresh Cold-stored Allografts for Osteochondral Defects at 1 Year

Ranawat

Vidal

Chen

et al. 2008

Clin Orthop Relat Res

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“…In 3 other patients where corrective realignment procedures were carried out, the grafts healed with good results. Davidson et al [19] analysed 10 knees in 8 patients using second-look arthroscopic evaluation and biopsy at a mean of 40 mo post fresh allograft transplantation in the distal femur. The mean International Knee Documentation Committee (IKDC) score significantly improved from 27 to 79 (P = 0.002).…”

Section: Femurmentioning

confidence: 99%

Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Chui

Jeys

Snow

2015

WJO

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The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per 100000 people. These lesions can become symptomatic causing pain, swelling and decreased function of the knee, and may eventually progress to osteoarthritis. In the young and active population, partial or total knee arthroplasty (TKA) is rarely the treatment of choice due to risk of early failure. Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom TKA is not recommended. Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset. Patients with bipolar lesions, uncorrectable malalignment, advanced osteoarthritis, and those over 40 tend to have less favourable outcomes. Core tip:Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom total knee arthroplasty is not recommended. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset.

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“…Biopsy specimens of the graft and native articular cartilage were not statistically different for cell density and viability [33]. Treatment of steroid-associated osteonecrosis has demonstrated acceptable results [34••], but inferior to posttraumatic osteochondral lesions [35].…”

Section: Clinical Evidencementioning

confidence: 99%

The use of osteochondral allografts in the management of cartilage defects

Demange

Gomoll

2012

Curr Rev Musculoskelet Med

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Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.

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Clinical, Histologic, and Radiographic Outcomes of Distal Femoral Resurfacing with Hypothermically Stored Osteoarticular Allografts

Cited by 75 publications

References 25 publications

Material Properties of Fresh Cold-stored Allografts for Osteochondral Defects at 1 Year

Material Properties of Fresh Cold-stored Allografts for Osteochondral Defects at 1 Year

Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

The use of osteochondral allografts in the management of cartilage defects

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