Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation

Gürsoy, Safa; Şimşek, Mehmet Emin; Akkaya, Mustafa; Kaya, Özgür; Bozkurt, Murat

doi:10.1007/s00167-020-06319-4

Cited by 10 publications

(8 citation statements)

References 34 publications

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“…Many studies have shown the importance of matching the AC surface of the knee joint with the natural topographic anatomy during OCA transplantation. [31][32][33] The failure to match these components may negatively affect clinical outcomes [31,34] and subregional transplantation may be the solution. There was no signi cant difference in biomechanical properties between LP and MP, or between LTP and MTP; therefore, no more detailed division was required.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Properties of Articular Cartilage in Different Regions and Sites of the Knee Joint: Acquisition of Osteochondral Allografts

Lin

Wang

et al. 2023

Preprint

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Background: Osteochondral allograft (OCA) transplantation involves grafting of natural hyaline cartilage and supporting subchondral bone into the cartilage defect area of a joint to recover its biomechanical and tissue structure. However, differing biomechanical properties and donor-host matching may impair the integration of articular cartilage (AC). This study analyzed the biomechanical properties of the AC in different regions of different sites of the knee joint and provides a novel approach to OCA transplantation. Methods： Intact stifle joints from skeletally mature pigs were collected from a local abattoir less than 8 h after slaughter. OCAs were collected from different regions of the joints. The patella and thetibial plateau were divided into medial and lateral regions, while the trochlea and femoral condyle were divided into six regions. The OCAs were analyzed and compared for Young’s modulus, the compressive modulus, and cartilage thickness. Results:Young’s modulus, cartilage thickness and compressive modulus of OCA were significantly different in different regions of the joints. A negative correlation was observed between Young's modulus and the proportion of the subchondral bone (r=−0.4241, P<0.0001). Cartilage thickness was positively correlated with Young’s modulus (r=0.4473, P<0.0001) and the compressive modulus (r=0.3678, P<0.0001). Conclusions: During OCA transplantation, OCAs may be xenotransplanted into similar regions, or at the closest possible regions to ensure consistency of the biomechanical properties and cartilage thickness of the donor and recipient and, thus, easy integration with the surrounding tissue. A 7-mm depth achieved a higher Young's modulus, and may represent the ideal length.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Properties of Articular Cartilage in Different Regions and Sites of the Knee Joint: Acquisition of Osteochondral Allografts

Lin

Wang

et al. 2023

Preprint

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“…Gursoy et al 9 indirectly investigated the effect of RC mismatch by measuring local curvature mismatch between the donor and host in the setting of femoral condyle OCA transplant. Large relative graft convexity demonstrated a negative effect on clinical outcomes in that retrospective comparative study.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Factors Associated With Osteochondral Allograft Matching for Trochlear Cartilage Defects: A Computer-Simulation Study

et al. 2022

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Background: Articular step-off between the donor and recipient in osteochondral allograft transplant has been shown to alter contact pressures. Currently, commercial allograft donor selection is primarily based on simple anatomic parameters such as trochlear length, trochlear width, and tibial width. Purpose: To identify anatomic factors associated with optimal graft matching by using a 3-dimensional simulation model. Study Design: Descriptive laboratory study. Methods: Computed tomography images of 10 cadaveric trochlear specimens were obtained to generate 3-dimensional models. Circular defects were created virtually in the recipient trochleae at both superolateral (18.0 mm and 22.5 mm) and central (18.0 mm, 22.5 mm, 30.0 mm) locations. The donor models were virtually projected onto the defect models, and the most optimal graft from any location of the donor specimen was selected. Cartilage incongruity, subchondral bone incongruity, and peripheral articular step-off were calculated for each graft-defect combination. Linear regression models were generated to identify predictors of incongruity, step-off, and the effect of sulcus and sagittal angle mismatch. Akaike information criterion–driven stepwise regression models were generated to identify multivariate predictors. Results: Ideal matches were found for 100% of superolateral defects but for only 15% to 53% of central defects, depending on the defect size. Multivariate stepwise regression identified laterality (odds ratio [OR], 0.54; P = .081), sulcus angle (OR, 0.79; P < .001), sagittal angle (OR, 0.83; P = .001), lateral radius of curvature (OR, 0.81; P < .001), and medial facet width (OR, 0.86; P = .155) as predictors of ideal graft matching. In central defects with proud grafts, increasing sagittal angle and sulcus angle resulted in significantly ( P < .001) increased articular step-off, which became sequentially larger with defect size. Conclusion: Sagittal angle, sulcus angle, and lateral radius of curvature mismatch should be used to determine optimal donor allografts, especially in the setting of large (30-mm) central defects. Increasing sulcus angle and sagittal angle mismatch correlated with increasing step-off in proud grafts, whereas sulcus angle and sagittal angle inconsistently correlated with step-off in recessed grafts. Clinical Relevance: Additional descriptive trochlear measurements should be incorporated into the algorithm for donor selection. These findings can be used to identify acceptable mismatch parameters.

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“…Mismatched graft curvature can produce at least a moderate increase in peak contact stresses about grafted site and has been shown to be associated with worse clinical outcomes. 24,36…”

Section: Discussionmentioning

confidence: 99%

“…When OAT donor grafts do not match the curvature of the recipient region, this can lead to significantly poorer clinical outcomes. 24…”

Section: Introductionmentioning

confidence: 99%

Ideal Donor Site for Osteochondral Autografting of the Distal Femur Using Radius of Curvature: A 3-Dimensional High-Resolution Scanner Comparison

et al. 2021

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Objective To compare radius of curvature (RoC) of distal femur osteochondral autograft transfer (OAT) donor sites from the intercondylar notch and trochlear ridge with recipient sites on the distal and posterior condyles and evaluate differences between recipient sites. Design Nineteen cadaveric femurs were scanned with a 3-dimensional high-resolution sensor. Donor regions included the lateral (LTR) and medial trochlear ridges (MTR), and the lateral (LICN) and medial intercondylar notch (MICN). Recipient regions analyzed were the distal medial (DMFC), posterior medial (PMFC), distal lateral (DLFC), and posterior lateral femur condyle (PLFC). Six-millimeter OAT grafts were simulated, and average RoC of all regions was compared using an analysis of variance. Post hoc testing was performed using Fisher’s least significant difference. Results We found no significant differences in RoC of the LICN compared with all 4 recipient sites ( P = 0.19, 0.97, 0.11, and 0.75 for DLFC, PLFC, DMFC, and PMFC, respectively) or the LTR and MTR to the posterior condyles (LTR vs. PLFC and PMFC; P = 0.72, 0.47, MTR vs. PLFC and PMFC P = 0.39, 0.22, respectively). Significant differences were found for RoC of the MICN compared with each recipient site ( P < 0.001) and between distal and posterior femoral condyles (DLFC vs. PLFC, P = 0.016; DMFC vs. PMFC, P = 0.023). Conclusion The LICN is the ideal donor option for all recipient sites on the femoral condyles with respect to RoC of 6-mm OAT plugs. The MTR and LTR were acceptable donor sources for the posterior condyles, while the MICN was a poor match for all recipient sites. Additionally, the distal femur condyle and posterior femur condyle have different RoCs.

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Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation

Cited by 10 publications

References 34 publications

Biomechanical Properties of Articular Cartilage in Different Regions and Sites of the Knee Joint: Acquisition of Osteochondral Allografts

Biomechanical Properties of Articular Cartilage in Different Regions and Sites of the Knee Joint: Acquisition of Osteochondral Allografts

Anatomic Factors Associated With Osteochondral Allograft Matching for Trochlear Cartilage Defects: A Computer-Simulation Study

Ideal Donor Site for Osteochondral Autografting of the Distal Femur Using Radius of Curvature: A 3-Dimensional High-Resolution Scanner Comparison

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