Perforations of Cortical Bone Allografts Improve Their Incorporation

Delloye, Christian; Simon, P.; Behets, Catherine; Banse, Xavier; Bresler, F.; Schmitt, D.

doi:10.1097/00003086-200203000-00035

Cited by 33 publications

(33 citation statements)

References 18 publications

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“…A nonhomogenous size distribution of the autograft pieces was used here. Although some have shown that using highly morselized autograft fragments of cortical bone (25 lm to 2 mm, in canines) resulted in fibrous nonunion [23], benefits of smaller bone fragments have also been reported, likely arising from larger surface area [13] or better distribution of available periosteal or endosteal cells [26]. Typically, cortical autograft is gradually remodeled and replaced by regenerating bone, often delaying healing [11,12,19].…”

Section: Discussionmentioning

confidence: 99%

“…This is likely explained by contributions from the graft-derived cells or by migration of stem cells/osteoprogenitor cells into the defect region, although this was not specifically characterized in this study. Although the diffusion-limited environment in large autografts may limit viability to only surface cells on the grafts [19], it is possible that the morselized nature of autograft used in this study contributed to mineralized healing either as a result of the larger available surface area or graft-associated cells [4,5,13,26].…”

Section: Discussionmentioning

confidence: 99%

“…Allograft has reduced osteoinductive potential and slower healing, whereas demineralized scaffolds lack structural stability [1,13,19,25]. The widespread use of recombinant human BMP-2 (rhBMP-2) highlights its capability to augment large segmental bone defect repair, especially in the context of animal studies, with BMP-2 supplementation showing improved healing compared with allograft and ceramic fillers [25,46].…”

Section: Introductionmentioning

confidence: 99%

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Hydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared With Autograft

Krishnan

Priddy

Esancy

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Autologous bone grafting remains the gold standard in the treatment of large bone defects but is limited by tissue availability and donor site morbidity. Recombinant human bone morphogenetic protein-2 (rhBMP-2), delivered with a collagen sponge, is clinically used to treat large bone defects and complications such as delayed healing or nonunion. For the same dose of rhBMP-2, we have shown that a hybrid nanofiber mesh-alginate (NMA-rhBMP-2) delivery system provides longer-term release and increases functional bone regeneration in critically sized rat femoral bone defects compared with a collagen sponge. However, no comparisons of healing efficiencies have been made thus far between this hybrid delivery system and the gold standard of using autograft. Questions/purposes We compared the efficacy of the NMA-rhBMP-2 hybrid delivery system to morselized autograft and hypothesized that the functional regeneration of large bone defects observed with sustained BMP delivery would be at least comparable to autograft treatment as measured by total bone volume and ex vivo mechanical properties. Methods Bilateral critically sized femoral bone defects in rats were treated with either live autograft or with the NMA-rhBMP-2 hybrid delivery system such that each animal received one treatment per leg. Healing was monitored by radiography and histology at 2, 4, 8, and 12 weeks. Defects were evaluated for bone formation by longitudinal micro-CT scans over 12 weeks (n = 14 per group). The bone volume, bone density, and the total new bone formed beyond 2 weeks within the defect were calculated from micro-CT reconstructions and values compared for the 2-, 4-, 8-, and 12-week scans within and across the two treatment groups. Two animals were used for bone labeling with subcutaneously injected dyes at 4, 8, and 12 weeks followed by histology at 12 weeks to

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared With Autograft

Krishnan

Priddy

Esancy

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Furthermore, BMP-2 seems to have limited effects on nonunions that mostly consist of fibroblastic tissues. In one such application [20], two allograft fracture nonunions and one nonunion at the allograft-host junction were treated with 12 mg rhBMP-2. The remaining three nonunions were treated with 7 mg rhBMP-7 (Osigraft 1 ; Stryker Biotech, Hopkinton, MA).…”

Section: Design Considerations For Functional Tissue Engineering Of Pmentioning

confidence: 99%

“…The outcome and radiographic evidence of healing were evaluated at a minimal followup of 12 months. There was neither healing of allograft fractures nor union of allograft-host junction [20]. Thus, improving the efficacy of BMP treatment and searching for alternative osteogenic factors or genes have become the most important topics in bone regeneration therapy.…”

Section: Design Considerations For Functional Tissue Engineering Of Pmentioning

confidence: 99%

A Perspective: Engineering Periosteum for Structural Bone Graft Healing

Zhang

Awad

O’Keefe

et al. 2008

Clin Orthop Relat Res

202

169

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Autograft is superior to both allograft and synthetic bone graft in repair of large structural bone defect largely due to the presence of multipotent mesenchymal stem cells in periosteum. Recent studies have provided further evidence that activation, expansion and differentiation of the donor periosteal progenitor cells are essential for the initiation of osteogenesis and angiogenesis of donor bone graft healing. The formation of donor cell-derived periosteal callus enables efficient host-dependent graft repair and remodeling at the later stage of healing. Removal of periosteum from bone autograft markedly impairs healing whereas engraftment of multipotent mesenchymal stem cells on bone allograft improves healing and graft incorporation. These studies provide rationale for fabrication of a biomimetic periosteum substitute that could fit bone of any size and shape for enhanced allograft healing and repair. The success of such an approach will depend on further understanding of the molecular signals that control inflammation, cellular recruitment as well as mesenchymal stem cell differentiation and expansion during the early phase of the repair process. It will also depend on multidisciplinary collaborations between biologists, material scientists and bioengineers to address issues of material selection and modification, biological and biomechanical parameters for functional evaluation of bone allograft healing.

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Chitosan‐heparin polyelectrolyte multilayers on cortical bone: Periosteum‐mimetic, cytophilic, antibacterial coatings

Almodóvar

Mower

Banerjee

et al. 2012

Biotech & Bioengineering

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Cortical bone allografts suffer from high rates of failure due to poor integration with host tissue, leading to non-union, fracture, and infection following secondary procedures. Here, we report a method for modifying the surfaces of cortical bone with coatings that have biological functions that may help overcome these challenges. These chitosan-heparin coatings promote mesenchymal stem cell attachment and have significant antibacterial activity against both S. aureus and E. coli. Furthermore, their chemistry is similar to coatings we have reported on previously, which effectively stabilize and deliver heparin-binding growth factors. These coatings have potential as synthetic periosteum for improving bone allograft outcomes.

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Perforations of Cortical Bone Allografts Improve Their Incorporation

Cited by 33 publications

References 18 publications

Hydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared With Autograft

Hydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared With Autograft

A Perspective: Engineering Periosteum for Structural Bone Graft Healing

Chitosan‐heparin polyelectrolyte multilayers on cortical bone: Periosteum‐mimetic, cytophilic, antibacterial coatings

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