Pulsed lavage cleansing of osteochondral grafts depends on lavage duration, flow intensity, and graft storage condition

Abstract

IntroductionOsteochondral allograft (OCA) transplantation is generally effective for treating large cartilage lesions. Cleansing OCA subchondral bone to remove donor marrow elements is typically performed with pulsed lavage. However, the effects of clinical and experimental parameters on OCA marrow removal by pulsed lavage are unknown. The aim of the current study was to determine the effects on marrow cleansing in human osteochondral cores (OCs) of (1) lavage duration, (2) lavage flow intensity, and (3) OC sample type and storage condition.MethodsOCs were harvested from human femoral condyles and prepared to a clinical geometry (cylinder, diameter = 20 mm). The OCs were from discarded remnants of Allograft tissues (OCA) or osteoarthritis patients undergoing Total Knee Replacement (OCT). The experimental groups subjected to standard flow lavage for 45 seconds (430 mL of fluid) and 120 seconds (1,150 mL) were (1) OCT/FROZEN (stored at -80°C), (2) OCT/FRESH (stored at 4°C), and (3) OCA/FRESH. The OCA/FRESH group was subsequently lavaged at high flow for 45 seconds (660 mL) and 120 seconds (1,750 mL). Marrow cleansing was assessed grossly and by micro-computed tomography (μCT).ResultsGross and μCT images indicated that marrow cleansing progressed from the OC base toward the cartilage. Empty marrow volume fraction (EMa.V/Ma.V) increased between 0, 45, and 120 seconds of standard flow lavage, and varied between groups, being higher after FROZEN storage (86–92% after 45–120 seconds) than FRESH storage of either OCT or OCA samples (36% and 55% after 45 and 120 seconds, respectively). With a subsequent 120 seconds of high flow lavage, EMa.V/Ma.V of OCA/FRESH samples increased from 61% to 78%.ConclusionsThe spatial and temporal pattern of marrow space clearance was consistent with gradual fluid-induced extrusion of marrow components. Pulsed lavage of OCAs with consistent time and flow intensity will help standardize marrow cleansing and may improve clinical outcomes.

Comparison of Techniques for Preimplantation Treatment of Osteochondral Allograft Bone

“…Remaining allogeneic marrow in the donor bone may instigate more severe immunogenic responses, particularly with larger grafts, which may also contribute to failure of integration. [38][39][40][41][42] The current SOC pretreatment of OCAs being prepared for transplantation, saline irrigation, only addresses marrow element removal. Based on translational and clinical evidence, 15,16 the OCA pretreatment protocol at our institution includes saturation of the osseous portion of the graft with autogenous BMC in an attempt to speed the process of creeping substitution.…”

“…The marrow portion of bone allografts is allogeneic, and remaining allogeneic marrow elements may incite more severe immunogenic responses, particularly with larger grafts. [38][39][40][41][42] For the current standard of care (SOC), power irrigation with saline is used to remove marrow elements from OCAs immediately prior to implantation. Marrow element removal by pulse lavage with saline has been demonstrated to increase with irrigation duration and volume.…”

“…Marrow element removal by pulse lavage with saline has been demonstrated to increase with irrigation duration and volume. 38,43 However, compressed carbon dioxide (CO 2 ) (Carbojet, Kinamed Inc., Camarillo, CA) usage, in combination with saline lavage, has been shown to more effectively clear bone marrow elements from the osseous portion of OCAs than saline pulse lavage alone. 44 In our efforts to continually improve the success of OCA transplantation for patients, we designed this study to compare clinically applicable methods for marrow element removal and techniques for enhanced delivery of BMC to OCA bone.…”

Osteochondral Allograft Transplantation: Identifying the Biomechanical Impact of Using Shorter Grafts and Pulsatile Lavage on Graft Stability

“…Previous studies have suggested that after PL, fresh OCAs may lose from 22.6 to 46% of their marrow volume when compared with control, and up to 63% of marrow volume if previously frozen, depending on duration of lavage. 7,19 It has previously been suggested that the majority of the OCA's ability to resist compressive/tensile forces come from the osseous component of the plug. 16,17,20 However, after subjecting the 7 mm grafts to a 1-minute, normal saline lavage, these plugs demonstrated no significant differences in their compressive and tensile resistance properties (p > 0.05) (►Table 2).…”

“…1,4 Allograft empty marrow volume was found to increase from 36 to 55% after fresh OCAs were subjected to 45 to 120 second periods of PL. 7,19 The effect of this decrease in nearly half of trabecular bone volume (thought to be the primary contributor to stability) on resistance to deforming forces has not been previously evaluated.…”