Two-stage late reconstruction with a fresh large osteochondral shell allograft transplantation (FLOCSAT) for a large ostechondral defect in a non-union after a lateral tibia plateau fracture 2-year follow up

Krettek, Christian; Clausen, Jan; Omar, Mohamed; Noack, Sandra; Neunaber, Claudia

doi:10.1016/j.injury.2017.05.010

Cited by 9 publications

(15 citation statements)

References 27 publications

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“…Die Schnitttechnik der Tibiaplateaus ist ebenfalls relativ einfach; die intraoperative Planung und die rotatorische Ausrichtung des FLOCSAT können trotzdem schwierig sein [48].…”

Section: Oberflächenersatz Mit Großflächigem Uniplanarem Osteochondraunclassified

“…Eine geringe Schichtdicke reduziert die Vaskularisati-onsstrecke für die Transplantate, erleichtert die Osseointegration und die Perfusion der Transplantate. Andererseits soll der knöcherne Anteil eine sichere Fixierung durch Implantate (Kirschner-Drähte, Schrauben) erlauben und Ermüdungsfrakturen verhindern [48].…”

Section: Oberflächenersatz Mit Großflächigem Uniplanarem Osteochondraunclassified

“…Bei den großflächigen uniplanaren osteochondralen Transplantaten (FLOCSAT) gelingt es nicht, diese "pressfit" einzubringen. Die Fixierung erfolgt dann mithilfe von Schrauben, Kirschner-Drähten und Miniplatten aus dem Kleinfragment-oder Handset [10, 25,48]; geometrische Unterschneidungstechniken können die Stabilität steigern (. Abb.…”

Section: Oberflächenersatz Mit Großflächigem Uniplanarem Osteochondraunclassified

“…Dafür müssen mindestens 6 Monate veranschlagt werden. Erst danach kann die FLOCSAT erfolgen [48,49].…”

Section: Knochendefekt Und Pseudarthroseunclassified

“…In allen Fällen kam es zur raschen Osseointegration innerhalb von 12 Wochen. Infektionen traten nicht auf [48,49].…”

Section: Ergebnisseunclassified

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Partielle und komplette Gelenktransplantation mit frischen osteochondralen Allografts – das FLOCSAT-Konzept

et al. 2017

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Cartilage defects in adult patients do not heal well. Fresh osteochondral allograft (OCA) transplantation is based on mature, living, mechanically sound hyaline cartilage attached to a bone interface, which is brought into an osteochondral defect, where it becomes osseointegrated. According to current knowledge, intact hyaline cartilage tissue is immune privileged and does not, in contrast to bone, meniscus or ligaments, cause an immune reaction. The technique has the unique advantage of transplanting viable, mature and mechanically stable hyaline cartilage into the affected area. An OCA is the only biological surgical technique for chondral and osteochondral lesions after failed cell-based techniques or autologous osteochondral transplantation.Fresh osteochondral allografts with mainly small cylindrical transplants show survival of 20 years and more. Based on this experience the FLOCSAT (fresh large [> 10 cm] osteochondral shell allograft transplantation) concept with the thinnest possible (< 6-8 mm) bone thickness has been developed. Cells survive in special media at 4 °C for 4 weeks or more and are transplanted with a minimum of 70% living cells in a live/dead assay and cell density > 200 cells/mm.FLOCSATs can replace parts or entire joints as uniplanar or multiplanar(n-planar)-FLOCSAT, as unipolar, bipolar or tripolar(n-polar)-FLOCSAT, and in combination with meniscus and/or ligaments (nMnL)-FLOCSAT (n number of structures).The FLOCSAT concept was applied successfully to knee, ankle and elbow joints. All transplants showed sound osseointegration. Cartilage failure was the reason for unsuccessful outcome. Challenges remain regarding graft availability, precise size matching, complex logistics, demanding surgical technique in complex geometries, and open questions in immunology and chimerism.

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“…Die Schnitttechnik der Tibiaplateaus ist ebenfalls relativ einfach; die intraoperative Planung und die rotatorische Ausrichtung des FLOCSAT können trotzdem schwierig sein [48].…”

Section: Oberflächenersatz Mit Großflächigem Uniplanarem Osteochondraunclassified

“…Dafür müssen mindestens 6 Monate veranschlagt werden. Erst danach kann die FLOCSAT erfolgen [48,49].…”

Section: Knochendefekt Und Pseudarthroseunclassified

“…In allen Fällen kam es zur raschen Osseointegration innerhalb von 12 Wochen. Infektionen traten nicht auf [48,49].…”

Section: Ergebnisseunclassified

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Partielle und komplette Gelenktransplantation mit frischen osteochondralen Allografts – das FLOCSAT-Konzept

et al. 2017

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Ex vivo storage of human osteochondral allografts: Long‐term analysis over 300 days using a Ringer‐based solution

Jiang,

Clausen,

Jahn

et al. 2024

Journal Orthopaedic Research

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Large osteochondral defects are a major challenge in orthopedics, for which osteochondral allograft (OCA) transplantation is nowadays considered as an option, especially in young patients. However, a major issue with OCA is the need for graft storage, which ensures adequate cartilage integrity over time. The aim of this study was to test how long a Ringer‐based storage solution can provide good graft quality after explantation and thus meet the requirements for OCA. For this purpose, human osteochondral allografts of the knee and ankle were analyzed. Live/Dead analysis was performed and glycosaminoglycan, as well as hydroxyproline content, were measured as crucial chondrocyte integrity factors. Furthermore, biomechanical tests focusing on stress relaxation and elastic compression modulus were performed. The critical value of 70% living chondrocytes, which corresponds to a number of 300 cells/mm², was reached after an average of 16 weeks of storage. In addition, a constant cell shrinkage was observed over time. The amount of glycosaminoglycan and hydroxyroline showed a slight and constant decrease over time, but no significant differences when compared from Day 0 to the values at Weeks 40–43. Biomechanical testing also revealed no significant differences at the different time points. Therefore, the results show that the Ringer‐based storage solution at 4°C is able to provide a chondrocyte survival of 70% until Week 16. This is comparable to previously published storage solutions. Therefore, the study contributes to the establishment of a Ringer‐based osteochondral allograft transplantation system for countries where medium‐based storage solution cannot be approved.

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Allogeneic Mesenchymal Stromal Cells for Cartilage Regeneration: A Review of in Vitro Evaluation, Clinical Experience, and Translational Opportunities

Aldrich

Cui

Murphy

et al. 2021

Stem Cells Translational Medicine

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The paracrine signaling, immunogenic properties and possible applications of mesenchymal stromal cells (MSCs) for cartilage tissue engineering and regenerative medicine therapies have been investigated through numerous in vitro, animal model and clinical studies. The emerging knowledge largely supports the concept of MSCs as signaling and modulatory cells, exerting their influence through trophic and immune mediation rather than as a cell replacement therapy. The virtues of allogeneic cells as a ready-to-use product with well-defined characteristics of cell surface marker expression, proliferative ability, and differentiation capacity are well established. With clinical applications in mind, a greater focus on allogeneic cell sources is evident, and this review summarizes the latest published and upcoming clinical trials focused on cartilage regeneration adopting allogeneic and autologous cell sources. Moreover, we review the current understanding of immune modulatory mechanisms and the role of trophic factors in articular chondrocyte-MSC interactions that offer feasible targets for evaluating MSC activity in vivo within the intra-articular environment. Furthermore, bringing labeling and tracking techniques to the clinical setting, while inherently challenging, will be extremely informative as clinicians and researchers seek to bolster the case for the safety and efficacy of allogeneic MSCs. We therefore review multiple promising approaches for cell tracking and labeling, including both chimerism studies and imaging-based techniques, that have been widely explored in vitro and in animal models. Understanding the distribution and persistence of transplanted MSCs is necessary to fully realize their potential in cartilage regeneration techniques and tissue engineering applications.

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Two-stage late reconstruction with a fresh large osteochondral shell allograft transplantation (FLOCSAT) for a large ostechondral defect in a non-union after a lateral tibia plateau fracture 2-year follow up

Cited by 9 publications

References 27 publications

Partielle und komplette Gelenktransplantation mit frischen osteochondralen Allografts – das FLOCSAT-Konzept

Partielle und komplette Gelenktransplantation mit frischen osteochondralen Allografts – das FLOCSAT-Konzept

Ex vivo storage of human osteochondral allografts: Long‐term analysis over 300 days using a Ringer‐based solution

Allogeneic Mesenchymal Stromal Cells for Cartilage Regeneration: A Review of in Vitro Evaluation, Clinical Experience, and Translational Opportunities

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