Unicompartmental bipolar osteochondral and meniscal allograft transplantation is effective for treatment of medial compartment gonarthrosis in a canine model

Abstract

Osteochondral allograft (OCA) transplantation can restore large articular defects in the knee. Bipolar OCA transplantations for partial and whole joint resurfacing often have less favorable results than single-surface transplants. This study was designed to use a large animal model to test the hypothesis that unicompartmental bipolar osteochondral and meniscal allograft transplantation (BioJoint) would be as or more effective for treatment of medial compartment osteoarthritis (OA) compared to standard-of-care nonoperative treatment. OA was induced in one knee of each research hound (n = 8) using a meniscal release model and pretreatment assessments were performed. After 3 months, dogs were randomly assigned to either the control group (n = 4, no surgical intervention, daily nonsteroidal antiinflammatory drugs [NSAIDs]) or the BioJoint group (n = 4). Clinical, radiographic, and arthroscopic assessments were performed longitudinally and histopathology was evaluated at the 6-month endpoint. At study endpoint, functional, pain, and total pressure index measures, as well as radiographic and arthroscopic grading of graft appearance and joint health, demonstrated superior outcomes for BioJoints compared to NSAID controls. Furthermore, histologic assessments showed that osteochondral and meniscal transplants maintain integrity and integrated into host tissues. Clinical significance: The results support the safety and efficacy of unicompartmental bipolar osteochondral and meniscal allograft transplantation in a preclinical model with highly functional outcomes without early OA progression.

Initial Outcomes After Unicompartmental Tibiofemoral Bipolar Osteochondral and Meniscal Allograft Transplantation in the Knee Using MOPS-Preserved Fresh (Viable) Tissues

“…23,30 For MATs, the meniscotibial ligament was preserved or reconstructed. [27][28][29] Patients received multimedia-based preoperative education from an integrated care team, were monitored and supported throughout recovery, and were assessed for adherence with prescribed postoperative rehabilitation protocols through at least the first year after transplantation. We suggest that this comprehensive evidence-based approach to patient-centered use of OCAT and MAT is essential in realizing consistently successful outcomes and patient satisfaction in these complex cases.…”

“…These results correspond to recent data for patellofemoral and multisurface OCAT and suggest that the number of OCATs, or relative ''bioburden,'' is not associated with increased risk for treatment failure when the multifactorial advances in tissue preservation, transplantation techniques, and patient education and management strategies are implemented. [7][8][9][23][24][25][27][28][29][30]32 Nonadherence with the prescribed postoperative rehabilitation protocol during the first year after transplantation was associated with the highest risk for treatment failure among the factors assessed in the present study. Patients who were nonadherent were 7 times more likely to require OCAT and/or MAT revision surgery or arthroplasty.…”

“…Therefore, based on current evidence, the superior outcomes are most likely related to multifactorial advances in tissue preservation, transplantation techniques, and patient education and management strategies. 8,9,23-25,27-30,32 For the present study, only patients who received fresh (viable) MOPS-preserved osteochondral and meniscal allografts for a primary biologic joint restoration surgery were included. Cylindrical and shell femoral and tibial OCAs, as well as separate or attached-to-tibia MATs, were used for patients in the present study: all OCAs were thin allografts (6-7 mm) that resurfaced entire defects >2.5 cm 2 , and all MATs were complete replacements of the entire medial or lateral meniscus.…”

“…8,9,[23][24][25]30,32 In addition, fresh (viable) MOPS-preserved meniscal allografts have potential advantages over frozen meniscal allografts used for MAT, 27,28 and unicompartmental tibiofemoral bipolar OCAT and MAT were proven effective for treatment of medial compartment gonarthrosis in a preclinical canine model. 29 Taken together, these data provided the impetus for our center to offer unicompartmental tibiofemoral bipolar OCAT and MAT as a potential option to select patients indicated for surgical treatment of symptomatic knee articular cartilage defects and meniscal deficiency. The objective of the present study was to use prospectively collected registry data to analyze and report the initial outcomes after primary MOPS-preserved OCAT and MAT for treatment of these complex knee problems.…”

“…8,9,23-25,30,32 In addition, fresh (viable) MOPS-preserved meniscal allografts have potential advantages over frozen meniscal allografts used for MAT, 27,28 and unicompartmental tibiofemoral bipolar OCAT and MAT were proven effective for treatment of medial compartment gonarthrosis in a preclinical canine model. 29…”