Closure of osteochondral lesions using chondral fragments and fibrin adhesive

Abstract

In 75 knee joints of 46 adult rabbits osteochondral defects of 4 mm diameter were placed by a drill reaching the cancellous bone. Twenty-three defects were left untreated, or closed by collagen foam or fibrin adhesive, or a combination of both. Fifty-two defects were closed with very small autologous cartilage fragments and a special fibrin adhesive. The adhesive differed from commercially supplied types by digested alpha chain of fibrinogen for increase in concentration, and by the addition of alpha-2-macroglobulin as protease-inhibitor. In most cases small pieces of collagen foam were added for hemostasis. In the first group of 23 joints observed over up to 40 weeks, no hyaline cartilage was found histologically in any of the defects. In the second group a rapid proliferation of chondrocytes appeared with development of hyaline cartilage with alcianblue-positive matrix. It resembled juvenile cartilage in its histologic appearance and with regard to the induction of ossification. The phenomenon is interpreted as a "second adolescence" of the adult cartilage induced by the rich nutritional and oxygen supply from the cancellous vessels, which resembles the environmental conditions before the forming of subchondral cortical bone at the end of the growth period. This method enabled us to achieve a complete closure of defects by hyaline cartilage on the very level of the surrounding articular surface.

Cocultures of Adult and Juvenile Chondrocytes Compared With Adult and Juvenile Chondral Fragments

“…showed rapid chondrocyte proliferation, hyaline-like repair tissue, and alcian blue-positive matrix in osteochondral defects treated with autologous cartilage fragments in a rabbit model. 3 …”

Juvenile Particulate Osteochondral Allograft for Treatment of Osteochondral Lesions of the Talus: Detection of Altered Repair Tissue Biochemical Composition Using 7 Tesla MRI and T2 Mapping

“…Because of preparation from immature articular cartilage, the DeNovo Ò NT Graft has a much greater cellular density, cell proliferation rate, cell outgrowth, and glycosaminoglycan content than mature articular cartilage (10). First tested in rabbit models in 1983 (11) and initially applied in the clinical context of knee osteochondral lesions (8,12,13), the DeNovo Ò NT Graft is a 1-stage procedure and thus is an attractive alternative to 2-stage procedures such as autologous chondrocyte transplantation (9). Also, the cost ($3800) is well below that of a matched, fresh talar allograft ($8000 to $10,000) or a second-stage surgical procedure (9).…”

Magnetic Resonance Imaging of Cartilage Repair Procedures

“…42 A particulated or minced adult chondral autograft was first shown to effect a chondral repair in a rabbit model in Germany. 43 The combined change in local environment from the mincing process and fibrin glue and possibly the exposure to subchondral bleeding are believed to modify adult chondrocytes to behave more like juvenile Osteochondral allograft is used for large lesions (>3 cm 2 ) after failure of other cartilage repair procedures such as ACI, or, by some surgeons, as a first-line treatment. This patient had a failed P-ACI on the medial femoral condyle (asterisk, A) and a full-thickness cartilage defect on the lateral femoral condyle (arrow, A).…”