Fresh Osteochondral Allografts for Posttraumatic Knee Defects: Long-term Followup

Abstract

Fresh osteochondral allograft transplantation has been an effective treatment option with promising long-term clinical outcomes for focal posttraumatic defects in the knee for young, active individuals. We examined histologic features of 35 fresh osteochondral allograft specimens retrieved at the time of subsequent graft revision, osteotomy, or TKA. Graft survival time ranged from 1 to 25 years based on their time to reoperation. Histologic features of early graft failures were lack of chondrocyte viability and loss of matrix cationic staining. Histologic features of late graft failures were fracture through the graft, active and incomplete remodeling of the graft bone by the host bone, and resorption of the graft tissue by synovial inflammatory activity at graft edges. Histologic features associated with long-term allograft survival included viable chondrocytes, functional preservation of matrix, and complete replacement of the graft bone with the host bone. Given chondrocyte viability, long-term allograft survival depends on graft stability by rigid fixation of host bone to graft bone. With the stable osseous graft base, the hyaline cartilage portion of the allograft can survive and function for 25 years or more.

Addition of hyaluronic acid improves cellular infiltration and promotes early-stage chondrogenesis in a collagen-based scaffold for cartilage tissue engineering

“…These approaches have shown promise by promoting synthesis of de novo tissue and restoring some joint function over a short term period. However, long term performance of de novo tissue is still a major challenge with none of these approaches encouraging total repair of tissue with physiologically similar hyaline-like cartilage and as a consequence, surface fibrillation and subsequent degeneration often occurs (Buckwalter, 1997, Gobbi et al, 2006, Gross et al, 2008. The potential of tissue engineering (TE) to promote defect healing has been recognised (Cascio andSharma, 2008, Getgood et al, 2009), although the ideal scaffold-based tissue engineered solution has yet to be realised.…”

Surgical Technique: Unicondylar Osteoallograft Prosthesis Composite in Tumor Limb Salvage Surgery

“…The rate of moderate and severe joint degeneration reportedly ranges from 31% to 72% (Table 3). To prevent degenerative changes, fresh allograft with superior chondrocyte viability (30% to 90%) has been used but limited availability of donor tissue has limited its application [12]. The unicondylar osteoarticular prosthesis composite reconstruction provided another alternative, and our patients showed no moderate or severe degenerative changes.…”

“…It is challenging for orthopaedic surgeons to reconstruct massive unicondylar osteoarticular defects in the distal femur after resection of aggressive or recurrent benign bone tumors and malignant bone sarcomas [2,6,12]. Owing to requirements for stability, motion, and function, reconstructing this joint has been demanding.…”

“…Owing to requirements for stability, motion, and function, reconstructing this joint has been demanding. Available options have included endoprostheses [3,4,10], bicondylar osteoarticular allografts [12,23], and unicondylar osteoarticular allografts [2,17,18]. Endoprostheses can provide immediate fixation and rapid return to weightbearing, but they are associated with major complications including aseptic loosening (6%-84% at 5 to 10 years), infection (7%-41%), and periprosthetic fracture (5%-15%) [13,14].…”

O uso do transplante osteocondral a fresco no tratamento das lesões osteocondrais do joelho

“…Bone healing occurs by a process of gradual replacement (creeping substitution) in which the bone of the host grows to occupy the trabeculae and gaps in the transplanted bone, leading to remodeling by the osteoblasts and osteoclasts, and the creation of new Haversian systems. Long-term studies carried out with osteochondral tissue sample collections taken during revision surgery demonstrate high viability and cell density of the chondrocytes (19,(24)(25)(26) .…”