Fresh Osteochondral Allograft Transplantation in the Knee: A Viability and Histologic Analysis for Optimizing Graft Viability and Expanding Existing Standard Processed Graft Resources Using a Living Donor Cartilage Program
Hevesi, Mario; Denbeigh, Janet M; Paggi, Carlo A; Galeano-Garces, Catalina; Bagheri, Leila; Larson, A Noelle; Stuart, Michael J; Saris, Daniel B F; van Wijnen, Andre J; Krych, Aaron J
(2021) Cartilage, volume 13, issue 1_suppl, pp. 948S - 956S
(Article)
Abstract
Objective: This study aims to (1) determine and validate living cartilage allograft transplantation as a novel source for viable osteochondral allograft (OCA) tissues and (2) perform histologic and viability comparisons of living donor cartilage tissues to currently available clinical-grade standard processed grafts. Design: Using healthy cartilage from well-preserved contralateral compartments
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in 27 patients undergoing total knee arthroplasty (TKA) and 10 clinical-grade OCA specimens obtained immediately following operative implantation, standard and living donor OCA quality was evaluated at the time of harvest and following up to 3 weeks of storage on the basis of macroscopic International Cartilage Repair Society grade, histology, and viability. Results: Osteochondral samples demonstrated a consistent decrease in viability and histologic quality over the first 3 weeks of storage at 37°C, supporting the utility of an OCA paradigm shift toward early implantation, as was the clinical standard up until recent adoption of transplantation at 14 to 35 days following donor procurement. Samples from the 10 clinical-grade OCAs, implanted at an average of 23 days following graft harvest demonstrated a mean viable cell density of 45.6% at implantation, significantly lower (P < 0.01) than the 93.6% viability observed in living donor allograft tissues. Conclusions: Osteochondral tissue viability and histologic quality progressively decreases with ex vivo storage, even when kept at physiologic temperatures. Currently available clinical OCAs are stored for 2 to 5 weeks prior to implantation and demonstrate inferior viability to that of fresh osteochondral tissues that can be made available through the use of a living donor cartilage program.
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Keywords: joint preservation, living donor, osteochondral allograft, viability, Physical Therapy, Sports Therapy and Rehabilitation, Biomedical Engineering, Immunology and Allergy, Journal Article
ISSN: 1947-6035
Publisher: SAGE Publications Inc.
Note: Funding Information: Osteochondral tissue viability and histologic quality progressively decreases with ex vivo storage, even when kept at physiologic temperatures. Currently available clinical OCAs are stored for 2 to 5 weeks prior to implantation and demonstrate inferior viability to that of fresh osteochondral tissues that can be made available through the use of a living donor cartilage program. osteochondral allograft living donor joint preservation viability National Institutes of Health https://doi.org/10.13039/100000002 R01/AR069049 edited-state corrected-proof Acknowledgments and Funding We thank the members of our laboratories and the laboratories of our colleagues, Elizabeth Bradley and Jennifer Westendorf for assistance, encouragement and stimulating discussions. We are also indebted to the kind support of the Mayo Clinic Bone Bank and the significant efforts of Susan Puffer and Renae Boyum. We also thank William and Karen Eby for their generous philanthropic support. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported in part by National Institutes of Health Grant R01-AR069049 (to AJvW). This project was also supported by a grant provided by the Eby Family Foundation and funding provided by the Mayo Clinic Department of Orthopedic Surgery Orthopedic Research and Review Committee (ORRC). Author Contributions Mario Hevesi, MD: Conception and design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, final approval of the article, statistical expertise, administrative, technical, or logistic support, collection and assembly of data. Janet M. Denbeigh, PhD: Conception and design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, final approval of the article, statistical expertise, administrative, technical, or logistic support, collection and assembly of data. Carlo A. Paggi, MS: Collection and assembly of data, critical revision of the article for important intellectual content, final approval of the article. Catalina Galeano-Garces, PhD: Collection and assembly of data, critical revision of the article for important intellectual content, final approval of the article. Leila Bagheri, PhD: Collection and assembly of data, critical revision of the article for important intellectual content, final approval of the article. A. Noelle Larson, MD: Conception and design, critical revision of the article for important intellectual content, final approval of the article. Michael J. Stuart, MD: Conception and design, critical revision of the article for important intellectual content, final approval of the article. Daniel B. F. Saris MD, PhD: Conception and design, critical revision of the article for important intellectual content, final approval of the article Andre J. van Wijnen, PhD: Conception and design, analysis and interpretation of the data, critical revision of the article for important intellectual content, final approval of the article, provision of study materials or patients, obtaining of funding, administrative, technical, or logistic support. Aaron J. Krych, MD: Conception and design, analysis and interpretation of the data, critical revision of the article for important intellectual content, final approval of the article, provision of study materials or patients, obtaining of funding. Declaration of Conflicting Interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M. Hevesi is a paid consultant for Moximed. M. J. Stuart is on the editorial or governing board of the American Journal of Sports Medicine ; received IP royalties from an is a paid consultant for Arthrex, Inc.; and receives research support from Stryker. D. B. F. Saris is a paid consultant for Cartiheal, Ivy Sports, and Smith & Nephew; is on the editorial or governing board, of Cartilage ; and receives research support from Ivy Sports and Smith & Nephew. A. J. Krych receives research support from Aesculap/B. Braun, Arthrex, Inc., Arthritis Foundation, Ceterix, and Histogenics; receives IP royalties from Arthrex, Inc.; is a paid consultant from Arthrex, Inc., JRF Ortho, and Vericel; is on the editorial or governing board of the American Journal of Sports Medicine ; and is a board or committee member of the International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Minnesota Orthopedic Society, and Musculoskeletal Transplantation Foundation. The other authors have no disclosures to make. Ethical Approval All aspects of this study were performed following institutional review board approval (IRB 13-005619). Informed Consent Written informed consent was obtained from all subjects before the study. Trial Registration Not applicable. ORCID iDs Andre J. van Wijnen https://orcid.org/0000-0002-5882-709X Aaron J. Krych https://orcid.org/0000-0003-3248-8007 Funding Information: We thank the members of our laboratories and the laboratories of our colleagues, Elizabeth Bradley and Jennifer Westendorf for assistance, encouragement and stimulating discussions. We are also indebted to the kind support of the Mayo Clinic Bone Bank and the significant efforts of Susan Puffer and Renae Boyum. We also thank William and Karen Eby for their generous philanthropic support. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported in part by National Institutes of Health Grant R01-AR069049 (to AJvW). This project was also supported by a grant provided by the Eby Family Foundation and funding provided by the Mayo Clinic Department of Orthopedic Surgery Orthopedic Research and Review Committee (ORRC). Publisher Copyright: © The Author(s) 2019.
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