Makino Takeshi, Fujioka Hiroyuki, Terukina Mitsunobu, Yoshiya Shinichi, Matsui Nobuzo, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Arthroscopy. 2004 Oct;20(8):837-40. doi: 10.1016/j.arthro.2004.06.039.
The goal of this study was to analyze the effect of graft sizing on the histologic property of articular cartilage in autologous osteochondral transplantation.
Histologic analysis using an animal model.
Eighteen skeletally mature female Japanese white rabbits were used in this study and divided into 2 groups based on the surgical procedure. Group I: A cylindrical fragment (7 mm in diameter and 5 mm in depth) was harvested at the femoral condyle using the Osteochondral Autograft Transfer System (Arthrex, Naples, FL), then precisely returned to the defect from which the fragment was originally harvested. This surgical model supposes that the articular surface geometry of the osteochondral graft exactly matches that of the cartilage lesion; however, the osteochondral graft is not the same size as the defect in this model because of the surrounding gap that corresponds to the blade thickness of the chisel used to take the graft. Group II: A 1-mm larger osteochondral fragment (8 mm in diameter and 5 mm in depth) taken from the contralateral femoral condyle was transplanted to the osteochondral defect made as in group I, achieving a tight fit. Specimens were stained with Safranin-O fast green and analyzed microscopically at 4, 12, and 24 weeks after surgery.
In group I, histologic examination revealed an increase in cartilage thickness and cell density during the implantation period. Round and polygonal hypertrophic clusters of chondrocytes with cytoplasmic vacuoles were observed. By contrast, in group II, the thickness of the articular cartilage was almost the same as that of the normal adjacent cartilage with no significant change observed.
It is suggested that sizing of the implanted osteochondral fragment plays an important role in preserving the histologic properties of cartilage.
This study suggests that osteochondral graft stability may influence the histologic properties of the repaired cartilage. It is preferable to implant the slightly oversized graft into the cartilage lesion in autologous osteochondral transplantation to preserve the histologic properties of cartilage.
本研究的目的是分析移植物大小对自体骨软骨移植中关节软骨组织学特性的影响。
使用动物模型的组织学分析。
本研究使用了18只骨骼成熟的雌性日本白兔，并根据手术方法将其分为2组。第一组：使用骨软骨自体移植转移系统（Arthrex，那不勒斯，佛罗里达州）在股骨髁处采集一个圆柱形碎片（直径7毫米，深度5毫米），然后精确地将其放回最初采集碎片的缺损处。该手术模型假设骨软骨移植物的关节表面几何形状与软骨损伤的完全匹配；然而，由于对应于用于获取移植物的凿子刀片厚度的周围间隙，该模型中的骨软骨移植物与缺损大小不同。第二组：从对侧股骨髁获取一个大1毫米的骨软骨碎片（直径8毫米，深度5毫米），并将其移植到与第一组相同的骨软骨缺损处，实现紧密贴合。标本用番红O固绿染色，并在术后4周、12周和24周进行显微镜分析。
在第一组中，组织学检查显示植入期软骨厚度和细胞密度增加。观察到圆形和多边形的肥大软骨细胞簇，伴有细胞质空泡。相比之下，在第二组中，关节软骨厚度与正常相邻软骨几乎相同，未观察到明显变化。
提示植入的骨软骨碎片大小在保留软骨组织学特性方面起重要作用。
本研究表明骨软骨移植物的稳定性可能影响修复软骨的组织学特性。在自体骨软骨移植中，将略大尺寸的移植物植入软骨损伤处更有利于保留软骨的组织学特性。
