Davidson Philip A, Rivenburgh Dennis W, Dawson Patti E, Rozin Roman
Tampa Bay Orthopaedic Specialists, 6500 66th Street North, Pinellas Park, Florida 33781, USA.
Am J Sports Med. 2007 Jul;35(7):1082-90. doi: 10.1177/0363546507299529. Epub 2007 Mar 9.
Fresh osteoarticular allograft transplantation has a long history of clinical success. These grafts have typically been implanted less than 1 week from donor asystole.
Osteoarticular allografts stored 4 to 6 weeks represent a viable alternative to treat full-thickness cartilage and osteochondral defects of the distal femur as measured by clinical, histologic, and magnetic resonance imaging (MRI) criteria.
Case series; Level of evidence, 4.
Osteoarticular allografts were implanted after a mean graft storage time (at 4 degrees C) of 36 days (range, 28-43). Sixty-seven patients received massive hypothermically stored osteoarticular allografts. Ten knees in 8 of these patients underwent second-look arthroscopic evaluation and biopsy at a mean of 40 months (range, 23-60) after implantation. Clinical assessment was performed using multiple outcome measures and sequential MRI evaluations. Biopsy specimens were obtained from the graft as well as from native articular cartilage at the time of second-look arthroscopy for histologic analysis.
The mean International Knee Documentation Committee scores were as follows: preoperative, 27 (range, 9-55); postoperative, 79 (range, 56-99); P = .002. The mean Lysholm scores were as follows: preoperative, 37 (range, 12-47); postoperative, 78 (range, 55-90); P = .002. The mean Short Form-36 physical scores were as follows: preoperative, 38 (range, 24-55); postoperative, 51 (range, 39-61); P = .002. The mean Tegner scores were as follows: preoperative, 4.3 (range, 1-9); postoperative, 5.3 (range, 4-7); P = .16. The mean International Cartilage Repair Society score at follow-up was 10 (nearly normal) (range, 7-11). The mean modified Outerbridge scores were as follows: preoperative, 4.3 (range, 3-5); postoperative, 0.6 (range, 0-1); P = .002. The mean graft and native cartilage cellular density and viability were not statistically different.
Fresh-stored osteoarticular grafts for full-thickness articular surface defects of the distal femur appear to offer a viable biological method to restore knee function. Our study suggests that osteoarticular grafts stored in cell culture medium at 4 degrees C for 4 to 6 weeks provide successful short-term clinical outcomes.
新鲜骨关节同种异体移植在临床应用中取得成功已有很长历史。这些移植物通常在供体心脏停搏后不到1周植入。
通过临床、组织学和磁共振成像（MRI）标准衡量，储存4至6周的骨关节同种异体移植物是治疗股骨远端全层软骨和骨软骨缺损的可行替代方法。
病例系列；证据等级，4级。
骨关节同种异体移植物平均储存时间（4℃）为36天（范围28 - 43天）后植入。67例患者接受了大量低温储存的骨关节同种异体移植物。其中8例患者的10个膝关节在植入后平均40个月（范围23 - 60个月）接受了二次关节镜评估和活检。使用多种结局指标进行临床评估，并进行连续的MRI评估。在二次关节镜检查时从移植物以及天然关节软骨获取活检标本进行组织学分析。
国际膝关节文献委员会平均评分如下：术前27分（范围9 - 55分）；术后79分（范围56 - 99分）；P = 0.002。Lysholm平均评分如下：术前37分（范围12 - 47分）；术后78分（范围55 - 90分）；P = 0.002。简短健康调查问卷-36身体功能平均评分如下：术前38分（范围24 - 55分）；术后51分（范围39 - 61分）；P = 0.002。Tegner平均评分如下：术前4.3分（范围1 - 9分）；术后5.3分（范围4 - 7分）；P = 0.16。随访时国际软骨修复协会平均评分为10分（接近正常）（范围7 - 11分）。改良Outerbridge平均评分如下：术前4.3分（范围3 - 5分）；术后0.6分（范围0 - 1分）；P = 0.002。移植物和天然软骨的平均细胞密度及活力无统计学差异。
用于股骨远端全层关节面缺损的新鲜储存骨关节移植物似乎为恢复膝关节功能提供了一种可行的生物学方法。我们的研究表明，在4℃细胞培养基中储存4至6周的骨关节移植物可提供成功的短期临床结果。
