Orthopedic Research Laboratory, Department of Orthopedics, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1962-70. doi: 10.1007/s00167-011-1650-6. Epub 2011 Sep 9.
The aim of this study was to evaluate subsidence tendency, surface congruency, chondrocyte survival and plug incorporation after osteochondral transplantation in an animal model. The potential benefit of precise seating of the transplanted osteochondral plug on the recipient subchondral host bone ('bottoming') on these parameters was assessed in particular.
In 18 goats, two osteochondral autografts were harvested from the trochlea of the ipsilateral knee joint and inserted press-fit in a standardized articular cartilage defect in the medial femoral condyle. In half of the goats, the transplanted plugs were matched exactly to the depth of the recipient hole (bottomed plugs; n = 9), whereas in the other half of the goats, a gap of 2 mm was left between the plugs and the recipient bottom (unbottomed plugs; n = 9). After 6 weeks, all transplants were evaluated on gross morphology, subsidence, histology, and chondrocyte vitality.
The macroscopic morphology scored significantly higher for surface congruency in bottomed plugs as compared to unbottomed reconstructions (P = 0.04). However, no differences in histological subsidence scoring between bottomed and unbottomed plugs were found. The transplanted articular cartilage of both bottomed and unbottomed plugs was vital. Only at the edges some matrix destaining, chondrocyte death and cluster formation was observed. At the subchondral bone level, active remodeling occurred, whereas integration at the cartilaginous surface of the osteochondral plugs failed to occur. Subchondral cysts were found in both groups.
In this animal model, subsidence tendency was significantly lower after 'bottomed' versus 'unbottomed' osteochondral transplants on gross appearance, whereas for histological scoring no significant differences were encountered. Since the clinical outcome may be negatively influenced by subsidence, the use of 'bottomed' grafts is recommended for osteochondral transplantation in patients.
本研究旨在评估动物模型中骨软骨移植后的沉降趋势、表面一致性、软骨细胞存活率和移植物嵌合。特别评估了移植骨软骨嵌体精确放置在受区软骨下宿主骨上（“贴合底部”）对这些参数的潜在益处。
在 18 只山羊中，从同侧膝关节滑车采集两个骨软骨自体移植物，并以压配方式插入内侧股骨髁关节面内的标准化软骨缺损中。在一半的山羊中，移植嵌体与受区孔的深度完全匹配（贴合底部嵌体；n=9），而在另一半山羊中，嵌体与受区底部之间留有 2mm 的间隙（未贴合底部嵌体；n=9）。6 周后，对所有移植物进行大体形态、沉降、组织学和软骨细胞活力评估。
与未贴合重建相比，贴合底部嵌体的表面一致性宏观形态评分显著更高（P=0.04）。然而，未发现贴合底部和未贴合底部嵌体之间在组织学沉降评分方面存在差异。两种贴合底部和未贴合底部嵌体的移植关节软骨均具有活力。仅在边缘处观察到基质褪色、软骨细胞死亡和簇形成。在软骨下骨水平，发生了活跃的重塑，而骨软骨嵌体的软骨表面整合未能发生。在两组中均发现了软骨下囊肿。
在该动物模型中，与“未贴合”骨软骨移植相比，“贴合底部”骨软骨移植的沉降趋势在大体外观上明显更低，而在组织学评分方面未发现显著差异。由于沉降可能对临床结果产生负面影响，因此建议在患者中使用“贴合底部”移植物进行骨软骨移植。
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