Krettek C, Clausen J-D, Bruns N, Neunaber C
Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Unfallchirurgische Klinik, Labor für Muskulo-Skelettales Trauma & Regenerative Therapien, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland.
Unfallchirurg. 2017 Nov;120(11):932-949. doi: 10.1007/s00113-017-0426-y.
Cartilage defects in adult patients do not heal well. Fresh osteochondral allograft (OCA) transplantation is based on mature, living, mechanically sound hyaline cartilage attached to a bone interface, which is brought into an osteochondral defect, where it becomes osseointegrated. According to current knowledge, intact hyaline cartilage tissue is immune privileged and does not, in contrast to bone, meniscus or ligaments, cause an immune reaction. The technique has the unique advantage of transplanting viable, mature and mechanically stable hyaline cartilage into the affected area. An OCA is the only biological surgical technique for chondral and osteochondral lesions after failed cell-based techniques or autologous osteochondral transplantation.Fresh osteochondral allografts with mainly small cylindrical transplants show survival of 20 years and more. Based on this experience the FLOCSAT (fresh large [> 10 cm] osteochondral shell allograft transplantation) concept with the thinnest possible (< 6-8 mm) bone thickness has been developed. Cells survive in special media at 4 °C for 4 weeks or more and are transplanted with a minimum of 70% living cells in a live/dead assay and cell density > 200 cells/mm.FLOCSATs can replace parts or entire joints as uniplanar or multiplanar(n-planar)-FLOCSAT, as unipolar, bipolar or tripolar(n-polar)-FLOCSAT, and in combination with meniscus and/or ligaments (nMnL)-FLOCSAT (n number of structures).The FLOCSAT concept was applied successfully to knee, ankle and elbow joints. All transplants showed sound osseointegration. Cartilage failure was the reason for unsuccessful outcome. Challenges remain regarding graft availability, precise size matching, complex logistics, demanding surgical technique in complex geometries, and open questions in immunology and chimerism.
成年患者的软骨缺损愈合情况不佳。新鲜骨软骨异体移植（OCA）是将附着于骨界面的成熟、有活力且力学性能良好的透明软骨移植到骨软骨缺损处，使其实现骨整合。根据目前的认知，完整的透明软骨组织具有免疫赦免特性，与骨、半月板或韧带不同，不会引发免疫反应。该技术具有将有活力、成熟且力学稳定的透明软骨移植到患区的独特优势。OCA是在基于细胞的技术或自体骨软骨移植失败后，用于治疗软骨和骨软骨损伤的唯一生物外科技术。主要采用小圆柱形移植物的新鲜骨软骨异体移植显示出20年及以上的存活率。基于这一经验，已开发出骨厚度尽可能薄（<6 - 8毫米）的FLOCSAT（新鲜大尺寸[>10厘米]骨软骨壳异体移植）概念。细胞可在4℃的特殊培养基中存活4周或更长时间，并在活/死检测中以至少70%的活细胞和细胞密度>200个细胞/立方毫米进行移植。FLOCSAT可作为单平面或多平面（n平面）-FLOCSAT替代部分或整个关节，作为单极、双极或三极（n极）-FLOCSAT，以及与半月板和/或韧带联合（nMnL）-FLOCSAT（n为结构数量）。FLOCSAT概念已成功应用于膝关节、踝关节和肘关节。所有移植均显示出良好的骨整合。软骨失效是手术结果不佳的原因。在移植物可用性、精确尺寸匹配、复杂物流、复杂几何形状中要求较高的手术技术以及免疫学和嵌合体方面的开放性问题上，仍存在挑战。
