Dwivedi Shashank, Kutschke Michael, Nadeem Maheen, Owens Brett D
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Orthop J Sports Med. 2021 Nov 12;9(11):23259671211044993. doi: 10.1177/23259671211044993. eCollection 2021 Nov.
Distal femoral osteochondral allograft transplantation (OAT) is an effective treatment of osteochondral lesions in the knee measuring >2 cm in select patients. Prior studies have demonstrated that the morphology of the plug can affect graft-host interference fit. To our knowledge, there are no data comparing the initial biomechanical stability of standard cylindrical plugs with multiple-plug and oblong-plug morphologies.
Large cylindrical single-plug (LCSP) and oblong single-plug (OSP) grafts will have greater pull-out strength, and therefore greater initial stability, than multiple-plug (MP) grafts in a cadaveric porcine femur model.
Controlled laboratory study.
A total of 55 porcine distal femurs were divided into 3 groups-LCSP (n = 18), OSP (n = 19), and MP (n = 18)-according to the plug morphology used. The method of graft harvesting and implantation was based on technique guides for the respective implant systems. The sizes (length × width × depth) of the osteochondral defects created in each of the groups were approximately 20.2 × 20.2 × 9.4-mm for the LCSP group, 14.4 × 30.5 × 7.9-mm for the OSP group, and 14.8 × 14.8 × 9.9-mm for the MP group. Tensile testing was performed on each graft to determine pull-out strength.
The pull-out strength was significantly lower in the OSP group (65.7 N) versus the LCSP (133 N; = .0005) and the MP (117.6 N; = .001) groups. There was no statistically significant difference in pull-out strength between the LCSP and MP groups ( = .42). There were no statistically significant differences in displacement at maximum load among any 2 of the 3 groups.
These findings suggest that while initial stability may play a role in the clinical outcomes of osteochondral allograft (OCA) implantation, the biological milieu in vivo for each graft setting perhaps has a greater impact on the success of an OAT procedure. Further study is needed on the relationship between OCA biomechanics and clinical outcomes of OAT.
对于特定患者膝关节中直径大于2 cm的骨软骨损伤，股骨远端骨软骨异体移植（OAT）是一种有效的治疗方法。先前的研究表明，移植块的形态会影响移植物与宿主的压配。据我们所知，尚无数据比较标准圆柱形移植块与多块移植块和长方形移植块形态的初始生物力学稳定性。
在猪尸体股骨模型中，大型圆柱形单块移植（LCSP）和长方形单块移植（OSP）移植物的拔出强度将高于多块移植（MP）移植物，因此初始稳定性更高。
对照实验室研究。
根据所使用的移植块形态，将55个猪股骨远端分为3组——LCSP组（n = 18）、OSP组（n = 19）和MP组（n = 18）。移植物的获取和植入方法基于各自植入系统的技术指南。LCSP组、OSP组和MP组创建的骨软骨缺损尺寸（长×宽×深）分别约为20.2×20.2×9.4 mm、14.4×30.5×7.9 mm和14.8×14.8×9.9 mm。对每个移植物进行拉伸测试以确定拔出强度。
OSP组的拔出强度（65.7 N）显著低于LCSP组（133 N；P = .0005）和MP组（117.6 N；P = .001）。LCSP组和MP组之间的拔出强度无统计学显著差异（P = .42）。3组中任意两组在最大载荷下的位移无统计学显著差异。
这些发现表明，虽然初始稳定性可能在骨软骨异体移植（OCA）植入的临床结果中起作用，但每种移植环境下体内的生物学环境可能对OAT手术的成功有更大影响。需要进一步研究OCA生物力学与OAT临床结果之间的关系。
