Center for Cartilage Repair, Division of Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Cartilage. 2023 Sep;14(3):329-337. doi: 10.1177/19476035221141420. Epub 2022 Dec 9.
While the percentage of viable cells is a major determinant of graft performance during osteochondral allograft (OCA) transplantation, the baseline chondrocyte viability at the periphery of osteochondral plugs is defined at the time of harvest. In this laboratory study, we aimed to determine the optimal technique for OCA plug harvest by evaluating commercial standard techniques compared to sharp blade harvest technique.
Osteochondral explants were harvested from bovine and human samples using 3 different techniques: (1) standard OATS manual punch device (Osteochondral Autograft Transplant System OATS; Arthrex, Naples, FL), (2) powered trephine device, and (3) fresh scalpel blade. Chondrocyte viability and the dead area at the periphery of the tissue were evaluated by LIVE/DEAD staining. Safranin-O and fast-green were performed for structural evaluation.
For both bovine and human samples, the dead area at the periphery of the explant was significantly smaller after scalpel blade preparation compared to harvest with OATS ( < 0.001) and powered trephine devices ( < 0.001). In addition, while powered device had a smaller remaining dead area compared to the OATS device ( < 0.001), there was significantly greater tissue loss and peripheral contour change for plugs harvested with the powered trephine device.
Our study demonstrated that OCA plugs harvested with OATS and powered device lead to a significant mechanical injury at the periphery of the explants compared to a scalpel. We propose that the optimal technique for OCA harvest utilizes a combined approach incorporating a scalpel blade/circular scalpel to prepare the chondral surface and a powered trephine to prepare the osseous surface.
虽然活细胞的百分比是骨软骨同种异体移植（OCA）移植过程中移植物性能的主要决定因素，但骨软骨栓子周边软骨细胞的基础活力是在采集时确定的。在这项实验室研究中，我们旨在通过比较商业标准技术与锐刀片采集技术来确定 OCA 栓子采集的最佳技术。
使用 3 种不同技术从牛和人样本中采集骨软骨外植体：（1）标准 OATS 手动冲头装置（Osteochondral Autograft Transplant System OATS；Arthrex，Naples，FL），（2）动力环钻装置，和（3）新鲜手术刀刀片。通过 LIVE/DEAD 染色评估组织周边的软骨细胞活力和死区。进行番红 O 和固绿快速染色进行结构评估。
对于牛和人样本，与 OATS（<0.001）和动力环钻装置（<0.001）相比，手术刀刀片准备后的外植体周边死区明显更小。此外，虽然动力装置的剩余死区比 OATS 装置小（<0.001），但动力环钻装置采集的栓子的组织损失和周边轮廓变化明显更大。
我们的研究表明，与手术刀相比，OATS 和动力装置采集的 OCA 栓子在外植体周边会导致明显的机械损伤。我们提出，OCA 采集的最佳技术是采用结合手术刀刀片/圆形手术刀来准备软骨表面和动力环钻来准备骨表面的方法。
