Allahabadi Sachin, Haneberg Erik C, Elias Tristan J, McMorrow Katie J, Yanke Adam B, Cole Brian J
Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A.
Arthrosc Tech. 2023 Nov 20;12(12):e2281-e2287. doi: 10.1016/j.eats.2023.07.056. eCollection 2023 Dec.
We present an evidence-based approach to optimize the biologic incorporation of osteochondral allografts: (1) The donor graft is gradually rewarmed to room temperature to reverse the metabolic suppression from cold storage. (2) The graft is harvested while submerged in saline to limit thermal necrosis. (3) Subchondral bone depth is preferred at 4 to 6 mm depth (total plug depth ∼5-8 mm including articular cartilage) to reduce graft immunogenicity and to promote incorporation. (4) The bone is prepared with grooves/beveling to decrease impaction forces, increase access to subchondral deep zones during preparation, and promote graft-host interface healing. (5) High-pressure pulsed lavage is used to reduce antigenicity by removing marrow elements. (6) Pressurized carbon dioxide following pulsed lavage further reduces marrow elements and improves graft porosity for orthobiologic incorporation. (7) Orthobiologic substances (e.g., concentrated bone marrow aspirate) may enhance incorporation on imaging and result in greater osteogenic potential. (8) A suture is placed behind the graft to facilitate removal and repositioning; atraumatic graft insertion without high impaction forces maintains chondrocyte viability. These evidence-based pearls for osteochondral allograft handling optimize metabolic activity, reduce thermal necrosis, reduce antigenicity with removal of marrow elements, enhance biologic potential, and maintain chondrocyte viability to optimize biologic healing and clinical success.
（1）将供体移植物逐渐复温至室温，以逆转冷藏引起的代谢抑制。（2）在盐水中浸没状态下采集移植物，以限制热坏死。（3）软骨下骨深度优选为4至6毫米（包括关节软骨在内的总栓深度约为5 - 8毫米），以降低移植物免疫原性并促进整合。（4）对骨进行开槽/倒角处理，以减小撞击力，在制备过程中增加进入软骨下深层区域的机会，并促进移植物与宿主界面的愈合。（5）使用高压脉冲冲洗通过去除骨髓成分来降低抗原性。（6）脉冲冲洗后使用加压二氧化碳进一步减少骨髓成分，并改善移植物孔隙率以促进生物整合。（7）生物活性物质（如浓缩骨髓抽吸物）可能会增强影像学上的整合效果，并产生更大的成骨潜力。（8）在移植物后方放置缝线以方便取出和重新定位；无高撞击力的无创移植物插入可维持软骨细胞活力。这些基于证据的异体骨软骨移植处理要点可优化代谢活性，减少热坏死，通过去除骨髓成分降低抗原性，增强生物潜力，并维持软骨细胞活力，以优化生物愈合和临床效果。
