Meade Michael J, Patel Kisan, Sgaglione Nicholas A
Department of Orthopaedic Surgery, Northwell Health, Queens, New York, U.S.A.
Zucker Hofstra Northwell School of Medicine, Hempstead, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2025 Apr 19;7(4):101151. doi: 10.1016/j.asmr.2025.101151. eCollection 2025 Aug.
To investigate the current optimal processing and storage protocols for fresh cold-stored osteochondral allografts (OCAs) used for resurfacing osteochondral defects in the knee.
Using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, 3 databases (PubMed, Embase, and Scopus) were queried for peer-reviewed articles on OCA storage and processing techniques. Articles were excluded if performed on nonhuman subjects or were narrative or systematic reviews, meta-analyses, or other forms of secondary sources. In vivo data included study type, population size, follow-up time, type, site and location of injury, description of surgery, description of postoperative rehabilitation, and outcome criteria used. Ex vivo data collection included tissue source and type, storage procedure including temperature, media changes, gas environment, storage solution including type of solution and additive used, cell viability methodology, and outcomes methodology.
In total, 386 studies were screened between the 3 databases, with 27 studies satisfying all criteria. Eight human studies were included, with mean Modified Coleman Methodology Score of 48.38 ± 5.73. In total, 397 total patients were included with a mean of 49.6 patients per study. Five of the 8 studies had follow-up greater than 24 months. Three articles were retrospective studies, 4 were case series, 1 was a prospective cohort. Four articles were Level III evidence, 4 articles were Level IV evidence. In addition, 19 ex vivo human studies were included. A total of 78.95% of studies included grafts stored at 4°C or 1 to 10°C, 31.58% investigated 37°C, and 21.05% investigated room temperature. In total, 19 different storage media were investigated, with 68.42% including various additives.
OCA storage at 4°C remains the most common temperature with the most evidence-based research. However, investigation of OCAs at 37°C and room temperature, particularly those stored with proprietary protocol such as the Missouri Osteochondral Preservation System, have shown promising results at improved maintenance of viable chondrocyte density. Variability in storage media remains without clear consensus.
A variety of methodologies are used for OCAs, and the best strategies are not well understood. There is a need to compile the available evidence from in vivo and ex vivo studies of OCAs to resolve conflicts regarding various available methodologies and provide better understanding of current techniques.
探讨用于修复膝关节骨软骨缺损的新鲜冷藏骨软骨异体移植（OCA）目前的最佳处理和储存方案。
按照系统评价和Meta分析的首选报告项目指南，检索3个数据库（PubMed、Embase和Scopus）中关于OCA储存和处理技术的同行评议文章。如果研究是在非人类受试者上进行的，或者是叙述性或系统性综述、Meta分析或其他形式的二手资料，则予以排除。体内数据包括研究类型、人群规模、随访时间、损伤类型、部位和位置、手术描述、术后康复描述以及所使用的结果标准。体外数据收集包括组织来源和类型、储存程序（包括温度、培养基更换、气体环境）、储存溶液（包括所用溶液类型和添加剂）、细胞活力测定方法和结果测定方法。
3个数据库共筛选出386项研究，其中27项研究符合所有标准。纳入8项人体研究，改良科尔曼方法评分平均为48.38±5.73。总共纳入397例患者，每项研究平均49.6例。8项研究中有5项随访时间超过24个月。3篇文章为回顾性研究，4篇为病例系列研究，1篇为前瞻性队列研究。4篇文章为III级证据，4篇文章为IV级证据。此外，纳入19项体外人体研究。总共78.95%的研究包括储存在4°C或1至10°C的移植物，31.58%研究了37°C，21.05%研究了室温。总共研究了19种不同的储存培养基，68.42%的培养基含有各种添加剂。
4°C储存OCA仍然是最常见的温度，且有最多的循证研究。然而，对37°C和室温下的OCA进行研究，特别是那些采用专有方案（如密苏里骨软骨保存系统）储存的OCA，在维持活软骨细胞密度方面显示出有前景的结果。储存培养基的差异仍然存在，尚未达成明确共识。
OCA使用了多种方法，最佳策略尚不清楚。需要汇总OCA体内和体外研究的现有证据，以解决各种现有方法之间的冲突，并更好地理解当前技术。
