Skip to main content
SpringerLink
Log in

The Use of Fresh Osteochondral Allografts to Replace Traumatic Joint Defects

  • Chapter
Orthopaedic Allograft Surgery

Abstract

The scientific rationale for utilizing fresh rather than preserved osteochondral allografts is as follows. Cartilage harvested without a blood supply within 24 hours of the death of the donor is 100% viable and can be preserved for up to 4 days at 40° C. This has been shown both experimentally and clinically [4,8,12,27,29,30,32,33,42,6,37,47,11,28,9, 23]. The bone whether fresh or preserved, is not viable because of its inability to survive without immediate vascularization, but remains structurally intact and mechanically strong until it is replaced by host bone by creeping substitution [3, 11, 28, 30] or weakened and absorbed by invasion of granulation tissue. Freezing on the other hand kills the cartilage [39]. Even with cryopreservation, the best viability rates that could be achieved varied from 15 to 50% using glycerol or DM SO (dimethyl sulfoxide) and controlled rates of freezing and thawing [5,40,44,45,38,19]. It has also been shown that freezing decreases the immunogenicity of the bone, but does not ablate it completely [13]. Fresh bone is more immunogenic than frozen bone, but there is not enough of a difference to affect the clinical outcome [13]. It has been shown that chondrocytes are immunogenic [14] but when surrounded by matrix they are isolated from the immunocompetent cells and do not sensitize the host.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aston J, Bentley G (1986) Repair of articular surfaces by allografts of articular and growth-plane cartilage. J Bone Joint Surg 68B (1): 29 – 35

    Google Scholar 

  2. Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE (1992) Fresh osteochondral allografts: post traumatic defects in the knee, a survivorship analysis. J Bone Joint Surg 74-B: 105 – 110

    CAS  Google Scholar 

  3. Burchardt H (1983) The biology of bone graft repair. C.O.O.R. 174: 28 – 42

    Google Scholar 

  4. Campbell CJ, Ishida H, Takahashi H, Kelly F (1963) The transplantation of articular cartilage. An experimental study in dogs. J Bone Joint Surg 45-A: 1579 – 1592

    PubMed  CAS  Google Scholar 

  5. Chesterman PJ, Smith AU (1968) Homotransplantation of articular cartilage and isolated chon¬drocytes: an experimental study in rabbits. J Bone Joint Surg 50-B: 184

    CAS  Google Scholar 

  6. Craigmyle MBL (1958) An autoradiographic and histochemical study of long-term cartilage grafts in the rabbit. J Anat 92: 467 – 472

    PubMed  CAS  Google Scholar 

  7. Czitrom A, Keating S, Gross A (1990) The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. J Bone Joint Surg 72-A: 574

    PubMed  CAS  Google Scholar 

  8. DePalma AF, Tsaltas TT, Mauler GG (1963) Viability of osteochondral grafts as determined by uptake of S35. J Bone Joint Surg 45-A: 1565 – 1578

    PubMed  CAS  Google Scholar 

  9. Garret J (1987) Osteochondral allografts for treatment of chondral defects of the femoral condyles: early results. Proceedings of the Knee Society. Am J Sports Med 14: 4, 387

    Google Scholar 

  10. Goldberg VM, Porter BB, Lance EM (1980) Transplantation of the canine knee joint on a vascular pedicle. J Bone Joint Surg 62-A: 414

    PubMed  CAS  Google Scholar 

  11. Kandel RA, Gross AE, Gavel A, McDermott AGP, Langer F, Pritzker KPH (1985) Histopathol- ogy of failed osteoarticular shell allografts. Clin Orthop Rel Res 197: 103 – 110

    Google Scholar 

  12. Lance EM, Fisher RL (1970) Transplantation of the rabbit’s patella. J Bone Joint Surg 52-A: 145 – 156

    PubMed  CAS  Google Scholar 

  13. Langer F, Czitrom AA, Pritzker KP, Gross AE (1975) The immunogenicity of fresh and frozen allogeneic bone. J Bone Joint Surg 57-A: 216

    PubMed  CAS  Google Scholar 

  14. Langer F, Gross AE (1974) Immunogenicity of allograft articular cartilage. J Bone Joint Surg 56-A: 297

    PubMed  CAS  Google Scholar 

  15. Langer F, Gross AE, West M, Urovitz EP (1978) The immunogenicity of allograft knee joint transplants. Clin Orthop 132: 155

    PubMed  Google Scholar 

  16. Lexer E (1908) Substitution of joints from amputated extremities. Surg Gynecol Obstet 6: 601

    Google Scholar 

  17. Lexer E (1925) Joint transplantation and arthroplasty. Surg Gynecol Obstet 40: 782

    Google Scholar 

  18. Locht RC, Gross AE, Langer F (1984) Late osteochondral allograft resurfacing for tibial plateau fractures. J Bone Joint Surg 66-A: 328

    PubMed  CAS  Google Scholar 

  19. Malinin TI, Wagner JL, Pita JC, Lo H (1985) Hypothermic storage and cryopreservation of cartilage. Clin Orthop 197: 15 – 26

    PubMed  Google Scholar 

  20. Mankin HJ, Doppelt S, Tomford WW: Clinical experience with allograft implantation. Clin Orthop 174: 69–86

    Google Scholar 

  21. Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW (1982) Osteoarticular and intercalary allograft transplantation in the management of malignant tumours of bone. Cancer 50: 613

    Google Scholar 

  22. Meyers MH: Resurfacing of the femoral head with fresh osteochondral allografts. Clin Orthop 197: 111–114

    Google Scholar 

  23. Meyers M, Akeson W, Convery R (1989) Resurfacing of the knee with fresh osteochondral allografts. JBJS 71-A(5): 704 – 713

    CAS  Google Scholar 

  24. Mnaymneh W, Malinin TI, Makley JT, Dick HM (1985) Massive osteoarticular allografts in the reconstruction of extremities following resection of tumors not requiring chemotherapy and radiation. Clin Orthop 197: 76 – 87

    PubMed  Google Scholar 

  25. McDermott AGP, Finkelstein JA, Farine I, Boynton EL, Macintosh DL, Gross AE (1988) Distal femoral varus osteotomy for valgus deformity of the knee. JBJS 70-A(l): 110

    CAS  Google Scholar 

  26. McDermott AGP, Langer F, Pritzker KPH, Gross AE (1985) Fresh small fragment osteochondral allografts. Clin Orthop 197: 96 – 102

    PubMed  Google Scholar 

  27. McKibbin B (1971) Immature joint cartilage and the homograft reaction. J Bone Joint Surg 53-B(l): 123 – 135

    CAS  Google Scholar 

  28. Oakeshott RD, Farine I, Pritzker KPH, Langer F, Gross AE (1988) A clinical and histologic analysis of failed fresh osteochondral allografts. Clin Orthop Rel Res 233: 283 – 294

    Google Scholar 

  29. Paccola CAJ, Xavier CAM, Goncalves RP (1979) Fresh immature articular cartilage allografts. A study on the integration of chondral and osteochondral grafts both in normal and in papain- treated knee joints of rabbit. Arch Orthop Traumat Surg 93: 253 – 259

    Article  CAS  Google Scholar 

  30. Pap K, Krompecher S (1961) Arthroplasty of the knee. Experimental and clinical experiences. J Bone Joint Surg 43-A: 523 – 537

    Google Scholar 

  31. Pelker RR, Friedlaender GE, Markham TC (1983) Biomechanical properties of bone allografts. COOR 174: 54 – 57

    Google Scholar 

  32. Porter BB, Lance EM (1974) Limb and joint transplantation. A review of research and clinical experience. Clin Orthop 104: 249 – 274

    Article  PubMed  Google Scholar 

  33. Pritzker KPH, Gross AE, Langer F, Luk SC, Houpt JB*(1977) Articular cartilage transplantation. Hum Pathol 8: 635–651

    Article  PubMed  CAS  Google Scholar 

  34. Prolo DI, Rodrigo JJ (1985) Contemporary bone graft physiology and surgery. Clin Orthop 200: 322

    PubMed  Google Scholar 

  35. Rodrigo J J, Sakovich L, Travis C, Smith G (1978) Osteocartilaginous allograft as compared with autografts in the treatment of knee joint osteocartilaginous defects in dogs. Clin Orthop 134: 342

    PubMed  Google Scholar 

  36. Rodrigo JJ, Block N, Thompson EC (1978) Joint transplantation. Vet Clin North America 8: 523

    CAS  Google Scholar 

  37. Rodrigo J, Thompson E, Travis C (1980) 4-C Preservation of avascular osteocartilaginous shell allografts in Rats. Transact Orthop Res Soc 5: 72

    Google Scholar 

  38. Schachar NS, McGann LE (1986) Investigations of low-temperature storage of articular cartilage for transplantation. Clin Orthop 208: 146 – 150

    PubMed  Google Scholar 

  39. Sedgewick AD, Moore AR, All-Duaij AY, Edwards JCW, Willoughby DA (1985) Studies into the influence of carrageenan induced inflammation on articular cartilage degradation using implanta¬tion into air pouches. Br J Exp Pathol 66: 445

    Google Scholar 

  40. Simon W, Richardson S, Herman W, Parsons R, Lane J (1976) Long-term effects of chondrocyte death on rabbit articular cartilage in vivo. J Bone Joint Surg 58-A(4): 517 – 526

    PubMed  CAS  Google Scholar 

  41. Smith AU (1965) Survival of frozen chondrocytes isolated from cartilage of adult mammals. Nature 205: 782

    Article  Google Scholar 

  42. Thomas V, Jimenez S, Brighton C, Brown N (1984) Sequential changes in the mechanical properties of viable articular cartilage stored in vitro. J Orthop Res 2: 55 – 60

    Article  PubMed  CAS  Google Scholar 

  43. Tissue Banking: In: Fawcett KJ, Barr HR (eds) Arlington, V.A.: American Association of Blood Banks, pp 97–107

    Google Scholar 

  44. Tomford WW, Dugg GP, Mankin HJ (1985) Experimental freeze-preservation of chondrocytes. Clin Orthop 197: 11 – 14

    PubMed  Google Scholar 

  45. Tomford WW, Mankin HJ (1983) Investigational approaches to articular cartilage preservation. Clin Orthop 174: 22 – 27

    PubMed  Google Scholar 

  46. Volkov M (1970) Allotransplantation of joints. J Bone Joint Surg 52-B: 49

    Google Scholar 

  47. Wiley AM, Kosinka E (1974) Experimental and clinical aspects of transplantation of entire hyaline cartilage surfaces. J Am Geriatr Soc 25: 547

    Google Scholar 

  48. Zukor D, Oakeshott R, Gross A (1989) Osteochondral allograft reconstruction of the knee. Part 2. Experience with successful and failed fresh osteochondral allografts. Am J Knee Surg 2 (4): 182 – 191

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, Ontario, ONT M5G IX5, Canada

    A. E. Gross M.D., FRCS(C) & M. T. Ghazavi M.D.

  2. Royal Perth Hospital, Perth, Australia

    R. J. Beaver MB, BS, FRCS(C)

  3. Department of Orthopaedic Surgery, Jewish General Hospital, McGill University, Montreal, PQ, Canada

    D. J. Zukor M.D., FRCS(C)

  4. Orthopaedic Center of Dallas, Dallas, Texas, USA

    A. Czitrom M.D., FRCS(C), Ph. D.,

Authors
  1. A. E. Gross M.D., FRCS(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. J. Beaver MB, BS, FRCS(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. J. Zukor M.D., FRCS(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Czitrom M.D., FRCS(C), Ph. D.,
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. T. Ghazavi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Orthopaedic Center of Dallas, Texas, USA

    Andrei A. Czitrom M.D., Ph.D.

  2. Department of Orthopaedics, Donauspital, Vienna, Austria

    Heinz Winkler M.D.

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Springer-Verlag/Wien

About this chapter

Cite this chapter

Gross, A.E., Beaver, R.J., Zukor, D.J., Czitrom, A., Ghazavi, M.T. (1996). The Use of Fresh Osteochondral Allografts to Replace Traumatic Joint Defects. In: Czitrom, A.A., Winkler, H. (eds) Orthopaedic Allograft Surgery. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6885-1_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-6885-1_33

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-7423-4

  • Online ISBN: 978-3-7091-6885-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation