Treatment failures (revision or arthroplasty) after knee osteochondral allograft transplantation with minimum two-year follow-up

BACKGROUND

Knee osteochondral allograft transplantation (OCAT) has been associated with good short- to mid-term outcomes, however, treatment failures occur more frequently than desired. This study used data from a lifelong outcomes registry to analyze knee OCAT treatment failure rates, variables associated with knee OCAT treatment failures, and outcomes after revision or arthroplasty surgery for knee OCAT treatment failures.

METHODS

Patient outcomes were followed after knee OCAT performed using standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS®) allografts. The study population consisted of patients undergoing primary OCAT with ≥ 2-year follow-up. For comparisons, the treatment failure population was defined by patients in the study population with documented treatment failure (revision or arthroplasty) with ≥ 2-year follow-up after failure. Functional graft survival was defined as no further need for revision surgery after primary or revision OCAT.

RESULTS

A total of 262 patients (n = 136 males; 51.9%) were analyzed. SP grafts were used for 59 cases and MOPS grafts were used for 203 cases. Treatment failure was documented in 61 cases (23.3%). MOPS grafts were 3.3 times more likely to be associated with functional graft survival. SP grafts, older patient age, higher BMI, tibiofemoral bipolar OCAT and non-adherence to the postoperative rehabilitation protocol were significantly associated with treatment failure.

CONCLUSIONS

Knee OCAT resulted in functional graft survival at short- to mid-term follow-up in the majority (70-88%) of cases. In addition, revision of primary OCAT resulted in functional graft survival for at least 2 years after revision surgery in the majority (66%) of patients.

LEVEL OF EVIDENCE

2, prospective cohort study.

Impaction bone grafting for femoral revision hip arthroplasty with Exeter stem in Japan: An extended 10- to 15-year stem survival analysis of the previously reported series

BACKGROUND

Femoral impaction bone grafting (IBG) was introduced in the late 1990s in Japan and has gradually become recognized as a useful option for femoral revision. The aim of the present study was to retrospectively analyze 10 to 15 years of clinical results of femoral revision arthroplasties of IBG using Exeter stem performed by experienced Japanese surgeons.

METHODS

We investigated radiographic and clinical records more than 2 years after surgery in 99 hips of 93 patients. The average age was 66.3 years (36-84 years) and the average follow-up period was 11 years (2-23 years and 8 months). Merle d'Aubigné and Postel hip score was used for clinical assessment, and re-operations for any reason were recorded. The survival curve was estimated using Kaplan-Meier method.

RESULTS

The mean Merle d'Aubigné and Postel hip score improved from 9.0 points to 14.5 points at the final follow-up. Re-operations were undertaken in 15 hips of 14 patients for aseptic acetabular component loosening (n = 1 hip), recurrent dislocation (n = 2 hips), infection (n = 4 hips), and periprosthetic femoral fracture (n = 8 hips). The survival rates at 10 and 15 years after operation were 87.1% and 81.1% with any type of re-operation as the endpoint, 92.2% and 92.2% with stem removal or exchange as the endpoint, 94.9% and 88.1% with re-operation for periprosthetic femoral fracture as the endpoint, and 99.0% and 99.0% with re-operation for aseptic stem loosening as the endpoint, respectively.

CONCLUSIONS

The present study showed encouraging results of femoral IBG over 10 years by experienced surgeons in Japan. Although femoral IBG is recognized as a technically complex procedure, survivorship of the stem is excellent, with a 15-year stem survival rate of 99.0% at the end point of aseptic loosening.

Neurosensory recovery of inferior alveolar nerve gap reconstruction: a systematic review

Numerous procedures can potentially injure the inferior alveolar nerve during oral and maxillofacial surgery, eventually causing loss or alteration of local sensitivity. When its total rupture occurs, a conduit, such as an autogenous graft, can be used to join it. Due to the morbidity resulting from this technique, alternative forms of sensorineural repair have been investigated. This systematic review includes an electronic search of PubMed, Embase, LILACS, and Web of Science databases, in addition to a grey literature and manual search. Article selection was performed by two independent researchers following a predetermined inclusion criterion: human studies evaluating the regression of sensorineural disorders after any form of grafting (autogenous, allogeneic, and synthetic). Of the 789 studies, 648 were analysed. Only 11 articles met the eligibility criteria. After analysing the results, it was noted that regaining normal sensitivity was uncommon, but the majority of reconstructed nerves recovered their protective abilities. Allografts showed success rates similar to autogenous grafts, making them a viable alternative. However, clinical trials are still needed to provide solid evidence. Prognosis for sensory recovery was impacted by grafting time and patient age.

Management of chondral and osteochondral lesions of the hip : A comprehensive review

Chondral and osteochondral lesions encompass several acute or chronic defects of the articular cartilage and/or subchondral bone. These lesions can result from several different diseases and injuries, including osteochondritis dissecans, osteochondral defects, osteochondral fractures, subchondral bone osteonecrosis, and insufficiency fractures. As the cartilage has a low capacity for regeneration and self-repair, these lesions can progress to osteoarthritis. This study provides a comprehensive overview of the subject matter that it covers. PubMed, Scopus and Google Scholar were accessed using the following keywords: "chondral lesions/defects of the femoral head", "chondral/cartilage lesions/defects of the acetabulum", "chondral/cartilage lesions/defects of the hip", "osteochondral lesions of the femoral head", "osteochondral lesions of the acetabulum", "osteochondral lesions of the hip", "osteochondritis dissecans," "early osteoarthritis of the hip," and "early stage avascular necrosis". Hip osteochondral injuries can cause significant damage to the articular surface and diminish the quality of life. It can be difficult to treat such injuries, especially in patients who are young and active. Several methods are used to treat chondral and osteochondral injuries of the hip, such as mesenchymal stem cells and cell-based treatment, surgical repair, and microfractures. Realignment of bony anatomy may also be necessary for optimal outcomes. Despite several treatments being successful, there is a lack of head-to-head comparisons and large sample size studies in the current literature. Additional research will be required to provide appropriate clinical recommendations for treating chondral/osteochondral injuries of the hip joint.

Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy: A propensity score matched analysis

Objective

Placement of human placenta derived grafts during robotic-assisted radical prostatectomy (RARP) hastens the return of continence and potency. The long-term impact on the oncologic outcomes remains to be investigated. Our objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane (dHACM) at RARP compared to a matched cohort.

Methods

In a referral centre, from August 2013 to October 2019, 599 patients used dHACM in bilateral nerve-sparing RARP. We excluded patients with less than 12 months follow-up, simple prostatectomy, and unilateral nerve-sparing. Patients with dHACM (amnio group) were 529, and were propensity score matched 1:1 to 2465 patients without dHACM (non-amnio group) and a minimum follow-up of 36 months. At the time of RARP, dHACM was placed around the neurovascular bundle in the amnio group. Continuous and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test respectively. Outcomes measured were biochemical recurrence (BCR), adjuvant and salvage therapy rates.

Results

Propensity score matching resulted in two groups of 444 patients. Cumulative incidence functions for BCR did not show a difference between the groups (p=0.3). Patients in the non-amnio group required salvage therapy more frequently than the amnio group, particularly after partial nerve-sparing RARP (6.3% vs. 2.3%, p=0.001). Limitations are the absence of prospective randomization.

Conclusion

The data suggest that using dHACM does not have a negative impact on BCR in patients. Outcomes of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts' impact on prostate cancer biology.

The effect of sterilization and storage on the viscoelastic properties of human tendon allografts - Continued: Storage for 0 to 4 months

The role of donor-derived tendons, also known as allografts, in anterior cruciate ligament replacement surgeries is steadily increasing. Before surgery, temporary storage and, in most cases, sterilization are essential. It is, thus, crucial to determine how these procedures alter the grafts' biomechanical properties. The purpose of this research was to analyze the effect of different sterilization methods (native, frozen, frozen + 21 kGy gamma irradiation, frozen + 21 kGy electron beam irradiation) and storage durations (0 to 4 months) on the deformation and creep of two tendon types (tibialis anterior, peroneus longus). 80 tibialis anterior and 83 peroneus longus tendons from 51 human cadavers were included. The samples were removed, placed in a radio-cryoprotectant solution, then slowly cooled, sterilized and stored at -80 °C. All groups were subject to 60 s static creep test with 250 N load. Deformation during the loading phase, creep during static loading, and the ratio of these two were evaluated. Deformation at the end of the loading phase and creep consistently exhibited significantly smaller values in the tibialis anterior compared to the peroneus longus type, as well as in electron beam-sterilized grafts as opposed to gamma beam-sterilized ones. Prolonged storage periods (within 0 to 4 months) resulted in a notable increase in these values, particularly in deformation. Based on the experimental data, the tibialis anterior tendon type and sterilization by gamma beam irradiation are better choices for anterior cruciate ligament reconstruction than the peroneus longus and sterilization by electron beam. Increased storage time affects negatively the evaluated mechanical properties.

Wrist arthrodesis combined with a bulk bone allograft for implant loosening after total wrist arthroplasty: A case report

Total wrist arthroplasty (TWA) is a challenging procedure for wrist joints severely destroyed by rheumatoid arthritis. The most common postoperative complication of TWAs is the loosening of the carpal component. Revision surgeries for failed TWAs can be complicated owing to severe bone loss and concomitant soft-tissue problems. Here, we report a case (68-year-old woman with a history of rheumatoid arthritis for 24 years) of severe aseptic loosening of semi-constrained TWA and its salvage surgery. During the primary arthroplasty procedure, severe instability at the second through fifth carpometacarpal joints was observed and arthrodesis of these joints was required. The radiographs obtained 9 months after surgery showed loosening of the carpal component. Subsequently, she suffered a stroke, resulting in a loss of follow-up, and higher stress was loaded on her upper extremities during standing and walking. In the radiograph taken at her revisit 25 months after the primary surgery, the subsidence of the carpal component progressed and loosening of the radial component was observed. Total wrist arthrodesis was performed using a bulk bone allograft of the femoral head, combined with a penetrating Wrist Fusion Rod®. Rapid bone union was achieved without soft-tissue irritation. We conclude that wrist arthrodesis with a bulk bone allograft combined with an intramedullary nail is a reasonable option for failed total wrist arthroplasty.

Impact of irradiation on load-to-failure in bone-patellar tendon-bone allografts: A systematic review and meta-analysis

Introduction

To evaluate the impact various levels of irradiation have on bone-patellar tendon-bone (BTB) allograft load-to-failure.

Materials and methods

Pubmed, Google Scholar and Embase were searched for studies reporting load-to-failure measurements of BTB allografts following gamma or eBeam irradiation. All systematic reviews, editorials, as well as studies that utilized animal models and/or other graft sources (achilles, hamstring, quadriceps) were excluded. Meta-analysis was performed to compare the impact of low dose (19 ≤ kGy), intermediate (20-49 kGy) and high dose (>50 kGy) gamma and eBeam radiation on load-to-failure.

Results

Twelve studies, containing a total of 429 BTB allografts (159 controls, 270 irradiated), were identified. Load-to-failure of BTB allograft was significantly decreased at intermediate (20-49 kGy) doses of radiation, while low (≤19 kGy) and high (>50 kGy) doses did not significantly change load-to-failure.

Conclusions

Intermediate doses of radiation may negatively impact the biomechanical integrity of BTB allograft in vitro. Future studies are required to examine clinical outcomes at varying irradiation levels.

[The first allogenic tracheal transplantation in humans 45 years ago : Procedure, course, and outcome]

In November/December 1978, the first successful tracheal transplantation in humans was performed at the University ENT Clinic in Cologne by the then senior physicians Kurt G. Rose (later chief physician in Dortmund) and Klaus Sesterhenn (later chief physician in Duisburg). Director of the clinic at that time was Prof. Dr. Dr. Fritz Wustrow [10]. The immunological foundations and preliminary work were laid by Sesterhenn in the context of a total of 338 tracheal transplants in Lewis rats in the 1970s (details in the text). The first successful tracheal transplantation was performed on 18 November 1978 in a, then 19-year-old patient who had previously had a motorcycle accident. The donor organ was explanted in the University Hospital Essen and transplanted about 160 min later in the Cologne University ENT Clinic, first into a pocket of the right sternocleidomastoid muscle. The definitive transplantation took place on 06 December 1978. In the article, the circumstances at that time and the perioperative course in the Cologne University ENT Clinic are described by an eyewitness. The former patient is still well and without complications after more than four decades.

Normothermic ex vivo perfusion of deceased donor kidneys and its clinical potential in kidney transplantation outcomes

In recent years, normothermic machine perfusion (NMP) has emerged in conversation surrounding organ preservation and transplantation techniques with the goal of improving patient and clinical outcomes. This is in great attempt to address the rate of non-utilization and the shortage of available organs in kidney transplantation. This focus in mind, normothermic perfusion presents itself as a potential tool to mimic physiological conditions and improve current preservation methods, such as static cold storage. This review serves to improve understanding of the observed connection between the consequences of ischemia and reperfusion injury and traditional preservation techniques as well as how renal NMP may mitigate these issues. Previous studies suggest that reducing time in static cold storage methods by promoting the normothermic perfusion model results in decreased delayed graft function and post-transplant complications. This review also aims to present the immense clinical potential NMP has on future kidney transplantation success and what this means for the fields of nephrology and transplantation. While great strides have been made to evaluate normothermic perfusion's impact on kidney graft viability and transplant success, future research into unified protocol, clinically relevant biomarkers, cost-utility analysis, and use with associated therapeutic and imaging modalities is paramount.

A bioscaffold of decellularized whole osteochondral sheet improves proliferation and differentiation of loaded mesenchymal stem cells in a rabbit model

As a Natural decellularized extracellular matrix, osteochondral tissue is the best scaffold for the restoration of osteoarthritis defects. Bioscaffolds have the most similarly innate properties like biomechanical properties and the preserved connection of the bone-to-cartilage border. Although, their compacity and low porosity particularly, are proven to be difficulties of decellularization and cell penetration. This study aims to develop a new bioscaffold of decellularized osteochondral tissue (DOT) that is recellularized by bone marrow-derived mesenchymal stem cells (BM-MSCs), as a biphasic allograft, which preserved the interface between the cartilage section and subchondral bone of the joint. Whole osteochondral tissues of rabbit knee joints were sheeted in cartilaginous parts in 200-250 µm sections while connected to the subchondral bone and then fully decellularized. The BM-MSCs were seeded on the scaffolds in vitro; some constructs were subcutaneously implanted into the back of the rabbit. The cell penetration, differentiation to bone and cartilage, viability, and cell proliferation in vitro and in vivo were evaluated by qPCR, histological staining, MTT assay, and immunohistochemistry. DNA content analysis and SEM assessments confirmed the decellularization of the bioscaffold. Then, histological and SEM evaluations indicated that the cells could successfully penetrate the bone and cartilage lacunas in implanted grafts. MTT assay confirmed cell proliferation. Prominently, gene expression analysis showed that seeded cells differentiated into osteoblasts and chondrocytes in both bone and cartilage sections. More importantly, seeded cells on the bioscaffold started ECM secretion. Our results indicate that cartilage-to-bone border integrity was largely preserved. Additionally, ECM-sheeted DOT could be employed as a useful scaffold for promoting the regeneration of osteochondral defects.

A deep learning image analysis method for renal perfusion estimation in pseudo-continuous arterial spin labelling MRI

Accurate segmentation of renal tissues is an essential step for renal perfusion estimation and postoperative assessment of the allograft. Images are usually manually labeled, which is tedious and prone to human error. We present an image analysis method for the automatic estimation of renal perfusion based on perfusion magnetic resonance imaging. Specifically, non-contrasted pseudo-continuous arterial spin labeling (PCASL) images are used for kidney transplant evaluation and perfusion estimation, as a biomarker of the status of the allograft. The proposed method uses machine/deep learning tools for the segmentation and classification of renal cortical and medullary tissues and automates the estimation of perfusion values. Data from 16 transplant patients has been used for the experiments. The automatic analysis of differentiated tissues within the kidney, such as cortex and medulla, is performed by employing the time-intensity-curves of non-contrasted T1-weighted MRI series. Specifically, using the Dice similarity coefficient as a figure of merit, results above 93%, 92% and 82% are obtained for whole kidney, cortex, and medulla, respectively. Besides, estimated cortical and medullary perfusion values are considered to be within the acceptable ranges within clinical practice.

Hypothermic machine perfusion for uterus transplantation

OBJECTIVE

To describe the feasibility of hypothermic machine perfusion (HMP) in uterus transplantation (UT) to potentially improve the preservation of the uterus and enhance graft preservation in the donation after brainstem death (DBD) context. Uterus transplantation is a new surgical approach to treating absolute uterine infertility; it can be performed after living donation or after DBD. In the DBD context, the uterus is typically the last organ removed after other vital organs, with the exception of the Baylor team, which removes the uterus first. This key aspect imposes an unavoidable mild temperature ischemia for >1 hour on the uterus during the removal of the vital abdominal and chest organs. In renal transplantation, the perfusion machine reduces the risk of delayed graft function; thus, we hypothesized that machine perfusion could result in a reduction of uterus graft dysfunction. The uterus graft dysfunction could be expressed by a low embryo implantation rate, pregnancy loss, or vascular pregnancy diseases such as preeclampsia or fetal growth restriction." To date, static cold storage of the uterus is the only standard method for preservation before transplantation. HMP is an emerging method that could potentially improve the preservation of the uterus to enhance graft preservation in the DBD context.

DESIGN

This video article shows all the technical details of using the HMP for uterine transplantation.

SETTING

University.

ANIMALS

Porcine model.

INTERVENTION

Porcine uterus was retrieved from a DBD domestic animal model and flushed with KPS MP (Bridge To Life Ltd in UK) at 4 °C. After vascular preparation on the back table, the uterus was perfused using KPS MP through a cannula in the aorta using the VitaSmart device (Bridge To Life Ltd in UK) for 18 hours. Then, the uterus was transplanted to the porcine recipient.

MAIN OUTCOME MEASURES

The macroscopic appearance of the uterus at the end of HMP and the assessment of the uterus vascularization after transplantation in the recipient compared with the native uterus.

RESULTS

This video shows the cannulation of the iliac vessels, cooling and removal of the uterus on a porcine model, uterus preservation using HMP during 18 hours, and then UT in a new recipient pig with the reperfusion of the transplanted uterus next to the native, intact uterus of the recipient. The macroscopic appearance of the uterus at the end of HMP appeared viable and was perfectly flushed. The assessment of the uterus vascularization after transplantation in the recipient was similar to that of the native uterus. To our knowledge, we describe here for the first time the UT procedure in DBD context on an animal model and the use of HMP for uterus preservation in UT programs; this could increase the number of uterine grafts available for a greater number of female recipients.

CONCLUSION

Hypothermic machine perfusion could allow the duration of cold ischemia to be prolonged without altering the uterine graft. Nevertheless, this assertion has to be validated in a human context.

Bone Substitute Options for Spine Fusion in Patients With Spine Trauma-Part I: Fusion Biology, Autografts, Allografts, Demineralized Bone Matrix, and Ceramics

Spinal trauma accounts for a large portion of injuries to the spine area, particularly as societies are entering an era of aging populations. Consequently, spine fractures accompanied by osteoporosis are becoming more prevalent. Achieving successful fusion surgery in patients with spine fractures associated with osteoporosis is even more challenging. Pseudarthrosis in the spine does not yield clinically favorable results; however, considerable effort has been made to achieve successful fusion, and the advancement of bone graft substitutes has been particularly crucial in this regard. Autograft bone is considered the best fusion material but is limited in use due to the quantity that can be harvested during surgery and associated complications. Accordingly, various bone graft substitutes are currently being used, although no specific guidelines are available and this mainly depends on the surgeon's choice. Therefore, the purpose of this review, across part I/II, is to summarize bone graft substitutes commonly used in spine surgery for spine fusion in patients with spine trauma and to update the latest knowledge on the role of recombinant human bone morphogenetic protein-2.

Serial change of femoral and tibial tunnel width after anterior cruciate ligament reconstruction with allograft

PURPOSE

To investigate progressive tunnel widening and its correlation with postoperative outcomes after anterior cruciate ligament (ACL) reconstruction using allografts.

METHODS

Sixty-five patients who underwent ACL reconstruction using a tibialis anterior allograft between 2015 and 2017 were enrolled. Femoral and tibial tunnel widths were measured on anteroposterior (AP) and lateral radiographs immediately and at 3, 6, 12, and 24 months postoperatively. Average femoral and tibial tunnel widths in AP and lateral views were calculated at three different measurement points. Tunnel widening was calculated as the difference in tunnel width immediately and 2 years postoperatively. The correlation between tunnel widening and the postoperative results was analysed.

RESULTS

Tunnel width changes between immediate and 2 years postoperatively were as follows, in AP and lateral views, respectively: femur, 3.0 mm ± 1.5 mm and 2.4 mm ± 1.4 mm; and tibia, 2.8 mm ± 1.4 mm and 2.9 mm ± 1.5 mm. Femoral tunnel widths significantly increased until 1 year, but not from 1 to 2 years postoperatively. Tibial tunnel width significantly increased until 2 years postoperatively. In all tunnels, the increments in tunnel widening decreased over time. Increased knee laxity significantly correlated with greater femoral tunnel widening in AP (r = 0.346, P = 0.006) and lateral views (r = 0.261, P = 0.049).

CONCLUSION

Femoral tunnel widths gradually increased until 1 year postoperatively, and tibial tunnel widths increased until 2 years after ACL reconstruction with allografts. The tunnel widening rate gradually decreased over time. Femoral tunnel widening of 3.7 mm and 3.2 mm on AP and lateral views, respectively, were the cut-off values for postoperative knee laxity.

LEVEL OF EVIDENCE

Level III.

The fate of adipose tissue and adipose-derived stem cells in allograft

Utilizing adipose tissue and adipose-derived stem cells (ADSCs) turned into a promising field of allograft in recent years. The therapeutic potential of adipose tissue and ADSCs is governed by their molecular secretions, ability to sustain multi-differentiation and self-renewal which are pivotal in reconstructive, genetic diseases, and cosmetic goals. However, revisiting the existing functional capacity of adipose tissue and ADSCs and their intricate relationship with allograft is crucial to figure out the remarkable question of safety to use in allograft due to the growing evidence of interactions between tumor microenvironment and ADSCs. For instance, the molecular secretions of adipose tissue and ADSCs induce angiogenesis, create growth factors, and control the inflammatory response; it has now been well determined. Though the existing preclinical allograft studies gave positive feedback, ADSCs and adipose tissue are attracted by some factors of tumor stroma. Moreover, allorecognition is pivotal to allograft rejection which is carried out by costimulation in a complement-dependent way and leads to the destruction of the donor cells. However, extensive preclinical trials of adipose tissue and ADSCs in allograft at molecular level are still limited. Hence, comprehensive immunomodulatory analysis could ensure the successful allograft of adipose tissue and ADSCs avoiding the oncological risk.

Combined structural allograft and tantalum cone to manage segmental metaphyseal tibial bone defect in revision knee arthroplasty

Tibial bone defect remains a challenge in revision knee arthroplasty. The present innovative technique combines structural allograft and tantalum metaphyseal cone for treatment of AORI stage 2A and 2B (uncontained peripheral metaphyseal) tibial defect. The aim is to reconstitute bone stock and enhance allograft osseointegration, while limiting stress to the allograft by implanting the metaphyseal cone through the allograft and the original bone. LEVEL OF EVIDENCE: V (expert opinion).

Long-term outcomes after osteochondral allograft transplantation to the humeral head

BACKGROUND

Long-term outcomes of osteochondral allograft (OCA) transplantation to the humeral head have been sparsely reported in the literature.

PURPOSE

To evaluate outcomes and survivorship of OCA transplantation to the humeral head in patients with osteochondral defects at a minimum of 10 years of follow-up.

METHODS

A registry of patients who underwent humeral head OCA transplantation between 2004 and 2012 was reviewed. Patients completed pre and postoperative surveys including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 12 (SF-12), and the visual analog scale. Failure was defined by conversion to shoulder arthroplasty.

RESULTS

Fifteen of 21 (71%) patients with a minimum of ten year of follow-up (mean: 14.2 ± 2.40) were identified. Mean patient age was 26.1 ± 8.8 years at the time of transplantation and eight (53%) patients were male. Surgery was performed on the dominant shoulder in 11 of the 15 (73%) cases. The use of local anesthetic delivered via an intra-articular pain pump was the most often reported underlying etiology of chondral injury (n = 9; 60%). Eight (53%) patients were treated with an allograft plug, while seven (47%) patients were treated with a mushroom cap allograft. At final follow-up, mean American Shoulder and Elbow Surgeons (49.9 to 81.1; P = .048) and Simple Shoulder Test (43.1 to 83.3; P = .010) significantly improved compared to baseline. Changes in mean SF-12 physical (41.4 to 48.1; P = .354), SF-12 mental (57.5 to 51.8; P = .354), and visual analog scale (4.0 to 2.8; P = .618) did not reach statistical significance. Eight (53%) patients required conversion to shoulder arthroplasty at an average of 4.8 ± 4.7 years (range: 0.6-13.2). Kaplan-Meier graft survival probabilities were 60% at 10 years and 41% at 15 years.

CONCLUSION

OCA transplantation to the humeral head can result in acceptable long-term function for patients with osteochondral defects. While patient-reported outcomes metrics were generally improved compared to baseline, OCA graft survival probabilities diminished with time. The findings from this study can be used to counsel future patients with significant glenohumeral cartilage injuries and set expectations about the potential for further surgery.

Treatment of a case of septic tibial nonunion by the Capanna technique

This report presents the case of a 25-year-old male with an infected tibial diaphyseal nonunion caused by a bone transport procedure carried out to treat an open fracture the patient had sustained 10 years before referral to our hospital. After an initial radical debridement, a bone defect was created, which was subsequently obliterated by placement of an antibiotic-impregnated cement spacer and Stimulan beads and covered by an anterolateral thigh flap. As the patient refused to wear an external fixator and his osseous biology was not amenable to a Masquelet procedure, a decision was made to apply the Capanna technique as soon as the infection healed. The second debridement resulted in a 12-cm-long bone defect that was filled with a tibial allograft and a vascularized fibular graft. At six months, the patient had regained full knee function and was able to bear his full weight, without pain or the need of support equipment. At one year, the bone had healed completely, the infection had subsided and the patient was able to resume his everyday activities. Although the Capanna technique was initially developed to reinforce reconstructions at risk of fracture or nonunion as a result of chemotherapy, its use in post-traumatic cases has been shown to be successful in a selected group of patents. Our study demonstrated that increasing the stability of a reconstruction with an allograft can accelerate the time to heal, and that using a vascularized fibular graft can enhance incorporation of the whole construct. It can be concluded that the Capanna technique is a valid treatment option for managing infected segmental bone defects in selected patients.

Outcome of different reconstruction options using allografts in revision total hip arthroplasty for severe acetabular bone loss: a systematic review and meta-analysis

INTRODUCTION

Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available.

MATERIAL AND METHODS

Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system.

RESULTS

Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22-95). The average follow-up period was 7.9 years (range 2-22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87-93]. Trabecular metal augments (93% [76-98]) and shells (97% [84-99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons).

CONCLUSION

Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts.

CLINICAL TRIAL REGISTRATION

PROSPERO: CRD42020223093.

Effects of Structural Allograft versus Polyetheretherketone Cage in Patients Undergoing Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Inter body spacers have been widely used in patients undergoing spinal fusion surgery; however, it is not clear whether one implant shows superior clinical outcomes compared with the other. This systematic review and meta-analysis comprehensively evaluated the radiologic outcomes and patient-reported outcomes of structural allograft versus polyetheretherketone (PEEK) implants in patients undergoing spinal fusion surgery.

METHODS

Extensive literature searches were conducted on online databases, including MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Library, until January 2023. The present study adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and the Newcastle-Ottawa Scale and Cochrane Collaboration Risk of Bias tool were used to assess the quality of the included studies.

RESULTS

Fifteen studies, encompassing 8020 patients, met the eligibility criteria. The results indicate that structural allografts show a higher fusion rate compared with PEEK implants (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.05-3.37; P ＝0.03; I2 = 71%). In addition, the structural allograft group also had a lower pseudarthrosis rate (OR, 0.40; 95% CI, 0.20-0.80; P = 0.009; I2 = 75%) and reoperation rate (OR, 0.46; 95% CI, 0.26-0.81; P = 0.007; I2 = 38%).

CONCLUSIONS

Our systematic review and meta-analysis show that structural allograft has a higher fusion rate compared with PEEK implants in patients undergoing spinal fusion surgery. In addition, structural allograft has a lower pseudarthrosis rate and reoperation rate.

Comparison of failure rates and functional outcomes between hamstring autografts and hybrid grafts in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

BACKGROUND

The viability of augmenting small-diameter hamstring autografts with allografts remains unclear. Recent studies have reported different clinical results after allograft augmentation. Hence, we sought to determine whether hamstring autografts and hybrid grafts differed in terms of failure rates and functional outcomes after anterior cruciate ligament (ACL) reconstruction. We also evaluated whether the results of the comparisons differed based on allograft sterilization methods.

PATIENTS AND METHODS

This systematic review and meta-analysis were performed by searching the PubMed, Cochrane Library, and EMBASE databases to identify prospective or retrospective studies (evidence levels 1, 2, or 3) that compared the failure rates and functional outcomes of ACL reconstruction using autografts and hybrid grafts.

RESULTS

We identified 15 relevant studies, including 1,521 patients, with 798 and 723 treated using autografts and hybrid grafts, respectively. Fourteen studies were retrospective comparative studies, and one was a prospective randomized controlled trial. Of these, three studies used non-irradiated allografts. In the analysis of all participants, no significant differences in failure rates and subjective International Knee Documentation Committee (IKDC) scores were observed between the autograft and hybrid graft groups. Comparing the autograft and hybrid graft groups that used non-irradiated allografts, no differences in the failure rates and subjective IKDC scores were also noted. Meanwhile, in the groups that used irradiated allograft, the autograft group demonstrated higher Lysholm knee scores and reduced anterior laxity than the hybrid graft group.

DISCUSSION

Overall, ACL reconstruction using hybrid grafts may not reduce failure rates compared to reconstructions using hamstring autografts, although hybrid grafts with irradiation may decrease functional outcomes.

LEVEL OF EVIDENCE

III; systematic review of level II and III studies.

TIM-4 Identifies Effector B Cells Expressing An IL-23-Driven Proinflammatory Cytokine Module That Promotes Immune Responses

B cells can express pro-inflammatory cytokines that promote a wide variety of immune responses. Here we show that B cells expressing the phosphatidylserine receptor TIM-4, preferentially express not only IL-17A, but also IL-22, IL-6, and GM-CSF - a collection of cytokines reminiscent of pathogenic Th17 cells. Expression of this proinflammatory module requires B cell expression of IL-23R, RORγt and IL-17. IL-17 expressed by TIM-4+ B cells not only enhances the severity of experimental autoimmune encephalomyelitis (EAE) and promotes allograft rejection, but also acts in an autocrine manner to prevent their conversion into IL-10-expressing B cells with regulatory function. Thus, IL-17 acts as an inflammatory mediator and also enforces the proinflammatory activity of TIM-4+ B cells. TIM-4 serves as a broad marker for effector B cells (Beff) that will allow the study of the signals regulating their differentiation and expression of their effector molecules.

Surgery for fibrous dysplasia associated with aneurysmal-bone-cyst-like changes in right proximal femur: A case report

BACKGROUND

Fibrous dysplasia associated with aneurysmal bone cyst (ABC)-like changes in the right proximal femur has a low incidence. It is considered more difficult to make early diagnosis than for single fibrous dysplasia.

CASE SUMMARY

A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo. She had no history of present or past illness. Preoperative photography, enhanced computed tomography, and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck. Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur. The patient was diagnosed with fibrous dysplasia based on medical history, physical examination, and results of laboratory, imaging and pathological examinations. According to final pathological examination, the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC. Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABC-like changes. No obvious allograft absorption, loosening of fixation, or secondary fracture were observed during 6-months' follow-up with re-examination by plain radiography and computed tomography. Fibrous dysplasia associated with ABC-like changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.

CONCLUSION

We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.