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1.
Fresh osteochondral allografts for post-traumatic knee defects have been carried out at our institution since 1972. These grafts are performed for unipolar traumatic defects that involve a significant amount of both bone and cartilage in young patients who are not suitable candidates for prosthetic replacement. These grafts are done fresh within 24 hours of the death of the donor. If there is an associated deformity in the knee, then a realignment osteotomy is carried out through the femur if the deformity is valgus, and through the tibia if the deformity is varus. One hundred and twenty six knees in 123 patients were reconstructed with this procedure, with an average follow-up of 7.5 years. Survivorship analysis showed a 95% success rate at 5 years, 71% at 10 years, and 66% at 20 years. 相似文献
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Bugbee WD 《The journal of knee surgery》2002,15(3):191-195
Fresh osteochondral allografts have a long clinical history and have demonstrated use in a wide spectrum of knee joint pathology. The allografting procedure takes advantage of the unique characteristics of osseous and chondral tissue components. Transplanted bone is readily incorporated by the host while the articular cartilage survives transplantation. Allografts have demonstrated >75% clinical success in the treatment of focal femoral condyle lesions due to trauma, chondral injury, osteochondral trauma, osteochondritis dissecans, avascular necrosis, and post-traumatic reconstruction. Fresh allografts also are finding an increasing role in the salvage of difficult cases that have failed other cartilage procedures, and particularly in individuals who are believed to be too young and active for joint arthroplasty. Further refinements in the technical aspects of the allografting procedure, as well as further understanding of the biology of osteochondral allografts, should lead to improved clinical outcomes. 相似文献
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Ninety-two fresh osteochondral allografts were implanted in 91 patients with posttraumatic osteoarticular defects of the knee joint. These patients have been prospectively followed since 1972. An analysis of long-term survival of these grafts has been performed to determine their success rates: 75% at 5 years, 64% at 10 years, and 63% at 14 years. An evaluation was made between unipolar grafts, which involve only one surface of the compartment, and bipolar grafts, which involve both surfaces. The unipolar grafts had a lower failure rate at all time periods compared to bipolar grafts, with 76% survival at 5 years, 69% at 10 years, and 67% at 14 years. While investigating other factors that might affect the survival of the fresh osteochondral allografts, we calculated the influence of the anatomical location of the graft, patient sex, and patient age. There was no meaningful impact on allograft survival by either the location of the allograft or the sex of the patient. However, there was a significant effect on allograft longevity in terms of patient age, with patients under age 60 doing better. The best indication for the use of unipolar fresh osteochondral allografts is for posttraumatic defects in relatively young, active patients. Joint malalignment should be corrected to achieve best results. 相似文献
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R.S. Bell MD FRCS A. Davis BScPT D.G. Allan MD FRCS F. Langer MD FRCS A.A. Czitrom MD FRCS A.E. Gross MD FRCS 《The Journal of arthroplasty》1994,9(6)
Sixteen patients with advanced giant cell tumors presenting at the knee were treated with complete tumor resection and reconstruction using fresh osteochondral allografts. All patients had one or more of the following indications for tumor resection (as opposed to curettage): tumor recurrence, pathologic fracture, or destruction of the subchondral bone plate. At the 3–15-year follow-up period (mean, 9 years), two grafts have been revised to second fresh grafts because of fracture and one graft has been converted to an allograft-implant composite reconstruction. One joint was fused because of late infection. Functional assessment was carried out in 13 patients, and 8 were good or excellent, 4 were fair, and 1 was poor. The authors conclude that the fresh osteochondral allograft is a viabie treatment alternative to prosthetic arthroplasty in advanced, benign, aggressive bone tumors. 相似文献
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There have been very few clinical reports on osteochondral allograft in Japan. In the allograft we did for osteochondral defects of the knee, seven fresh grafts and four frozen grafts were used. In six of the seven fresh grafts, the surface presented macroscopically and/or arthroscopically the appearance of almost complete normality. From the histological study of the cartilage for biopsy which was obtained from the fresh graft at postoperative fifteen months, the cell viability, though decreased in the superficial layer, was fairly normal and profusely produced proteoglycan stained with safranin-O in both the middle and the deep layers. The cell viability, however, was decreased remarkably or disappeared in all three layers in the biopsy cartilage taken from the frozen graft at over one year postoperatively. The eight of the eleven knees treated with the osteochondral allograft have preserved the joint space on one foot standing radiogram and revealed good function clinically. 相似文献
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Treatment of osteochondral defects of the distal femur with fresh osteochondral allografts: A preliminary report 总被引:2,自引:0,他引:2
Twenty-four patients with osteochondral defects of a femoral condyle who failed to respond adequately to arthroscopic arthroplasty underwent osteochondral grafting with fresh allografts. Grafts were obtained from young donors and were matched according to skeletal size as measured by standard x-rays. Transplantation was performed within 12 h of harvesting. Follow-up extends from 2 to 4 years in 10 cases and is 1-2 years in the remaining 14. All ten patients with follow-up greater than 2 years were improved when evaluated in terms of pain, buckling, and swelling. Of the 24 patients, 11 have been evaluated arthroscopically following transplantation. In all 11 cases, the graft appeared viable. Fraying, if present, was limited to the margins of the graft in all except two cases. Collapse was not observed. 相似文献
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Fresh small-fragment osteochondral allografts. Long-term follow-up study on first 100 cases 总被引:2,自引:0,他引:2
A G McDermott F Langer K P Pritzker A E Gross 《Clinical orthopaedics and related research》1985,(197):96-102
Of 100 patients receiving fresh osteochondral fragment allografts, 95 had replacement of the weight-bearing portion of the knee. The allografts excised under sterile conditions were stored in Ringer's lactate at 4 degrees and transplanted into recipients within 24 hours. The average follow-up time was 3.8 years. One-half of the patients had allografts because of traumatic injury, and the best results (75% success) were obtained in this group of patients. The overall results were not encouraging for patients with osteoarthritis or spontaneous osteonecrosis. 相似文献
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Treatment of post-traumatic ankle arthrosis with bipolar tibiotalar osteochondral shell allografts 总被引:1,自引:0,他引:1
Kim CW Jamali A Tontz W Convery FR Brage ME Bugbee W 《Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society》2002,23(12):1091-1102
We report on tibiotalar osteochondral shell allografts for post-traumatic ankle arthropathy in seven patients. Average follow-up was 148 months (range, 85 to 198). Patients were evaluated by a questionnaire, SF-12 survey, ankle score, physical exam and radiographs. The ankle score increased from 25 preoperatively to 43 at latest follow-up (maximum score 100). SF-12 scores increased from 30 to 38 (Physical Component) and 46 to 53 (Mental Component). The failure rate was 42%. Four of seven patients reported good or excellent results. Five patients stated they would undergo a similar procedure again. Complications included graft fragmentation, poor graft fit, graft subluxation, and non-union. Follow-up radiographs demonstrated joint space narrowing, osteophytes, and sclerosis, even in cases with excellent clinical status. Fresh osteochondral shell allografting may provide a viable alternative for the treatment of post-traumatic ankle arthrosis in selected individuals. 相似文献
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This study reports on 13 patients (mean age: 31 years) with a femoral condyle defect >1.5 cm2 who underwent treatment with an osteochondral graft of the same size obtained from the superior aspect of the lateral condyle, preserving the patellar groove. Mean follow-up was 61.5 months (range: 13-141 months). Twelve results were rated clinically as satisfactory with patients able to resume their normal pre-injury level of activity, and 1 case was rated as poor. No patient reported any patellar problems. Radiographic and computed tomographic evaluation demonstrated good integration of the graft in the host bone. The results of this technique at relatively long-term follow-up are encouraging, with a high percentage of subjective satisfaction. This technique appears to be reliable and provides a valid solution for treatment of wide cartilage defects when other techniques are too complex or inadequate. 相似文献
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The treatment of deep chondral defects at the knee joint poses major difficulties and challenges to the orthopaedic surgeon, particularly in young patients for whom solutions like total or hemi-joint arthroplasty are not recommended, because of their limited durability. Biological resurfacing with materials such as perichondrium, periosteal allografts, and cultured chondrocytes is still at the experimental stage and there has been limited clinical validation. Since 1978, we have successfully used fresh osteochondral (`shell') allografts for the treatment of selected patients with a chondral defect at the knee joint. These grafts, implanted mainly in young patients, have proved durable and have provided good functional results for more than 15 years, as shown by an average of 84.6 in the Hospital for Special Surgery (HSS) Knee Score. The operative technique and results of long-term follow-up of patients receiving fresh, osteochondral (shell) allografts are presented and discussed. 相似文献
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Many techniques are currently used in an attempt to regenerate cartilage surfaces in the presence of a chondral or osteochondral defect. Clinical results have been mixed and no single treatment has emerged as being superior. This article reviews the techniques previously and currently being used and evidence to support their use. 相似文献
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同种异体骨软骨移植修复关节软骨缺损研究现状 总被引:5,自引:0,他引:5
关节软骨缺损常因软骨再生能力低而难以自行修复.新鲜的同种异体骨软骨移植修复关节软骨缺损的疗效稳定,成功率逐渐提高.冷冻保存的同种异体骨软骨移植修复关节软骨缺损的成功率可与新鲜的同种异体骨软骨移植媲美,梯度降温法是目前保存软骨细胞存活率最好的冷冻方法.该文就同种异体骨软骨移植的实验和临床研究、免疫排斥问题及其相关研究动态作一综述. 相似文献
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R D Oakeshott I Farine K P Pritzker F Langer A E Gross 《Clinical orthopaedics and related research》1988,(233):283-294
Fresh small osteochondral allografts were implanted in 108 patients. A clinical and histologic analysis was undertaken in 18 patients whose grafts failed and were excised. Twelve of these patients had evidence of viable hyaline cartilage despite adverse conditions. If careful attention is given to patient selection, age, appropriate timing for correction of alignment, and meticulous technique associated with graft positioning, size, and thickness, then the incidence of clinical failure should be minimized. 相似文献
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Transplantation of cryopreserved osteochondral Dowel allografts for repair of focal articular defects in an ovine model. 总被引:13,自引:0,他引:13
N S Schachar K Novak M Hurtig K Muldrew R McPherson G Wohl R F Zernicke L E McGann 《Journal of orthopaedic research》1999,17(6):909-919
The purpose of this study was to test whether successful cryopreservation of osteochondral tissue is possible and whether, with the appropriate surgical procedure, it can be used for the successful repair of focal articular defects within joints. Fresh (nonfrozen) and snap-frozen (plunged in liquid nitrogen and thawed in a water bath at 37 degrees C, repeated three times) autografts were used as positive and negative controls, respectively. Snap-frozen, frozen (fresh tissue placed in a freezer at -80 degrees C), and cryopreserved (immersed in 10% dimethyl sulfoxide for 30 minutes and then frozen at 1 degrees C/min to -80 degrees C) allografts were transplanted into the knees of adult sheep. Outcomes were evaluated 3, 6, and 12 months after transplantation. The morphological, histological, biochemical, and biomechanical behaviors and characteristics of the graft cartilage, the host cartilage adjacent to the grafts, and the opposing tibial cartilage were assessed. Freezing protocols that yielded poor chondrocyte recovery after thawing (frozen and snap-frozen) resulted in poor overall graft outcome. The cryopreservation protocol, however, resulted in intermediate recovery (50%) of chondrocytes and in intermediate overall graft outcome compared with fresh autografts. The membrane integrity of the allograft chondrocytes immediately following cryopreservation was identified as the most reliable predictor of long-term outcome of the graft. Further improvements in cryopreservation technique may lead to an effective method of banking osteochondral tissue for successful transplantation for the repair of focal defects and larger joint reconstructions. 相似文献
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Summary Repair of osteochondral defects in articular weightbearing areas presents its own particular problems because of the low potential of hyaline cartilage for regeneration.Our first group of experiments on the knee of the rabbit confirms that the new regenerated cartilage comes from bone marrow which degenerates before developing into true hyaline cartilage. The second group of experiments shows that autologous grafts from the non-weightbearing articular area suitable for the repair of defects in weightbearing areas. In an third group, autologous mensical fibro-cartilage was used as a graft for the repair of osteochondral defects.
Résumé La réparation des pertes de substance ostéo-cartilagineuses au niveau des zones d'appui pose des problèmes particuliers en raison du faible pouvoir de régénération du cartilage hyalin.Notre premier groupe d'expériences sur le genou du lapin montre que le cartilage régénéré provient de la moelle osseuse qui dégénère avant de se transformer en véritable cartilage hyalin. Le deuxième groupe d'expériences démontre que des autogreffes, prélevées sur la partie non portante du cartilage articulaire, sont susceptibles de combler les pertes de substance en zone d'appui. Dans un troisième groupe on a utilisé comme greffe le fibro-cartilage ménsial autologue.相似文献
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Kish G Hangody L 《The Journal of bone and joint surgery. British volume》2004,86(4):619; author reply 619-619; author reply 620