Artikel
Unicompartmental Bipolar Osteochondral and Meniscal Allograft Transplantation is Effective for Treatment of Medial Compartment Gonarthrosis in a Canine Model
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Autoren
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Anna Janine Schreiner
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
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James P. Stannard
- Dep. of Orthopaedic Surgery, University of Missouri, Thompson Laboratory, University of Missouri, Columbia, Columbia, MO, United States
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Aaron M. Stoker
- Dep. of Orthopaedic Surgery, University of Missouri, Thompson Laboratory, University of Missouri, Columbia, Columbia, MO, United States
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Chantelle C. Bozynski
- Dep. of Orthopaedic Surgery, University of Missouri, Thompson Laboratory, University of Missouri, Columbia, Columbia, MO, United States
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Keiichi Kuroki
- Dep. of Orthopaedic Surgery, University of Missouri, Thompson Laboratory, University of Missouri, Columbia, Columbia, MO, United States
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Cristi R. Cook
- Dep. of Orthopaedic Surgery, University of Missouri, Thompson Laboratory, University of Missouri, Columbia, Columbia, MO, United States
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James L. Cook
- Dep. of Orthopaedic Surgery, University of Missouri, Thompson Laboratory, University of Missouri, Columbia, Columbia, MO, United States
| Veröffentlicht: | 26. Oktober 2021 |
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Gliederung
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Objectives: Osteochondral allograft (OCA) transplantation can functionally restore large articular defects in the knee. Bipolar OCA transplantations for partial and whole joint resurfacing often have less favorable results than single-surface transplants. With the advent of technologies and strategies to address limiting factors, a comprehensive approach to optimize outcomes for unicompartmental bipolar biologic joint resurfacing has been employed and assessed. This study was designed to use a large animal model to test the hypothesis that unicompartmental bipolar osteochondral and meniscal allograft transplantation (BioJoint) would be as or more effective for treatment of medial compartment knee osteoarthritis (OA) compared to typical non-operative treatment based on functional, diagnostic imaging, and histologic assessments.
Methods: With IACUC approval, OA was induced in one knee of each research hound (n=8, weighing > 20 kg) using a validated arthroscopic meniscal release model (MR). Three months after MR, dogs were randomly assigned to either the NSAID Control group (n=4, managed with daily NSAIDs [Carprofen 4.4 mg/kg po q24h]) or the BioJoint group (n=4, BioJoint surgery entirely replacing the medial femorotibial joint with MOPS-preserved tissue allografts and BMC application). Clinical assessments (range of motion, VAS pain and function scores), radiographic and arthroscopic assessments were then performed after 1, 3 and 6 months. Additionally, joint histologic assessments, biochemical content and properties of grafts were analyzed. ANOVA analyses were performed with significance set at p<0.05 and displaying means with standard deviations.
Results and Conclusion: At the 6-month study endpoint, functional measures, radiographic assessment of integration and joint health, and arthroscopic evaluation of graft appearance and joint health showed non-inferior or superior (p<0.05) outcomes (range of motion, pain, function, radiographic and arthroscopic OA) for BioJoints compared to NSAID Controls. Furthermore, histologic and mechanistic outcome measures showed that osteochondral and meniscal transplants maintained donor cell viability, integrated into host tissues, and allowed for maintenance of joint function without progression of OA as noted in NSAID-treated controls. The findings support the safety and efficacy of unicompartmental bipolar osteochondral and meniscal allograft transplantation in a rigorous preclinical large animal model. The improved results for extensive bipolar OCA transplantation noted in this study compared to historical controls are thought to be related to high chondrocyte viability in OCAs at time of transplantation due to preservation in MOPS, anatomically-shaped grafts, use of fresh meniscal allografts with intact meniscotibial ligaments, BMC to enhance allograft bone integration, and careful attention to postoperative management. This may result in highly functional outcomes that prevent development and progression of OA.
