Allograft For Treatment Research Articles

Mid-term outcomes of arthroscopically assisted lower trapezius tendon transfer using Achilles allograft in treatment of posterior-superior irreparable rotator cuff tear

Arthroscopically assisted lower trapezius tendon (aLTT) transfer is one of the treatment options for posterior-superior irreparable rotator cuff tears (PSIRCTs). Although short-term clinical outcomes have shown promising results, there are currently no reported clinical outcomes over a longer follow-up period. This study evaluated the mid-term outcomes of aLTT transfer in patients with a diagnosis of PSIRCT. This retrospective case-series study included patients who underwent aLTT transfer between May 2017 and May 2019. The clinical outcome assessment included the visual analog scale (VAS) pain score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, Activities of Daily Living Requiring Active External Rotation (ADLER) score, active range of motion, Single Assessment Numeric Evaluation score, and return-to-work rate. The radiographic analysis included the acromiohumeral distance, Hamada grade, and integrity of the transferred tendon at final follow-up. Subgroup analyses were performed based on the integrity of the transferred tendon and the trophicity of the teres minor (Tm). This study enrolled 36 patients with a mean age of 63.4 years who met the inclusion criteria and were followed up for a mean of 58.2±5.3 months. At final follow-up, the patients showed significant improvement in mean VAS score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, ADLER score, and active range of motion in all directions except internal rotation. A decrease in the acromiohumeral distance and an increase in the Hamada grade were observed at final follow-up (P=.040 and P=.006, respectively). Retears of the transferred tendon occurred in 7 patients, and postoperative infections developed in 2 individuals. An interesting finding was that the retear group still demonstrated improvement in the VAS score but did not show improvement in external rotation at the side by the final follow-up. Compared with the Tm non-hypertrophy group, the Tm hypertrophy group showed significantly better improvement in external rotation at 90° of abduction and at the side, as well as the ADLER score. Of the study patients, 30 (83.3%) were able to successfully resume their previous work. In this study, aLTT transfer in patients with PSIRCTs demonstrated significant improvements in clinical and radiologic outcomes by the final follow-up. These findings provide support for the mid-term safety and effectiveness of aLTT transfer as a viable joint-preserving treatment option for PSIRCTs. However, larger and longer-term studies are still needed to further validate these findings.

Comparison of Hydroxyapatite/Poly(lactide-co-glycolide) and Hydroxyapatite/Polyethyleneimine Composite Scaffolds in Bone Regeneration of Swine Mandibular Critical Size Defects: In Vivo Study.

Reconstruction of jaw bone defects present a significant problem because of specific aesthetic and functional requirements. Although widely used, the transplantation of standard autograft and allograft materials is still associated with significant constraints. Composite scaffolds, combining advantages of biodegradable polymers with bioceramics, have potential to overcome limitations of standard grafts. Polyethyleneimine could be an interesting novel biocompatible polymer for scaffold construction due to its biocompatibility and chemical structure. To date, there have been no in vivo studies assessing biological properties of hydroxyapatite bioceramics scaffold modified with polyethyleneimine. The aim of this study was to evaluate in vivo effects of composite scaffolds of hydroxyapatite ceramics and poly(lactide-co-glycolide) and novel polyethyleneimine on bone repair in swine’s mandibular defects, and to compare them to conventional bone allograft (BioOss). Scaffolds were prepared using the method of polymer foam template in three steps. Pigs, 3 months old, were used and defects were made in the canine, premolar, and molar area of their mandibles. Four months following the surgical procedure, the bone was analyzed using radiological, histological, and gene expression techniques. Hydroxyapatite ceramics/polyethyleneimine composite scaffold demonstrated improved biological behavior compared to conventional allograft in treatment of swine’s mandibular defects, in terms of bone density and bone tissue histological characteristics.

``Sandwich technique” with dual strut allograft in surgical treatment of femoral nonunion

ObjectiveThe treatment of femoral nonunion is challenging for both the surgeon and the patient. Strut allografts increase the bone stock, enhance fracture healing and increase stability by acting as a biological plate. In this study, we aimed to report the results of the sandwich technique with two-strut allograft in the treatment of oligotrophic or atrophic femoral nonunions. MethodsMedical records of the patients who were treated due to femoral nonunion in a single center were retrospectively reviewed. Twenty-one patients (10 males, 11 females) with a mean age of 49 (range: 21 to 79) years were included in the study. The left side was affected in 11 patients, whereas the right side was affected in ten. The patients had 11 femoral shaft fractures, seven proximal femoral fractures and three distal femoral fractures. The mean time from the previous operation to the nonunion surgery was 9.6 (range: 6 to 22) months. ResultsUnion was achieved in all patients after a mean period of 6.2 (range: 4 to 10) months. The mean follow-up time was 46.8 (range: 12 to 86) months. One patient had superficial surgical site infection in the autologous graft donor site. ConclusionThe sandwich technique with two-strut allograft provides good results in the treatment of femoral nonunion. The technique can be used on any type of nonunion, at any segment of the femur and can be combined with different fixation techniques.

456P - Use of gamma irradiated bone allografts in treatment of various bone tumours

BackgroundOsteogenic augmentation is required in various orthopaedic conditions. Defects caused by removal of malignant or local bone tumours requires reconstructive surgeries to restore skeletal continuity and bone grafts to fill bone defects. Different modalities which can help to increase osteogenesis include autografts, allografts and synthetic bone graft substitutes. Autograft is the gold standard, provides osteogenic, osteoinductive and osteoconductive properties but has limitations of requirement for additional incisions, poor bone quality in elderly patients, increases operation time, causes donor site pain and morbidity and likely permanent residual disability and limited amount. Autograft is the gold standard but is available in limited amount and morbidities associated with it. Bone graft substitutes are costly, limited in quantity and don’t integrate with host bone. Bone allografts are a good option, but not widely used in India and there are sparse reports in literature from developing countries. Our study signifies use of gamma irradiated deep freezed bone allografts in treatment of various bone tumours. MethodsIt’s a prospective descriptive study. Strict inclusion and exclusion criteria, as per standard guidelines of American and European Association of Tissue Banking, were followed. We have a in-house facility of gamma irradiated deep freezed bone allografts available in hospital. 20 patients with giant cell tumours of proximal tibia, proximal ulna and distal radius, aneurysmal bone cysts of proximal humerus and distal radius, etc were operated during one year and followed up for atleast 24 weeks thereafter. Sloof's Criteria was used for assessing osteointegration of grafts. ResultsAllografts have not only accepted well but defects have healed and bone integration is at various stages. Only one patient got infected (5%). 19 out of 20 patients (95 %) in our study group had either attained or at various stages of osteointegration and healing. ConclusionsWe conclude that deep freezed bone allografts is a viable option in patients with large bone defects after resection of bone tumours, thus give satisfactory surgical outcome, with no serious side effects. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Clinical Trial to Examine Effectiveness of a Human Allograft for Treatment of DFU and VLU

Clinical Trial to Examine Effectiveness of a Human Allograft for Treatment of DFU and VLU

Injectable Platelet Rich Fibrin With Demineralized Freeze-dried Bone Allograft in Treatment of Intraosseous Defects

Injectable Platelet Rich Fibrin With Demineralized Freeze-dried Bone Allograft in Treatment of Intraosseous Defects

Subtalar Distraction Arthrodesis with Fresh Frozen Femoral Neck Allograft: A Retrospective Case Series.

Subtalar joint distraction arthrodesis has been well reported with use of structural iliac crest or local autologous bone graft for malunited calcaneal fractures. Early reports for structural allograft did not yield good, consistent results, leading to a subsequent lack of recommendation in previous literature. Newer studies have had promising results utilizing femoral allograft as an alternative to autogenous bone graft. We performed a retrospective chart review on 10 patients (12 feet) undergoing subtalar joint distraction arthrodesis with femoral neck allograft for malunited calcaneal fractures. The primary aim of this study was to report on successful union rates and, in addition, outline any consistent complications. Twelve of the 12 procedures (100%) yielded successful fusion with a mean final follow-up of 7.7 months (range = 2.2-35.1 months). The mean increase in talocalcaneal height was 4 mm (range = 2-6 mm). The overall complication rate was 16.6%, including one superficial wound complication that healed uneventfully and one hardware removal. In conclusion, the current study reports a 100% successful fusion rate with interpositional structural femoral neck allograft in treatment for malunited calcaneal fractures. Therapeutic, Level IV: Case series.

Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures: A Systematic Review and the Authors' Preferred Surgical Technique.

Background:Proximal humerus fractures are common problems plaguing the elderly population.Purpose:The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation (ORIF) and to present the authors’ preferred surgical technique. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with ORIF will provide low reoperation rates with acceptable outcomes.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review was registered with PROSPERO and performed with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student t tests, 1-way analysis of variance, chi-square tests, and 2-proportion Z tests.Results:Four studies met the inclusion criteria. While there is great heterogeneity existing in the literature surrounding use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures, current evidence shows a humeral head screw penetration rate of 3.7% with acceptable functional outcome scores, with a reoperation rate of 4.4% at a weighted mean 80.78 weeks (1.55 years) of postoperative follow-up.Conclusion:There is great heterogeneity that exists in the literature surrounding the use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures. Current evidence shows a screw penetration rate of 3.7% with acceptable functional outcome scores, demonstrating fibular strut allograft is a viable option for treating proximal humerus fractures.

Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial.

Aims:The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects.Materials and Methods:Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively.Results:Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm).Conclusions:Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.

Demineralized freeze-dried bone allograft in treatment of interproximal vertical defect - a clinical report

Bone destruction due to periodontal disease is one of the factors responsible for loss of teeth. The ultimate goal of periodontal therapy is predictable regeneration of lost periodontal tissue including bone defects. Various bone graft materials have been used for periodontal regeneration, which include autogenous grafts, allografts, xenografts, and synthetically produced ones. Amongst allogenic bone grafts, demineralized freeze-dried bone allograft (DFDBA) is most commonly used. All the bone allografts are osteoconductive, but DFDBA also provide an osteoinductive effect. DFDBA has been successfully used to reconstruct intraosseous periodontal defects and furcation defects. This case report describes the management of an intrabony defect in a maxillary left canine where the osseous defect included loss of buccal wall extending up to the periapical region. This localized periodontitis was successfully treated with periodontal regenerative technique using DFDBAs. DFDBA was used because it contains BMP, which induces new bone formation during the healing process. After 1-year follow-up of treatment, the tooth was functional without any signs and symptoms. Clinical and radiographic changes revealed healthy periodontal support.

Clinical and radiological results of femoral head structural allograft for severe bone defects in revision TKA — A minimum 8-year follow-up

BackgroundProper treatment of bone loss is essential for the long term durability of revision TKA. However, the method of choice in managing large bone defects is still under debate. We therefore assessed the mid to long term clinical and radiographic results of revision TKA using a fresh frozen femoral head allograft and a standard condylar implant or varus–valgus constrained prosthesis with a diaphyseal-engaging stem. MethodsWe retrospectively reviewed the records of 27 patients who had undergone revision TKA between August 1997 and March 2003 using a fresh frozen femoral head allograft and a standard condylar implant or varus–valgus constrained prosthesis with a diaphyseal-engaging stem. The median follow-up period was 107months (range, 96–157months). ResultsClinical evaluation revealed that the mean range of motion had increased from 71° to 113° and the mean Hospital for Special Surgery knee score had improved from 46 to 83 points. The overall tibio-femoral angle improved from varus 7.3° to valgus 6.l°. In 26 out of 27 knees, union was demonstrated at an average of seven months postoperatively, and there were no cases of collapse, disease transmission or stress fractures. In one knee, an infection recurred. ConclusionsOur results demonstrate that femoral head allografts in treatment of severe bone defects are reliable and durable. If possible, less constrained prostheses with diaphyseal-engaging stems should be chosen for increased durability. Level of evidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Treatment of an Articular Lesion of the Lateral Tibial Plateau Utilizing a Tibial “Drawer-Exposure” Osteotomy and Osteochondral Allograft Transplant

Articular cartilage lesions of the knee are recognized and treated frequently1. Despite evolving techniques, treatment of cartilage lesions in the knee remains a therapeutic challenge2. The nonoperative management of chondral injuries in young patients is often unsatisfactory for the patient and the surgeon3. Surgical options, such as microfracture, autogenous chondrocyte implantation, resurfacing techniques, and osteochondral allograft transplantation have been developed to treat cartilage defects; however, there is little Level-I or Level-II evidence to inform the decision-making process regarding the various surgical options2,3. Treating cartilage defects of the tibial plateau presents a unique challenge because the tibial plateau is partially obscured by the menisci and the distal part of the femur throughout all knee motion, with resultant difficulty in orthogonal access with instrumentation. Few reports exist on the treatment of tibial plateau chondral injuries with osteochondral grafting4,5. This case report presents a novel technique to treat a cartilage defect of the tibial plateau with use of a “drawer-exposure” osteotomy of the tibial plateau combined with fresh-frozen osteochondral allograft for treatment of an osteonecrotic lesion. The patient and her family were informed that data from this case would be submitted for publication, and they consented. The patient was a thirteen-year-old girl with juvenile rheumatoid arthritis who had a history of chronic prednisone treatment in excess of 60 mg per day, but who at presentation had been managed with Enbrel (etanercept), methotrexate, and Mobic (meloxicam). The patient had multiple concomitant polyarthropathies, predominantly involving the knees and the ankles, and had undergone two previous arthroscopic debridements for osteonecrosis of the left talus. In October 2007, the patient presented to a pediatric hospital with intractable right knee pain, swelling, and difficulty with walking, all of which worsened with activity and improved …

Influence of donor specific transfusion with impaired ICOS/B7h allorecognition on CD4 + CD25+regulatory T cells of cardiac allograft recipient

Objective To investigate the possibility of CD4+CD25+ regulatory T cells (Treg) enhancement, which induced by donor specific transfusion combined with blockade of ICOS/B7h costimulation following an allogenic murine heterotopic cardiac transplantation. Methods Recipient mice were assigned to 3 groups. In allogenic group, donor hearts were harvested from BALB/C mice, and allografts were heterotopically transplanted in the neck of C57BL/6 using Chen' s technique, without treatment. In isogeneic group, donor hearts were harvested from C57BL/6 mice, and isografts were heterotopically transplanted in the neck of C57BL/6, without treatment. In treatment group, a combination of 5 × 106 ICOS-Fcrecipient C57BL/6 mice following a heterotopic cardiac allograft transplantation. Graft function was assessed daily by palpation, with rejection defined as the absence of detectable beating, then survival of grafts was recorded. CD4 + CD25 + Treg subsets in the peripheral blood of allograft recipients were analyzed by flow cytometry. The expression of FOXP3 mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR). To assess the suppressive activity of CD4 + CD25 + Treg from tolerant C57BL/6 mice on CD4 + CD25- Teff from naive BALB/C mice, suppression allogeneic MLR assays were performed in vitro.Results In comparison with allogenic group, the survival of cardiac grafts could be prolonged by the comICOS-Fc on the day 0-6 [(84.38 ± 29. 14) days vs (7.00 ± 0. 76) days, P ＜ 0. 01]. Among 3 groups, a considerable proportion of CD4 + CD25 + Treg could be observed in treatment group [(15.60 ± 5.69 )% ,P ＜0. 01], meanwhile, high expression of FOXP3 mRNA was also detected within allografts in treatment group.Furthermore, in contrast to naive C57BL/6 mice, CD4+ CD25 + Treg harvested from tolerant C57BL/6 mice showed more potent suppressive effect on the proliferation of CD4 + CD25 - Teff. Conclusion Allograft tolerance can be induced by donor specific transfusion with impaired ICOS/B7h allorecognition. CD4 + CD25 + Treg played a critical role in the establishment and the maintenance of this allograft tolerance. Key words: Regulatory T cells; Donor specific transfusion; Inducible costimulator; Cardiac allograft tolerance

Exploratory development of titanium mesh with bone allograft in treatment of cervical spinal tuberculosis

To evaluate the exploratory development of bone graft by titanium mesh with bone allograft in treatment of cervical spinal tuberculosis. Thirty two cases of cervical spinal tuberculosis treated with anterior radical debridement, decompression and inter fixation from January 2002 to January 2007 were included (at least two years follow-up). 18 male and 14 female, age from 18 to 72, mean 41.3 years old. 0.5 - 15.0 months before visit, mean 6.9 months. There were 13 cases in initial treatment group and 19 cases in retreatment group. All cases were divided into two groups (group A and group B) by resource of bone graft. Group A, titanium mesh with bone allograft, 17 cases. Group B, autograft with ilium, 15 cases. Operation time, blood loss, curing conditions, cervical curvature (absolute rotation angle, ARA), function of spinal cord and the rate for bone graft fusions in two groups were compared. The mean follow-up was 3.5 years (range 2 - 5 years). The primary healing rate of incisions was 93.8% (30/32), and total healing rate was 96.9% (31/32). There were no significant differences in operation time or in blood loss between two groups (P > 0.05). Operation time and blood loss, 72 min/121 ml in group A and 90 min/198 ml in group B, there were significant differences between two groups (P < 0.05). In each group, there were significant differences in the function of spinal cord between preoperative and immediately post operative, between preoperative and follow-up, and between immediately post operative and follow-up (P < 0.05), and there were significant differences in ARA between preoperative and immediately post operative, and between preoperative and follow-up (P < 0.05), and there were no significant differences between immediately post operative and follow-up (P > 0.05). On preoperative, immediately post operative and follow-up, there were no significant differences in the function of spinal cord or in ARA between two groups (P > 0.05). For cervical spinal tuberculosis followed by effective individual chemotherapy, a good effect can be obtained by treated with radical debridement and bone allograft with titanium mesh.

Utilisation of glycerolised skin allografts in severe burns

Recognition of the utility of skin allografts in the treatment of critical burn injuries goes back six decades. Since World War II, the use of allografts in burn treatment has been accepted practice. The material has proved to be highly adaptable as burn care has evolved through the years. However, a number of difficulties have emerged which limit utilisation of these grafts, including the possibility of disease transmission, absence of permanent take and shortage of supply [1]. Nevertheless, as has been clearly shown in two French surveys [2,3], the use of allografts remains unchallenged, despite improvements in local and general burn care. With the aims of improving availability and of reducing delays and administrative charges, a skin bank was planned and installed in Tours in 1986. Allograft procurement, as a component of multi-organ donations, was assigned to the burn surgeon on call; responsibility for skin preparation and preservation was assumed by the Tissue Bank Department of the Blood Centre. This arrangement proved to be effective and remains the same today. During the first 4 years of operation, supplies of allograft were generally adequate. Agreements were made with the other skin banks in France, especially Paris, to transfer supplies when appropriate to alleviate shortages and to distribute surfeits (Fig. 1). Recently, the number of procurements has declined markedly; in fact no allograft skin has been acquired locally for the last 3 years. It must be stressed that this development is not linked to disinterest, increased load of work of the teams involved, nor failure of the organisation. There has been a general decline in donors in France, which is especially obvious in Tours. Confronted by this situation, the Burn Centre in association with the Tissue Bank in Tours decided in 1998 to obtain glycerolised skin allografts from the Euro Skin Bank (GPA) in The Netherlands. This was considered appropriate in view

One - staged Saucerization and Cancellous Chip Allograft for Treatment of Chronic Localized Osteomyelitis

One - staged Saucerization and Cancellous Chip Allograft for Treatment of Chronic Localized Osteomyelitis

Superior Vena Cava Reconstruction Using An Iliocaval Allograft

Successful replacements of the superior vena cava (SVC) using autogenous saphenous or superficial femoral vein or prosthetic grafts have been previously performed, but the use of allograft for treatment of SVC syndrome has not been reported. The patient treated by the authors was a forty-one-year-old woman who presented with severe venous congestion of the head and neck caused by fibrosing mediastinitis. In addition, she had sclerosing cholangitis and chronic liver failure. To treat her SVC syndrome and provide access for fluid and blood transfusion and for possible venovenous bypass, SVC reconstruction was performed concomitant to orthotopic liver transplantation. A left innominate vein-right atrial bypass was inserted using an iliocaval allograft. The patient had an uncomplicated recovery, and at six months after surgery her SVC allograft is widely patent and her transplanted liver is functioning well. The venous allograft is an excellent conduit for those patients who are receiving immunosuppression therapy to avoid rejection of a transplanted organ.

Complete suppression of skin allograft rejection in rats treated with continuous infusion of 2'deoxycoformycin.

Congenital deficiency of the enzyme adenosine deaminase (ADA) results in severe combined immunodeficiency. 2'deoxycoformycin (2'dcf) is a tightly binding inhibitor of ADA, and the drug makes it possible to mimic a state of ADA deficiency. In this study we tested the immunosuppressive effect of 2'dcf in a rat skin transplantation model. Rats treated with continuous infusion of 2'dcf at doses of 0.3 mg/kg, 0.5 mg/kg and 0.7 mg/kg body wt/day showed significant prolongation of graft survival. 2'dcf given by bolus injections did not prolong graft survival. In rats treated with continuous infusion of 2'dcf at a dose of 0.7 mg/kg body wt/day mean graft survival time (MST) after withdrawal of treatment was equal to MST in untreated animals, suggesting that during 2'dcf treatment allograft rejection was completely suppressed. In vitro, lymphocytes isolated from animals treated with continuous infusion of 2'dcf showed marked suppression of mitogen response. The 2'dcf preferentially effects lymphocytes, but neutrophils seem resistant to the effect of the drug. The lymphocytotoxic effect of the drug is extreme; during therapy splenic weight decreased by almost 50% and the differential lymphocyte count in blood decreased from 85% to 17%. Immunofluorescence studies showed that, within the spleen, the amount of T cells and B cells decreased markedly. Both T cell subsets were affected--OX8+ cells (suppressor/cytotoxic T cells) and W3/25+ (helper T cells). However OX8+ cells were more resistant to the drug than W3/25+ cells. Skin-grafted rats treated with 2'dcf showed a strong decrease in the W3/25: OX8 ratio. In contrast, untreated rats showed a slight increase in the ratio after skin transplantation. It is concluded that 2'dcf is a strong immunosuppressive drug in rats if given by continuous infusion.