Cartilage Autografts Research Articles

Suitability of Minced Cartilage From Osteochondral Lesions of the Talus for Immediate Autograft Reimplantation.

Particulated autograft cartilage implantation is a surgical technique that has been previously described for the repair of osteochondral lesions of the talus (OLT). It uses cartilage fragments harvested from the OLT that are minced into 1-2-mm3 fragments and then immediately reimplanted back into the chondral defect and sealed with fibrin glue during a single-stage surgery. The purpose of this study was to characterize the suitability of these minced cartilage fragments as immediate autograft for the treatment of OLTs. Thirty-one patients undergoing primary arthroscopic surgery for their OLT consented to have their loose or damaged cartilage fragments removed and analyzed in the laboratory. Harvested specimens were minced into 1- to 2-mm3 fragments and cell count, cell density, and cell viability were determined. In addition, physical characteristics of the OLT lesion were recorded intraoperatively and analyzed including size, location, Outerbridge chondromalacia grade of the surrounding cartilage, density of underlying bone, and whether the surgeon thought the OLT was primarily hyaline or fibrocartilage. An average of 419 000 cells was able to be obtained from the harvested OLT fragments. The cells were 71.2% viable after mincing. Specimens from younger patients and from lesions with worse chondromalacia adjacent to the OLT had significantly higher cell numbers. Those from lateral lesions and with worse neighboring chondromalacia had a significantly higher cell density. None of the remaining physical OLT characteristics studied seemed to significantly affect cell number or viability. A large number of viable cells are available for immediate autografting by removing the loose or damaged cartilage from an OLT and mincing it into 1- to 2-mm3 fragments. These can be reimplanted into the chondral defect in a single-stage surgery. Future clinical studies are needed to determine if the addition of these live autologous cells either alone or in conjunction with other techniques significantly improves the quality of the repair tissue and clinical outcomes. Level IV, case series.

Investigation of Two New Grafting Techniques for Dorsal Augmentation Rhinoplasty: An Experimental Study with New Zealand White Rabbits.

Cartilage is an important source in supporting the structure of the nose for dorsal augmentation rhinoplasty. However, it is known that its viability is not always on the ideal level. Various wrapping materials are used to increase the strength of cartilage. Donor site morbidity, which develops following the harvesting of both cartilage and fascia as one such cover material, has attracted interest in recent years. In this study, we aimed to investigate the potential of dermis and tendon autografts as alternatives to fascia and cartilage. The sample of the study included 16 New Zealand white rabbits. The right auricular cartilage of all rabbits was amputated, and it was transformed into diced cartilage autografts. The dermis autografts from the right gluteal areas of the rabbits were deepithelialized, and lumbosacral fascia autografts were harvested from the same incision. Additionally, the Achilles tendon of each rabbit was harvested and transformed into diced tendon autografts. Four different autografts were embedded under the skin of each rabbit from 4 different pouches opened in the back of the rabbit. These autografts included diced cartilage alone (Intervention 1), fascia-wrapped cartilage (Intervention 2), dermis-wrapped cartilage (Intervention 3) and fascia-wrapped tendon (Intervention 4) autografts. Intervention 1 had the most irregular appearance, the outcomes in Intervention 4 were volumetrically smaller and softer. Connective tissue formed between the diced pieces in all interventions, and it was observed that the dermis and fascia had a capsule-like appearance, and their viability was preserved. The differences between the initial and final measurements of the volumes of interventions 1, 2 and 3 were statistically significant (p<0.05). There was no significant difference between the initial and final volumetric measurements of intervention 4 (p>0.05). More peripheral proliferation was observed in the interventions of fascia-wrapped and dermis-wrapped diced cartilage compared to the other interventions. The intervention including fascia-wrapped diced tendon grafts had displayed more fibrosis, fragmentation and collagen fibers, while it showed a lower amount of elastic fiber. There were no significant differences among the intervention in terms of other histological parameters. Tendon autografts may be a good option for dorsal augmentation rhinoplasty as they are easily harvested and have minimal donor site morbidity. Dermis autograft usage is more advantageous than fascia usage in terms of accessibility and convenience. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Using polypropylene mesh or ear cartilage autograft with mini screws for the treatment of induced cleft hard palate in puppies: A comparative study

Using polypropylene mesh or ear cartilage autograft with mini screws for the treatment of induced cleft hard palate in puppies: A comparative study

Immunohistochemical Analysis of Knee Chondral Defect Repair after Autologous Particulated Cartilage and Platelet-Rich Plasma Treatment in Sheep.

This study performs an analysis that will enable the evaluation of the quality, durability, and structure of repaired cartilaginous extracellular matrix tissue using an autologous-based particulated autograft cartilage and platelet-rich plasma treatment (PACI + PRP). A single-blind controlled experiment was conducted on 28 sheep to evaluate the efficacy of the PACI + PRP treatment for cartilage defects. Full-thickness 8 mm diameter defects were created in the weight-bearing area of both knees. The right knees received PACI + PRP. The left knees were treated with Ringer's lactate solution (RLS) or hyaluronic acid (HA) injections. Sheep were euthanized at 9- or 18-months post-surgery. An extensive immunohistochemical analysis was performed to assess collagen types (I, II, III, V, VI, IX, X, XI) and aggrecan positivity. A semiquantitative scoring system provided a detailed evaluation of immunostaining. Collagens and aggrecan scores in the PACI + PRP groups were similar to healthy cartilage. Significant differences were found in collagens associated with matrix maturity (II and V), degradation (IX), structure and mechanics (VI), and hypertrophy (X) between healthy cartilage and RLS- or HA-repaired cartilage. The PACI + PRP treatment advanced the repair cartilage process in chondral defects with mature hyaline cartilage and enhanced the structural and mechanical qualities with better consistent cartilage, less susceptible to degradation and without hypertrophic formation over time.

Assessment of Cartilage Resected from Osteochondral Lesions of the Talus for Intraoperative Reimplantation

Category: Basic Sciences/Biologics; Arthroscopy Introduction/Purpose: Osteochondral lesions of the talus (OLT) are frequently treated with microfracture and may be augmented with decellularized extracellular matrix or particulated juvenile cartilage. The damaged OLT cartilage is often discarded. Infrequently it is used as a source for autologous chondrocyte expansion and implantation in a subsequent procedure. This resected cartilage has demonstrated variable chondrocyte viability. The influence of cartilage type on chondrocyte viability, whether frayed fibrocartilage from in vivo repair or delaminated hyaline cartilage, remains unknown. Also, little has been reported on the use of the OLT cartilage as a source for immediate cartilage autograft. The purpose of this study is to evaluate chondrocyte quantity and viability from the excised cartilage of OLTs at the time of arthroscopic debridement and microfracture. Methods: Patients aged 18 to 65 undergoing arthroscopic debridement and microfracture of talar OLTs were included. IRB approval of the study protocol was obtained. At the time of ankle arthroscopy, the cartilage from the OLT was collected either by GraftNet™ Autologous tissue collector (GraftNet™ Autologous Tissue Collector, Arthrex; Naples, FL) or manual collection and mincing of the specimen with a scalpel. Chondrocytes were isolated by overnight digestion with 2% collagenase in tissue culture medium at 37°C. The isolated cells were stained with Trypan Blue and counted for total cell number and viability (%), using an automated cell counter. Data collection included patient age, size and location of the OLT, intraoperative surgeon assessment of cartilage type (hyaline cartilage, fibrocartilage, or mixed fibro-hyaline cartilage), histologic determination of cartilage type, weight of the specimen, and chondrocyte cell count and viability. Results: Fourteen OLT specimens were collected. The average size was 0.831 (SD ± 1.10) cm2, and average weight 0.19 (SD ± 0.17) grams. Overall, the average number of chondrocytes was 1.12 x106 (SD ± 1.13 x106) cells/mm2 and 3.99 x106 (SD ± 3.28 x106) cells/gram. The average viability was 72.36% (SD ± 12.25%). Using histologic determination of cartilage type, in hyaline specimens (n = 8, 57.14%) we found 1.08 x106 (SD ± 0.85 x106) chondrocytes/cm2, 70.73% (SD ± 11.73 %) viability. In fibrocartilage specimens (n = 2, 14.29%) we found 0.37 x106 (SD ± 0.10 x106) chondrocytes/cm2, 78.08% (SD ± 22.03%) viability. In mixed cartilage specimens (n = 4, 28.57%) we found 1.58 x106 (SD ± 1.80 x106) cells/cm2, 72.78% (SD ± 11.79%) viability. (Table 1) Conclusion: We found OLT chondrocyte viability of 72.36%, with a trend toward greater chondrocyte concentration and similar viability comparing hyaline and fibro cartilage, respectively. Cartilage type was consistent between intraoperative and histologic assessment in all but four specimens. OLT cartilage has the potential to serve as an immediate intraoperative chondrocyte autograft source for enhancement of talus cartilage repair procedures, eliminating the risk of donor site morbidity and additional surgeries as in culture-based methods. Further study with more patients may shed light on the accuracy of intraoperative cartilage classification, and differences in chondrocyte quantity and viability between cartilage types.

Wound healing after the implantation of the cartilage autograft and allograft (an experimental study)

Objective. To compare the wound healing after implantation of the freshly frozen allogeneic cartilage and the autogenic cartilage in a cutaneous flap.Materials and methods. Two groups of eighteen non-breed white lab rats weighing 180-200 g of both genders were studied. Each specimen had a plastic material with the inclusion of a skin flap and cartilage graft formed. Group 1 used the animal’s own cartilage, group 2 used freshly frozen allogenic cartilage. Histological examination of the flap and graft preparations was carried out on the 7th, 14th and 21st days after the intervention.Results. Semi-quantitative evaluation of inflammation and tissue reaction after cartilage autograft and allograft implantation was carried out. A gradual decrease in the evidence of the inflammatory reaction and the formation of a fibrous capsule around the implant during the study period was registered. The comparative analysis revealed no statistically significant differences in each of the indicators.Conclusion. Implantation of an allograft from freshly frozen cartilage has no negative effect on skin flap wound healing in the experiment. Freshly frozen allogenic cartilage can be used for reconstructive interventions on a par with autologous material.

Particulate cartilage and platelet-rich plasma treatment for knee chondral defects in sheep

PurposeArticular cartilage is vulnerable to multiple types of damage and it has limited reparative and regenerative capacities due to its absence of vascularity. Although a large number of therapeutic strategies exist to treat chondral defects, they have some limitations, such as fibrocartilage formation. Therefore, the goal of the present study was to evaluate the chondrogenic regenerative properties of an autologous-made matrix of particulated cartilage and platelet-rich plasma (PACI + PRP) implantation for the treatment of full-thickness chondral defects in sheep.MethodsA full-thickness 8 mm diameter cartilage defect was created in the weight-bearing area of the medial femoral condyle in both knees of 16 sheep. The right knees of all animals were treated with particulated autograft cartilage implantation and platelet-rich plasma, while the left knees were injected with Ringer’s lactate solution or hyaluronic acid. The sheep were killed 9 or 18 months after surgery. Macroscopic evaluations were performed using three different scoring systems, and histopathological evaluations were performed using a modified scoring system based on different scoring systems.ResultsThe PACI + PRP groups showed statistically significant differences in the percentage of defect repair and chondrocytes in the newly formed cartilage tissue at 18 months compared to 9 months.ConclusionsThe results suggest that macroscopic appearance, histological structure and chondrocyte repair were improved when using PACI + PRP treatment for chondral defects, producing an outcome similar to the surrounding healthy cartilage. PACI + PRP is a totally autologous, easy, and unexpensive treatment that can be performed in one-step procedure and is useful as a therapeutic option for knee chondral defects.

МЕТОДОЛОГИЯ ОБСЛЕДОВАНИЯ И УЛЬТРАЗВУКОВАЯ АНАТОМИЯ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ У ПАЦИЕНТОВ С КРАНИОФАЦИАЛЬНОЙ МИКРОСОМИЕЙ

The study presents findings of extended ultrasound examination of a maxillofacial area in 62 patients with craniofacial macrosomia. It was used to detect abnormalities in patients’ ultrasound anatomy and to apply a topographic anatomy option in order to advance the methodology of examination and planning for surgical procedures, namely auricle reconstruction. The following findings were detected throughout the ultrasound examination: 7 patients with a total aplasia of parotid salivary gland in a normal structure and size of salivary gland on the damaged side; all patients with a normal structure and size of submandibular salivary gland on the damaged side; and 25 patients with anatomic landmarks for auricle reconstruction using a carcass of costal cartilage autograft. An ultrasound examination of head and neck, particularly the temporal, parotid-masticatory and temporal areas on both sides, the masticatory and temporal muscles, the temporal fascia, the large salivary glands, the vessels of the temporal areas, is required for formation of unbiased assessment of the state of maxillofacial area in patients, as well as further systematization of results for detection of correlation with apparently healthy children. Based on an ultrasound examination of topographic anatomy of temporal area, a method for detection of optimal location for auricle reconstruction in patients with craniofacial macrosomia is found relevant and accessible.

Single Stage Minced Cartilage Repair

Cartilage injuries are notoriously difficult to treat and do not heal spontaneously. The available repair methods can be expensive and often provide an inconsistent clinical and biological outcome. The use of autologous or allogeneic particulated cartilage has shown promise in recent years. Chondrocytes can migrate from minced cartilage and facilitate clinical cartilage repair in one-step procedures. Four different techniques have been described in the literature: “The Cartilage Autograft Implantation System” (CAIS) is cartilage biopsies cut into 1- to 2-mm fragments and implanted in cartilage defects embedded in a polymer scaffold. “The DeNovo NT Natural tissue graft” is allogenic particulated juvenile cartilage from donors under the age of 13. The cartilage is cut into 1 mm 3 dice and implanted in cartilage defects embedded in fibrin glue. “Autologous minced cartilage” is cartilage biopsies cut into 0.25-0.5 mm 3 chips, embedded in fibrin glue and implanted in chondral or osteochondral defects. The technique can be used with or without concomitant bone grafting. In the “augmented autologous minced cartilage” technique, a bioactive component is added to augment the repair process. The different minced cartilage repair techniques have shown a great biological repair potential and provide clinical benefits. The techniques are easily applicable at a low cost, and they provide the surgeon with an alternative to marrow stimulation and chondrocyte expansion and transplantation. The clinical evidence is still limited, and further studies should be performed to establish the clinical efficacy of minced cartilage procedures.

Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty.

Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.

Sufficient Cartilage for Most Talar Articular Defects Can Be Harvested From the Non–Loadbearing Talus: A Cadaveric Analysis

PurposeTo assess the quantity of morselized cartilage that can be harvested from the non–load-bearing portion of the talus for immediate reimplantation.MethodsNon–load-bearing talar cartilage was harvested from 5 cadaveric specimens using a standard arthroscopic approach. Cartilage was separated from the talus in maximum dorsiflexion at the junction of the talar head and neck, grasped, and morselized into a graft using a cartilage particulator. The volume of reclaimed cartilage was measured, and the extrapolated area of coverage was compared to average osteochondral lesions of the talus previously reported.ResultsThe total yield of cartilage graft following processing that was obtained from 5 ankle joints ranged from 0.3 mL to 2.1 mL with a mean volume of 1.3 ± 0.7 mL, yielding a theoretical 13.2 ± 7.1 cm2 coverage with a 1-mm monolayer. While the average size of osteochondral lesions of the talus is difficult to estimate, they may range from 0.5 cm2 to 3.7 cm2 according to the literature.ConclusionsThis study validated that it is possible to harvest sufficient amount of cartilage for an autologous morselized cartilage graft via a single-stage, single-site surgical and processing technique to address most talar articular cartilage defects.Clinical RelevanceParticulated cartilage autografts have shown promise in surgical management of cartilage defects. A single-site, single-staged procedure that uses a patient’s autologous talar cartilage from the same joint has the potential to reduce morbidity associated with multiple surgical sites, multistaged procedure, or nonautologous tissue in ankle surgery.

Nanoscopic Single-Incision Autograft Cartilage Transfer (ACT)

Osteochondral defects in the young active patient remain a difficult issue to treat. Autograft cartilage implantation is a procedure that was originally devised as a difficult 2-stage process, with disadvantages including donor-site morbidity and the need for multiple procedures. Recently, a technique for a single stage autograft cartilage transfer, also known as AutoCart using the GraftNet device for autograft harvest and BioCartilage in addition to bone marrow concentrate to aid in graft incorporation and healing, has been described. In this article, we discuss a modification of this autograft cartilage transfer procedure using a minimally invasive single incision for lesion preparation, microfracture, graft harvest, and graft delivery using visualization from the NanoScope.

Способ хирургического лечения седловидной деформации спинки носа

Saddle deformity of the external nose, which is a consequence of trauma, is usually combined with a nasal septal deviation and is quite widespread in the population. The problem of surgical treatment of this group of patients lies not only in the technical complexity, trauma of the proposed methods but also in the need to carry out significant interventions under general anesthesia, which limits the use of available techniques by a wide number of ENT surgeons, increases the duration of the operation, recovery time and temporary disability of the patient. The invention aims to improve surgical treatment of patients with saddle nasal deformity by providing stable cosmetic and functional results. Materials and methods: The proposed method of surgical treatment of saddle deformity of nasal dorsum includes several stages. Cartilage autograft taken from nasal septum during septoplasty is milled to 0,5–1,0 mm, mixed with 0,5 ml of latex tissue glue (LTG) having hemostatic and antiseptic properties due to aminocaproic acid and dioxidine content, respectively. This mixture is kept for 5 minutes and delivered to the pocket formed under the SMAS (superficial musculoaponeurotic system) layer in the soft tissues of the dorsum of the external nose, after which the final shape of the nose is simulated and fixed with a plaster splint for a week. Results: Based on the department of otolaryngology of Semashko Ryazan Regional Clinical Hospital, for the period from 2012 to 2019, 17 patients were treated with a diagnosis: saddle deformity of the external nose and nasal septum deviation. All patients underwent rhinoseptoplasty under local anesthesia using LTG as described above. No complications were observed in the postoperative period. During follow-up from 7 to 24 months, patients retain constant functional and cosmetic results. Conclusions. This method is a simple, low-traumatic one of surgical treatment of saddle deformity of the nasal dorsum, which allows reducing the operation time, performing it under local anesthesia and obtaining good cosmetic and functional results. The technical simplicity and accessibility of the method make it possible to use it in hospitals engaged in the surgical treatment of nasal diseases.

A Cartilage Dicing Tool for Rapid Preparation of Rhinoplasty Grafts

AbstractOver 220,000 rhinoplasties are performed in the U.S. annually, with approximately 90% of all procedures requiring the use of cartilage autografts or allografts to augment nasal structure or contour. Prior to implantation, graft cartilage is shaped into the desired form by facial plastic surgeons through carving, crushing, or dicing, and molding of the tissue. The use of diced cartilage has been shown in literature to be the optimal technique for creating contour grafts, permitting increased graft moldability, and resulting in the fewest postoperative complications. Despite superior clinical outcomes, adoption of diced techniques is challenged by the laborious, time-intensive process of dicing tissue, which requires up to 2 h in the operating room and is currently performed manually with a blade. Manual dicing can result in inconsistently sized pieces, which can increase risk of graft breakage. Existing cartilage processing tools are primarily intended for crushing tissue and are unsuitable for dicing. This work describes the design and validation of an easy-to-use, effective device for rapid, consistent cartilage dicing. Cartilage sizing analysis demonstrated that the device produced approximately five times more diced cartilage within 5 min compared to manual dicing. The rapid dicer (RD) device consistently dices cartilage to a size suitable for grafting while significantly decreasing processing time and cartilage loss compared to current methods. Future development will focus on performing further user testing of the device to design a more ergonomic instrument casing.

Titanium prostheses versus stapes columella type 3 tympanoplasty: a comparative prospective study

IntroductionTympanoplasty is a surgical procedure designed to reconstruct the mechanisms of sound transmission in the middle ear. ObjectiveAnalyze, from an audiological point of view, patients with chronic otitis media undergoing type 3 tympanoplasty major columella with total ossicular replacement titanium prosthesis or with cartilage graft stapes columella. MethodsThis is a prospective analytical study, carried out at the otorhinolaryngology outpatient clinic in a tertiary care hospital, through the evaluation of 26 patients with chronic otitis media who underwent tympanoplasty using different materials for auditory rehabilitation such as titanium prostheses or cartilage autografts. ResultsThere was no statistically significant association between the group factors (cartilage or titanium reconstruction) and preoperative variables. There was no statistically significant association between the postoperative characteristics of the patients and the type of reconstruction. Neither subjective improvement (hearing improvement) nor residual perforation were associated with a type of material. The via factor was the only one that showed a statistically significant difference once air-conduction pathway improved more than bone-conduction pathway, decreasing the air-bone gap. ConclusionThere was no statistical difference between the two groups in relation to the audiometric improvement. There was hearing improvement in both groups. More studies must be done with a longer follow-up to better evaluate the outcome.

Thermal Chondroplasty Technique for Costal Cartilage Harvesting and Contouring.

Although costal cartilage autograft has versatile usage, harvesting the graft is an invasive procedure with potential risks for complications. Therefore, it is important to make every effort to minimize these risks. Moreover, sculpting costal cartilage to the desired shape is challenging and time-consuming because of the natural rigidity. This study aimed to evaluate cases of costal cartilage harvest in terms of the most important donor site complications and to present a novel, practical and inexpensive technique to overcome the challenges in costal cartilage harvesting and contouring. A retrospective review of patient records was made of 103 patients who underwent costal cartilage harvest by the senior author. Costal cartilage harvest was applied using either the thermal chondroplasty technique or the conventional technique on patients undergoing revision rhinoplasty surgery. The number of complications and operation times were compared between the 2 techniques.A cohort of 47 patients (30 males, 17 females; mean age 34.5 years [range, 28-48 years]) underwent costal cartilage harvest using the thermal chondroplasty technique and a cohort of 56 patients (31 males, 25 females; mean age 36 years [range, 28-52 years]) underwent costal cartilage harvest with the conventional technique. The mean operation time for the costal cartilage harvest decreased by 7.5 minutes and the total operation time decreased by 17 minutes with the use of the thermal chondroplasty technique compared to the conventional technique (P < 0.05). Complications of 2 pneumothorax and 1 hematoma developed in the conventional technique group, and no complications were seen in the thermal chondroplasty group. The results of this study suggest that the thermal chondroplasty technique is safer and time-saving compared to the conventional technique.

Platelet-Rich Fibrin Facilitates One-Stage Cartilage Repair by Promoting Chondrocytes Viability, Migration, and Matrix Synthesis.

The main aim of this study is to develop a one-stage method to combine platelet-rich fibrin (PRF) and autologous cartilage autografts for porcine articular cartilage repair. The porcine chondrocytes were treated with different concentrations of PRF-conditioned media and were evaluated for their cell viability and extracellular glycosaminoglycan (GAG) synthesis during six day cultivation. The chemotactic effects of PRF on chondrocytes on undigested cartilage autografts were revealed in explant cultures. For the in vivo part, porcine chondral defects were created at the medial femoral condyles of which were (1) left untreated, (2) implanted with PRF combined with hand-diced cartilage grafts, or (3) implanted with PRF combined with device-diced cartilage grafts. After six months, gross grades, histological, and immunohistochemical analyses were compared. The results showed that PRF promotes the viability and GAG expression of the cultured chondrocytes. Additionally, the PRF-conditioned media induce significant cellular migration and outgrowth of chondrocytes from undigested cartilage grafts. In the in vivo study, gross grading and histological scores showed significantly better outcomes in the treatment groups as compared with controls. Moreover, both treatment groups showed significantly more type II collagen staining and minimal type I collagen staining as compared with controls, indicating more hyaline-like cartilage and less fibrous tissue. In conclusion, PRF enhances the viability, differentiation, and migration of chondrocytes, thus, showing an appealing capacity for cartilage repair. The data altogether provide evidences to confirm the feasibility of a one-stage, culture-free method of combining PRF and cartilage autografts for repairing articular cartilage defects. From translational standpoints, these advantages benefit clinical applications by simplifying and potentiating the efficacy of cartilage autograft transplants.

Autograft Cartilage Transfer Augmented With Bone Marrow Concentrate and Allograft Cartilage Extracellular Matrix

The use of biologics in sports medicine is increasing rapidly. An osteochondral defect in a young active patient remains a difficult issue to treat. Autograft cartilage has tremendous advantages for the treatment of full-thickness defects, but harvesting and preparation have been difficult in the past. Disadvantages have included donor-site morbidity and the need for further surgery. With the recent development of the GraftNet device (Arthrex, Naples, FL), harvesting and delivery of autograft have become easier and can be performed arthroscopically in a single surgical procedure. Bone marrow concentrate has recently increased in popularity owing to the presence of mesenchymal stem cells. These stem cells combined with autograft cartilage and BioCartilage (Arthrex) could lead to better incorporation and healing. In this article, we show how this unique biological composite is obtained and then added in the cartilage defect during a single-stage arthroscopic procedure.

Acquired Full-Thickness Nasal Ala Defects: General Principles and Reconstruction Options

The article presents the data of scholarly publications on the general principles and organizational solutions for nasal ala reconstruction of full-thickness defects. The reconstruction of the full-thickness nasal ala defect includes restoration of the external skin and internal covering epithelium, formation of support structures to achieve a stabile shape and position of the alar subunit. With this end in view, plastic material in the form of composite grafts from the auricle is applied, and each tissue layer is formed separately in the region of the defect. The external skin is most often reconstructed with medial cheek cutaneous flaps. The support structures are formed with cartilage autografts. The reconstruction of the internal lining defect is performed with local mucosal or skin flaps, more rarely mucosal or skin grafts. The limiting factors are: risk for ischemic complications, surgical trauma, and secondary surgical correction. The agenda do not only include achievement of acceptable anatomical and functional results but also the quality of perioperative life, shorter time and duration of the surgical intervention and minimum changes in the donor site.

Cartilage Allografts for Aesthetic Nose Surgery: A Viable Option.

Background:Illusions in rhinoplasty are a powerful tool yet often overlooked. There are numerous examples of how a specific change in 1 part of the nose will influence the balance of the nose on the entire face. Although cartilage autograft remains the gold standard in structural reconstruction of the nose, for selected cases, allografts can be favored.Methods:A retrospective cohort study was performed on all patients who underwent cartilage allograft for aesthetic nose surgery from January 2012 to June 2017. All patients were informed of the therapeutic and experimental nature of the localized cartilage allograft use and then consented to the procedure orally and in writing. From January 2012 to June 2017, a total of 105 patients were operated on using cartilage allografts.Results:Of these 105 patients, follow-up to a year was achieved in 97.Conclusion:The use of cartilage allograft in our practice has been a useful proven tool that can help manage a patient aesthetic outcome. This gives us the opportunity for cartilage banking and thus, using it, fewer incisions and scars on our patients.