Combination Of Bone Graft Research Articles

Treatment of Non-Contained Infrabony Defects With Enamel Matrix Derivative Alone or in Combination With Biphasic Calcium Phosphate Bone Graft: A 12-Month Randomized Controlled Clinical Trial.

Use of enamel matrix derivative (EMD) when dealing with non-contained defects may be limited because EMD does not maintain a space itself. Use of combined therapy has been proposed, using a bone graft in combination with EMD to avoid collapse of the flap into the bony defect during healing time. Therefore, the aim of this study is to evaluate the clinical and radiologic healing response of non-contained infrabony defects after treatment with a combination of EMD and biphasic calcium phosphate (BC) or EMD alone. Fifty-two patients with at least one infrabony defect ≥3 mm in depth with a probing depth (PD) ≥6 mm were randomly treated with EMD/BC or EMD alone. Clinical and radiographic parameters were evaluated at baseline, 6, and 12 months after surgery. To standardize the procedure, an acrylic stent and millimeter radiographic grid were used. The primary outcome was the change in clinical attachment level (CAL). Analysis of the data demonstrated a statistically significant difference from baseline within each group (P <0.05), with a difference in clinical and radiographic parameters at 6 and 12 months. After 1 year, mean PD reductions of 3.14 ± 1.95 mm (39.6%) in the EMD/BC group and 3.30 ± 1.89 mm (48.7%) in the EMD group were achieved. A mean CAL gain of 2.38 ± 2.17 mm (24.9%) in the EMD/BC group and 2.65 ± 2.18 mm (36.2%) in the EMD group were obtained. Reduction in the infrabony component was 2.71 ± 1.79 mm (57.9%) in the test group and 2.60 ± 2.03 mm (28.5%) in the control group. There were no statistically significant differences between treatment groups. It was concluded that treatment of non-contained infrabony defects with EMD, with or without BC, resulted in statistically significantly better results after 12 months compared with baseline measurements. In contrast, the combined approach did not result in a statistically significant improvement.

Osteochondral lesion depth on MRI can help predict the need for a sandwich procedure

PurposeAutologous subchondral bone grafting in combination with autologous chondrocyte implantation (ACI) (sandwich procedure) is a well-accepted procedure for the treatment of osteochondral lesions of the knee. This requires a different surgical technique and preoperative planning compared to ACI alone. In addition, pain from bone marrow donor site locations can be expected and should be part of patient consent and expectations. This study evaluates whether the MRI made as part of the standard preoperative cartilage patient work up has the diagnostic accuracy to predict the need for a sandwich procedure. Methods and materialsRetrospectively, 185 preoperative MRI scans (PD and T2 sequences) of patients planned for ACI were included. The integrity of the subchondral bone and lamina was scored by four different observers (3 radiologists, and 1 orthopaedic resident). The depth of the defect was measured perpendicular from articulating surface to the bottom of the bony lesion. The area under the curve (AUC) for subchondral defect on MRI (i.e. lamina or bone defect or expert impression), depth measurements and eventual sandwich procedure were calculated. Also inter-observer Kappa values were determined. ResultsThe AUCs for lamina (0.74–0.80) and bone defect (0.73–0.79) were fair and inter-observer Kappas ranged from 0.49 to 0.76, indicating a moderate-good inter-observer agreement and moderate prediction of the need for a sandwich procedure based on the presence of lamina and or subchondral bone defect on MRI. However, depth measurements resulted in an AUC of 0.90 (95% CI: 0.84–0.95,) with an optimal cut-off point at 6.5mm depth of the lesion (90% sensitivity, 80% specificity) to predict the need for a sandwich procedure. ConclusionOurs is the first study examining MRI as a diagnostic tool in predicting the need for a sandwich procedure. Our results show that the integrity of the subchondral layer on MRI has a moderate role in predicting the need for an eventual autologous bone graft to augment ACI whereas in our cohort a depth of the lesion above 6.5mm accurately predicts the need for a sandwich procedure. This can aid in optimising the preoperative planning and patient consent.

Comparison of Different Periodontal Healing of Critical Size Noncontained and Contained Intrabony Defects in Beagles.

Background:Regenerative techniques help promote the formation of new attachment and bone filling in periodontal defects. However, the dimensions of intraosseous defects are a key determinant of periodontal regeneration outcomes. In this study, we evaluated the efficacy of use of anorganic bovine bone (ABB) graft in combination with collagen membrane (CM), to facilitate healing of noncontained (1-wall) and contained (3-wall) critical size periodontal defects.Methods:The study began on March 2013, and was completed on May 2014. One-wall (7 mm × 4 mm) and 3-wall (5 mm × 4 mm) intrabony periodontal defects were surgically created bilaterally in the mandibular third premolars and first molars in eight beagles. The defects were treated with ABB in combination with CM (ABB + CM group) or open flap debridement (OFD group). The animals were euthanized at 8-week postsurgery for histological analysis. Two independent Student's t-tests (1-wall [ABB + CM] vs. 1-wall [OFD] and 3-wall [ABB + CM] vs. 3-wall [OFD]) were used to assess between-group differences.Results:The mean new bone height in both 1- and 3-wall intrabony defects in the ABB + CM group was significantly greater than that in the OFD group (1-wall: 4.99 ± 0.70 mm vs. 3.01 ± 0.37 mm, P < 0.05; 3-wall: 3.11 ± 0.59 mm vs. 2.08 ± 0.24 mm, P < 0.05). The mean new cementum in 1-wall intrabony defects in the ABB + CM group was significantly greater than that in their counterparts in the OFD group (5.08 ± 0.68 mm vs. 1.16 ± 0.38 mm; P < 0.05). Likewise, only the 1-wall intrabony defect model showed a significant difference with respect to junctional epithelium between ABB + CM and OFD groups (0.67 ± 0.23 mm vs. 1.12 ± 0.28 mm, P < 0.05).Conclusions:One-wall intrabony defects treated with ABB and CM did not show less periodontal regeneration than that in 3-wall intrabony defect. The noncontained 1-wall intrabony defect might be a more discriminative defect model for further research into periodontal regeneration.

Autologous bone grafts with MSCs or FGF-2 accelerate bone union in large bone defects.

BacgroundAlthough the contribution of fibroblast growth factor (FGF)-2 and mesenchymal stromal cells (MSCs) to bone formation is well known, few studies have investigated the combination of an autologous bone graft with FGF-2 or MSCs for large bone defects.MethodsWe studied an atrophic non-union model with a large bone defect, created by resecting a 10-mm section from the center of each femoral shaft of 12-week-old Sprague-Dawley rats. The periosteum of the proximal and distal ends of the femur was cauterized circumferentially, and excised portions were used in the contralateral femur as autologous bone grafts. The rats were randomized to three groups and given no further treatment (group A), administered FGF-2 at 20 μg/20 μL (group B), or 1.0 × 106 MSCs (group C). Radiographs were taken every 2 weeks up to 12 weeks, with CT performed at 12 weeks. Harvested femurs were stained with toluidine blue and evaluated using radiographic and histology scores.ResultsRadiographic and histological evaluation showed that bone union had been achieved at 12 weeks in group C, while group B showed callus formation and bridging callus but non-union, and in group A, callus formation alone was evident. Both radiographic and histological scores were significantly higher at 2, 4, 6, 8, 10, and 12 weeks in groups B and C than group A and also significantly higher in group C than group B at 12 weeks.ConclusionsThese data suggest that autologous bone grafts in combination with MSCs benefit difficult cases which cannot be treated with autologous bone grafts alone.

Reconstruction of Zygomatico-Orbital Post Gunshot Defect: Case Report

Reconstruction of zygomatico-orbital complex remains as one of the troublesome and topical problems at steady posttraumatic deformations and fresh traumas of the mentioned region. The case of post gunshot zygomatico-orbital complex defect reconstruction with titanium mesh and autologous bone graft in combination with platelet rich plasma (PRP) is presented.

Nonunion of Traumatic Lumbar Fracture: Case Report

Nonunion of flexion-distraction thoracolumbar fractures has few been described previously. The case report discussed a case of nonunion of traumatic lumbar fracture. A 30-year-old man suffered a traumatic L1-2 flexion-distraction fracture and no paraplegia. After complete bed rest 2 months, then hyperextension thoracolumbar cast 3 months, he still felt back pain when out-of-bed activity. X-ray images demonstrated the fracture was not united. At last, the patient underwent open reduction of the fracture nonunion and L1-2 posterior fusion using short segmental pedicle screw instrumentation with autogenous iliac crest graft. The patient gained an excellent functional restoration at 5 months after operation. This suggests that the disease entity may require surgical treatment as early as possible. Spinal fusion combined instrumentation fixation and bone graft may be the best treatment.

Halo traction, single-segment circumferential fixation treating cervical tubercular spondylitis with kyphosis

ObjectiveTo evaluate the clinical efficacy and feasibility of twenty patients with cervical tubercular spondylitis with kyphosis (CTSK) treated by halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and bone grafting. MethodsRetrospective review of data on twenty patients who suffered from CTSK admitted to our hospital between January 2007 and December 2012. All of them were performed by halo traction, single-segment circumferential instrumented fusion (anterior titanium plate and posterior pedicle or lateral mass fixation) combined anterior debridement, decompression and titanium mesh cage (TMC) filled with allograft bone particles. X-ray and computed tomographic (CT) images were used to determined sagittal balance and bone fusion. The clinical efficacy was evaluated using statistical analysis about the visual analogue scale (VAS) scores of pain, neurological status according to the Frankel classification and erythrocyte sedimentation rate (ESR), which were collected at certain time. ResultsThe average follow-up period was 34.1±7.0months (24–48 months). In the 20 cases, no obvious postoperative complications related to instrumentation and bone grafting and neurologic function was improved in various degrees. The average pretreatment ESR was 46.4±21.7mm/h, which got normal within 3 months in all patients. The average VAS on admission was 6.7±1.7, which decreased to 1.6±1.1 postoperatively. All patients got bony fusion within 3.4–5.5 months after surgery. The Cobb angle of 30.8±10.5° on admission reduced to 2.9±3.9° performed by preoperative halo traction, became to −5.1±4.0° after operation and remained at −4.3±3.8°, with 0.9±0.7° of correction loss. ConclusionsHalo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and TMC can be an effective and safe treatment method for the treatment of cervical tubercular spondylitis with kyphosis and the preoperative halo traction should be laid on much emphasis.

The biological approach in acetabular revision surgery: impaction bone grafting and a cemented cup.

Acetabular impaction bone grafting (IBG) in combination with a cemented cup in revision total hip arthroplasty (THA) is a proven and well-recognised technique which has been used in clinical practice for more than 35 years. Nowadays, with cemented prostheses tending to lose a larger part of the THA market every year in primary and revision cases, and many young surgeons being only trained in implanting uncemented prostheses, this technique is considered by many as technically demanding and time consuming, making its use less appealing. Despite this image and many new innovative techniques using uncemented implants in acetabular revisions over the last 25 years, IBG with a cemented cup is still one of the few techniques that really can reconstitute bone and respects human biology. In this era of many biologically-based breakthroughs in medicine, it is hard to explain that the solution of most orthopaedic surgeons for the extensive bone defects as frequently seen during acetabular revision surgery, consists of implanting bigger and larger metal implants. This review aims to put the IBG method into a historical perspective, to describe the surgical technique and present the clinical results.

Clinical and radiographic evaluation of nanocrystalline hydroxyapatite with or without platelet-rich fibrin membrane in the treatment of periodontal intrabony defects.

Background:Nano-sized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline hydroxyapatite (NcHA) binds to bone and stimulate bone healing by stimulation of osteoblast activity. Platelet-rich fibrin (PRF), an intimate assembly of cytokines, glycan chains, and structural glycoproteins enmeshed within a slowly polymerized fibrin network, has the potential to accelerate soft and hard tissue healing. The present study aims to explore the clinical and radiographical outcome of NcHA bone graft with or without PRF, in the treatment of intrabony periodontal defects.Materials and Methods:In a split-mouth study design, 20 patients having two almost identical intrabony defects with clinical probing depth of at least 6 mm were selected for the study. Selected sites were randomly divided into two groups. In Group I, mucoperiosteal flap elevation followed by the placement of NcHA was done. In Group II, mucoperiosteal flap elevation, followed by the placement of NcHA with PRF was done. Clinical and radiographic parameters were recorded at baseline and at 6-month postoperatively.Results:Both treatment groups showed a significant probing pocket depth (PPD) reduction, clinical attachment gain, increase bone density 6-month after surgery compared with baseline. However, there was a significantly greater PPD reduction and clinical attachment gain when PRF was added to NcHA.Conclusion:The NcHA bone graft in combination with PRF demonstrated clinical advantages beyond that achieved by the NcHA alone.

A comparative clinico-radiographic study of guided tissue regeneration with bioresorbable membrane and a composite synthetic bone graft for the treatment of periodontal osseous defects

Aim:The aim was to evaluate the bonefill in periodontal osseous defects with the help of guided tissue regeneration, bioresorbable membrane (PerioCol) + bone graft (Grabio Glascera) in combination and with bonegraft (Grabio Glascera) alone.Materials and Methods:The study involved total 30 sites in systemically healthy 19 patients. The parameters for evaluation includes plaque index sulcus bleeding index with one or more periodontal osseous defects having (i) probing depth (PD) of ≥ 5 mm (ii) clinical attachment loss (CAL) of ≥ 5 mm and (iii) ≥3 mm of radiographic periodontal osseous defect (iv) bonefill (v) crestal bone loss (vi) defect resolution. The study involved the three wall and two wall defects which should be either located interproximally or involving the furcation area. The statistical analysis was done using Statistical Package for Social Sciences, the Wilcoxon signed rank statistic W + for Mann–Whitney U-test.Results:The net gain in PD and CAL after 6 months for Group I ([PerioCol] + [Grabio Glascera]) and Group II (Grabio Glascera) was 3.94 ± 1.81 mm, 3.57 ± 2.21 mm and 3.94 ± 1.81, 3.57 ± 2.21 mm, respectively. The results of the study for Group I and Group II with regards to mean net bonefill, was 3.25 ± 2.32 (58%) mm and 5.14 ± 3.84 (40.26 ± 19.14%) mm, crestal bone loss − 0.25 ± 0.68 mm and − 0.79 ± 1.19 mm. Defect resolution 3.50 ± 2.34 mm and 5.93 ± 4.01 mm, respectively.Conclusion:On comparing both the groups together after 6 months of therapy, the results were equally effective for combination of graft and membrane versus bone graft alone since no statistical significant difference was seen between above parameters for both the groups. Thus, both the treatment modalities are comparable and equally effective.

Horizontal bone augmentation in full-arch maxillary implant-supported restorations: a preliminary clinical report.

The purpose of this study was to describe a technique for horizontal maxillary bone grafting in combination with implant placement for full arch. Patients requiring complete rehabilitation of the edentulous maxillae were included. Two axial mesial implants and 2 tilted distal ones were placed approximately 2 mm buccally about the centre of the bone crest. A graft made of a mixture of deproteinized bovine bone and platelet-rich plasma was placed buccally covering bony dehiscence. Horizontal bone gain and differences in bone volume were evaluated 6 months after surgical intervention, at the time of prosthetic loading, through comparison of standardized cone beam computed tomographic scans. A total of 10 patients were consecutively treated after the proposed protocol. After 6 months, the mean horizontal bone gain was 1.87 ± 0.54 mm for the left side and 1.79 ± 0.78 mm for the right side without any significant difference between them. The bone volume increased by 610.5 ± 27.57 mm after 6 months. It can be postulated that the proposed protocol may provide a significant horizontal bone gain for minimizing the anterior cantilever in full-arch prosthesis.

Invasive electromagnetic field treatment in osteonecrosis of the femoral head: a prospective cohort study.

Introduction :The purpose of this prospective cohort study was to compare the surgical treatment of non-ONFH in adulthood by curettage and bone grafting with treatment by curettage and bone grafting in combination with invasive electromagnetic field treatment using Magnetodyn®. This was assessed by examining whether electromagnetic field treatment has a positive additive effect on the clinical parameters modified Harris Hip Score according to Haddad, Cook and Brinker, Merle d'Aubigné hip score and visual analogue scale, and on the subsequent need for treatment by total hip arthroplasty.Materials and Methodology :The prospective, non-randomised study included 35 patients with unilateral or bilateral osteonecrosis of the femoral head. These were divided into two groups according to the surgical treatment regime and assessed over a 12-month follow-up period. The study group (Group 1) comprised 19 patients (14 men and 5 women) with a total of 22 non-ONFH, who underwent minimally invasive curettage, bone grafting and electromagnetic field treatment (Magnetodyn®) by implantation of a bipolar induction screw. The control group (Group 2) comprised 16 patients (12 men and 4 women) with a total of 18 non-ONFH, who underwent minimally invasive curettage and bone grafting without Magnetodyn® therapy. At the initial pre-operative examination and the 6 and 12-month follow-up, all patients were assessed by clinical examination and radiological monitoring, and by bilateral hip MRI. The clinical evaluation was based on the modified Harris Hip Score according to Haddad, Cook and Brinker, the Merle d`Aubigné hip score and the visual analogue scale (VAS).Results :At the time of follow-up, total hip arthroplasty (THA) had been performed in four patients in Group 1 (18%). In Group 2, four patients (22%) had received a THA (n.s.). Both procedures led to an improvement in the clinical scores (Harris Hip Score, Merle d`Aubigné score and VAS), although no significant difference was observed.Conclusion : The authors conclude that electromagnetic field treatment with Magnetodyn®, using the special signal protocol applied here, as an adjunct to curettage and autologous bone grafting to treat non-ONFH, does not produce better clinical results and does not offer better prophylaxis for the avoidance of total hip arthroplasty over all ARCO stages.

Biomechanical Evaluation of a Novel Autogenous Bone Interbody Fusion Cage for Posterior Lumbar Interbody Fusion in a Cadaveric Model

A human cadaveric biomechanical study of a novel, prefabricated autogenous bone interbody fusion (ABIF) cage. To evaluate the biomechanical properties of the ABIF cage in a single-level construct with and without transpedicular screw and rod fixation. In current practice, posterior lumbar interbody fusion is generally carried out using synthetic interbody spacers or corticocancellous iliac crest bone graft (ICBG) in combination with posterior instrumentation. However, questions remain concerning the use of synthetic intervertebral implants as well as the morbidity ICBG harvesting. Therefore, ABIF cage has been developed to obviate some of the challenges in conventional posterior lumbar interbody fusion instrumentation and to facilitate the fusion process. Eighteen adult cadaveric lumbosacral (L3-S1) specimens were tested. Test conditions included single lumbosacral segments across (1) intact, (2) decompressed, (3) intervertebral cage alone, and (4) intervertebral cage with bilateral transpedicular fixation. Range of motion (ROM), neutral zone (NZ), and axial failure load were tested for each condition. The ICBG, polyetheretherketone cage, or ABIF cage alone exhibited a significantly lower (P < 0.05) ROM and NZ than the decompressed spine. In comparison with the intact spine, all 3 test conditions without supplemental fixation were able to decrease ROM and NZ to near intact levels. When stabilized with pedicle screws, the ROM was significantly less and the NZ was significantly lower (P < 0.05) for each group both compared with the intact spine. In axial compression testing, the failure load of polyetheretherketone cage was the highest, with no significant difference between the ICBG and the ABIF cage. These data suggest that the novel ABIF cage can bear the physiological intervertebral peak load, similar to ICBG. When combined with pedicle screw and rod fixation, it exhibits similar biomechanical properties as the polyetheretherketone cage plus posterior instrumentation. Based on the biomechanical properties of ABIF cage, the prospect of these cages in clinical practice is expected.

Using Growth Factors in Human Extraction Sockets: A Histologic and Histomorphometric Evaluation of Short-Term Healing

Ridge preservation protocols reduce crestal remodeling after tooth extraction. There is insufficient evidence on bone grafting in combination with platelet-rich plasma (PRP) or recombinant human platelet-derived growth factor (rhPDGF-BB). The aim of this study is to evaluate healing of grafted and nongrafted sockets and the effect of PRP and rhPDGF-BB on early remodeling. Forty-one patients whose treatment plan included extraction of anterior or premolar teeth were randomized into four groups. Group 1: collagen plug (control). Group 2: mineralized freeze-dried bone allograft (FDBA)/β-tricalcium phosphate (β-TCP)/collagen plug. Group 3: FDBA/β-TCP/PRP/collagen plug. Group 4: FDBA/β-TCP/rhPDGF-BB/collagen plug. At 8 weeks, a core was harvested from the center of 41 sockets. Histomorphometric analysis took place. Differences were analyzed using one-way analysis of variance (ANOVA) or chi-square tests for continuous and categorical data. Pairwise comparisons were tested using least squares means. Spearman correlation coefficients were used to evaluate the relationship of bone growth with potential confounders. A P value < .05 was considered statistically significant. ANOVA did not indicate statistical significance in age, gender, smoking, ethnicity, or race distribution. Significant differences in tissue distribution were identified between groups and between different thirds of harvested core. More new bone and amorphous organic matrix was noted in the control group. In sites where bone graft was combined with growth factors, the amount of residual particles was less than in sites where bone graft was used alone. Inclusion of bone replacement graft suppressed new bone formation during early healing. Inclusion of PRP and rhPDGF-BB produced less residual bone graft material, indicating more rapid turnover of bone graft. All treatment modalities achieved a significant amount of new vital bone at 8 weeks postextraction.

Intracranial Volume Before and After Surgical Treatment for Isolated Metopic Synostosis

Metopic synostosis results in a keel-shaped forehead, hypotelorism, and an increased interparietal width. This study aimed to measure the frontal and total intracranial volume in patients with metopic synostosis before and after surgery and to compare the effect of 2 different operation methods. All patients operated for isolated metopic synostosis between 2002 and 2008 at Sahlgrenska University Hospital who had undergone preoperative and/or postoperative computed tomographic examination (at 3 y of age) were included. The patients were grouped according to operation method: (1) forehead remodeling in combination with a bone graft or (2) forehead remodeling in combination with a spring. Sex- and age-matched controls were identified. A previously developed MATLAB computer program was used to measure the frontal and total intracranial volumes. Sixty patients and 198 controls were included. Preoperatively, the patients with metopic synostosis had significantly lower frontal volumes than those of the controls (P < 0.001) but equal total intracranial volumes. The operations redistributed the intracranial volume and resulted in an improved, frontal-total intracranial volume ratio. However, at 3 years of age, the frontal volume (P < 0.001), total intracranial volume (P ≤ 0.002), and ratio between the 2 (P < 0.001) were significantly lower in the patients than in the controls. The 2 operation methods were equally efficient in creating an improved frontal-total ratio. Surgery for metopic synostosis improves the distribution of the intracranial volume but does not result in normal total intracranial volume or frontal volume at 3 years of age.

A REVIEW ON HYDROXYAPATITE-BASED SCAFFOLDS AS A POTENTIAL BONE GRAFT SUBSTITUTE FOR BONE TISSUE ENGINEERING APPLICATIONS

HA a potential candidate in bone tissue engineering (BTE). Over the past few decades, its application as bone graft in combination with stem cells has gained much importance. The use of bone marrow-derived mesenchymal stromal cells (MSCs) will enhance the rate and quality of defect repair. However, application of hydroxyapatite as a material to develop a 3-dimension scaffold or carrier to support MSCs in vitro is still in its infant stage. This review will discuss the source, manufacturing methods and advantages of using HA scaffolds in bone tissue engineering applications.

Reconstruction of osteochondral defects by combined bone grafting and a bilayer collagen membrane as a sandwich technique

Treatment of osteochondral lesions of the knee remains a major challenge in orthopedic surgery. Recently established procedures like autologous chondrocyte implantation or matrix-associated chondrocyte implantation yield good results, but include the disadvantage of two-step procedures. The purpose of this study was to evaluate the clinical and magnetic resonance imaging outcome of repairs of osteochondral defects of the knee by a combined procedure of bone grafting and covering with a bilayer collagen membrane in a sandwich technique. Seven male patients with a mean age of 42 (range 30-55) years and symptomatic focal osteochondral lesions of the knee grade IV according to the International Cartilage Repair Society classification were included. The mean diameter of defects was 28.6 (range 15-40) mm. Results were evaluated at a minimum of 24 months after surgery by International Knee Documentation Committee score, Lysholm-score, visual analogue scale, and magnetic resonance imaging with specific cartilage sequences, evaluating the ICRS score and the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. All patients judged the operation as successful. Among the patients available for the long-term follow-up, mean visual analogue scale value was 1.3 (range 0-3) out of 10 points. Mean International Knee Documentation Committee score was 80.8 (range 63.2-88.5) out of 100 points. Mean Lysholm score was 85 (range 55-95) out of 100 points. None of the patients had to be reoperated until today. Evaluation of magnetic resonance imaging using the MOCART score revealed a good correlation to the clinical outcome. This is the first study reporting results after reconstruction of osteochondral defects of the knee joint by bone grafting and a bilayer collagen membrane. This new method offers the advantage of a one-step-procedure and yields both good clinical and magnetic resonance findings. We conclude that this procedure can be a valuable tool to improve joint function after osteochondral defects, trauma, and in joints with local arthritic lesions.

Scintigraphic and Histopathologic Evaluation of Combined Bone Grafts

We aimed to assess various bone grafts on bone formation using bone scintigraphy and histology, especially the first study that evaluated the demineralized bone matrix (DBM) + tricalcium phosphate (TCP) + hyaluronic acid (HA) combination. A total of 44 pieces in groups of autogenous bone graft, TCP, DBM, DBM + TCP combination, and DBM + TCP + HA combination were applied to parietal bones of 24 New Zealand rabbits. Bone scintigraphies of the rabbits were performed at 2, 6, and 12 weeks. The uptake ratios were compared for the different types of grafts. In addition, in 2, 6, and 12 weeks, the graft areas were taken from the sacrificed rabbits and examined histologically. In the 2-week evaluation, DBM + TCP combination and DBM + TCP + HA combination had more osteoblastic activity accumulation than the TCP and DBM groups. These findings supported that the DBM + TCP combination group showed new bone formation earlier in the histopathological evaluation. The DBM + TCP + HA combination had more uptake than the TCP and DBM groups on bone scintigraphy at 2 weeks, and this uptake ratio decreased in the following weeks. It was thought that the increased uptake in DBM + TCP + HA combination at 2 weeks was due to severe inflammation seen in the histopathological evaluation. The DBM + TCP + HA combination should not be used for graft repair, although it was thought to be a good combination in the early weeks.

A study on revascularization after the treatment of vacuum sealing drainage technology combined bone graft for bone and soft tissue composite defect

Objective To study the feasibility and efficiency of vacuum sealing drainage (VSD) technology combined with bone graft and its influence on revascularization.Methods Twenty-four rabbits with bone and soft tissue defects were randomly divided into experimental group (VSD therapy with open bone graft) and control group (only open bone graft).The curative efficacy was assessed by wound conditions and wound healing time,X-ray examination,immunohistochemistry,and real-time quantitative polymerase chain reaction (Real-time PCR).Results Wounds and bone defects in experimental group tended to have shorter healing time and healthier wound conditions.Hematoxylin and eosin (HE) staining showed that the graft in experimental group produced plentiful micrangium.The expression of vascular endothelial growth factor (VEGF) via immunohistochemistry and Real-time PCR was significantly higher in experimental group than in control group.Conclusion The VSD therapy combined with open bone graft can be used as a feasible and valuable method to treat composite bone and soft tissue defect,and it may promote revascularization of the graft through up-regulating the expression of VEGF. Key words: Vacuum sealing drainage; Open bone graft; Bone defect; Revascularization

Combination of Autologous Protein-Rich Fibrin and Bone Graft: An Invaluable Option for Reconstruction of Segmental Mandibular Defects

Combination of Autologous Protein-Rich Fibrin and Bone Graft: An Invaluable Option for Reconstruction of Segmental Mandibular Defects