Graft Stability Research Articles

Postoperative Outcomes of Pterygium Excision Surgery with Autograft Using Autologous Blood Versus Conventional Sutures

Introduction: Pterygium is an extremely common ocular condition believed to be occurring due to proliferation and overgrowth of abnormal epithelial and fibrovascular tissue onto the cornea. They are characterized by cellular proliferation, neovascularization, and inflammation. Ultraviolet rays (UVR) induced elastoid degeneration of subepithelial connective tissue, genetic alteration associated altered cytokine expression plays an important role in the pathogenesis of pterygium. The recent treatment entities include conjunctival autograft with good results. The most commonly used means of fixating conjunctival autografts is by sutures or fibrin glue.
 Aim: This study aimed at comparative assessment of postoperative outcomes of pterygium excision surgery with autograft using autologous blood versus conventional sutures.
 Methods: Forty post-operative cases of pterygium excision surgery with conjunctival autograft were enrolled in the study and serially followed up. The study included two groups of 20 patients each. Group-A included cases of pterygium excision with autograft using autologous blood, and Group-B included cases of pterygium excision with autograft and sutures. Post-operatively, patients were examined on the 1st, 7th and 30th day to document the graft loss. Graft stability was also assessed on day 1 in both groups. Final comparisons were documented in terms of graft edema, stability and recurrence. Also suture related complications like foreign body sensation, watering, discomfort, granuloma formation and suture abscess were assessed in follow-up.
 Results: Group-B (suture group) revealed better graft stability whereas displacement of graft was documented in six cases of Group-A. Graft edema was reported in 10 cases from Group A and 7 cases from Group B. On the 30th day, all patients of both groups presented with similar findings. However, subjective discomfort was reported to be more in group-B as compared to group-A during each follow-up.
 Conclusion: Issue of graft displacement was a critical challenge with autologous blood group (Group A) patients compared to suture-related complications in group B. Looking towards the evidence of less remarkable complications and almost similar outcomes, the surgeons dilemma on pterygium management still persists.

Current state of clinical trials regarding liver transplant rejection

BackgroundLiver transplant (LT) is the second most common transplant intervention. The rate of acute cellular rejection (ACR) is 15–25% after LT, while being higher in chronic rejection (CR). Clinical trials had a major role in getting more potent and selective immunosuppressive medications. Our study plays an important role by evaluating and tracking clinical trials related to liver transplant rejection, focusing on interventional therapeutic trials. MethodsOn October 28, we searched Clinicaltrials.gov for interventional clinical trials related to liver transplant rejection. A total of 27 clinical trials included in this study. Characteristics on each trial were collected, and availability of linked publications was searched using Medline/PubMed and Embase/Scopus. Content of publications was reviewed and main findings were summarized. ResultsMajority of trials were completed (15 out of 27). Eleven trials had between 11 and 50 participants, and 10 had above 100. The study duration was between 1 and 4 years for the majority of trials (16 trials), with an average of 3.77 years. Most of the trials were done in Europe/UK/Russia (n = 12). The results were provided in 9 trials but published in 4, showing the possible tolerogenic efficacy of MSC in liver transplantation, increased success of immunosuppression (IS) withdrawal after sirolimus addition, efficacy of Alemtuzumab, normal graft function and stability within 1 year of immunosuppression withdrawal. ConclusionThis study revealed a low number of trials, lack of variety in location and low publishing rates. The focus of trials was mainly towards side effects and safety of immunosuppressants, and their withdrawal. These trials reached results that must be built on to reach definitive guidelines and treatment strategies. This highlights the need for better management of human and financial resources, in order to reach new and more effective therapeutic strategies, leading to the decrease in rate of LTR.

Anterior Cruciate Ligament Patellar Tendon Autograft Fixation at 0° Versus 30° Results in Improved Activity Scores and a Greater Proportion of Patients Achieving the Minimal Clinical Important Difference For Knee Injury and Osteoarthritis Outcome Score Pain: A Randomized Controlled Trial

The aim of the current study was to determine the effect of the knee flexion angle (KFA) during tibial anterior cruciate ligament (ACL) graft fixation on patient-reported outcomes, graft stability, extension loss, and reoperation after anatomic single-bundle ACL reconstruction. All 169 included patients (mean age 28.5 years, 65% male) were treated with anatomic single-bundle ACL reconstruction using patellar tendon autograft and were randomized to tibial fixation of the ACL graft at either 0° (n= 85) or 30° (n= 84). The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) 2 years after surgery. Secondary outcomes were the Marx Activity Scale (MAS), the rate of reoperation, and physical examination findings at 1 year, including KT-1000 and side-to-side differences in knee extension. The follow-up rate was 82% (n= 139) for the primary outcome. Graft failure rate at 2 years was 1% (n= 2, 1 per group). ACL tibial graft fixation at 0° or 30° did not have a significant effect on KOOS scores at 2 years after ACLR. Patients whose graft was fixed at a knee flexion angle of 0° had greater scores on the MAS (mean 9.6 95% confidence interval [CI] 8.5 to 10.6, versus 8.0, 95% CI 6.9 to 9.1; P= .04), and a greater proportion achieved the minimal clinical important difference (MCID) for the KOOS pain subdomain (94% versus 81%; P= .04). There was no significant difference in knee extension loss, KT-1000 measurements, or reoperation between the 2 groups. In the setting of anatomic single-bundle ACLR using patellar tendon autograft and anteromedial portal femoral drilling, there was no difference in KOOS scores between patients fixed at 0° and 30°. Patient fixed in full extension did demonstrate higher activity scores at 2 years after surgery and a greater likelihood of achieving the MCID for KOOS pain. II, prospective randomized trial.

Cortical Bone Trajectory Pedicle Screw Fixation in Surgical Treatment of Monosegmental Pyogenic Lumbar Spondylodiskitis.

Pedicle screw fixation has been widely used in surgical treatment for infective lumbar spondylodiskitis to prevent instability and deformity. The cortical bone trajectory pedicle screw (CBTPS) fixation is a minimally invasive posterior spinal fixation system that runs from the pedicle's entry point of the caudiomedial region toward the cephalad-divergent direction. Successful results with CBTPS fixation have been reported to treat degenerative and osteoporotic spinal diseases. This study aims to investigate the clinical feasibility of CBTPS in the surgical treatment of pyogenic lumbar spondylodiskitis. We retrospectively retrieved 20 consecutive patients from two academic centers who were surgically treated for monosegmental lumbar pyogenic spondylodiskitis. The primary surgical treatment was the anterior lumbar interbody fusion with decompression, debridement, and reconstruction using an autogenous iliac strut bone graft. One to 2 weeks after the primary surgery, patients underwent a second surgery for posterior instrumentation using conventional pedicle screws (CPS; group I) and CBTPS (group II). Radiographic parameters of the deformity angle at the fusion segment and clinical parameter of visual analog scale (VAS) scores were assessed preoperatively, postoperatively, and at the last follow-up. There were 10 patients in each group. The mean follow-up periods of groups I and II were 51.10 ± 6.95 and 28.60 ± 9.31 months, respectively. Intergroup analysis indicated the two groups area age-matched (p = 0.38), but initial C-reactive protein (CRP; mg/dL, p = 0.04), CRP normalization (months, p = 0.00), and follow-up duration (months, p = 0.00) were heterogeneous. Meanwhile, deformity angles (segmental lordosis) between the two groups were not significantly different preoperatively (p = 0.25), postoperatively (p = 0.13), and at last follow-up (p = 0.38). The intragroup analysis indicated a significant postoperative increase of lordosis in both group I and II (p = 0.00 and 0.04, respectively) with subsequent subsidence. Lordosis remained increased at the last follow-up with or without significance (group I, p = 0.02; group II, p = 0.62). Both groups showed significant improvement in VAS scores (group I, p = 0.00; group II, p = 0.00). In monosegmental lumbar spondylodiskitis, posterior stabilization of the anterior strut bone graft by CBTPS and CPS was comparable via the radiographic parameter of segmental lordosis or deformity angle. Our observation suggests the clinical feasibility of CBTPS in the treatment of relatively mild monosegmental pyogenic lumbar spondylodiskitis.

In Vivo Supportive Effects of Mesenchymal Stem Cells on Fat Graft Stabilization and Local Induction of Angiogenesis Are Not Dependent on the Cell Donor Age or In Vitro Cell Culture Duration.

Mesenchymal stromal cells from adipose tissue (adipose stromal cells, ASCs) are regulators of repair processes in situ by paracrine mechanisms. These unique capabilities make ASCs candidates for the regenerative medicine applications, including cell-assisted lipotransfer method. ASC aging processes have been extensively researched in vitro, there is however limited information about the impact of ASC aging on their biological role in tissue regeneration in vivo. The aim of our study was the research of the possible effects of aging processes of ASCs resulting from the donor age or from in vitro aging during long-term culture (ASC expansion in bioreactors) on their capability to support survival of adipose subcutaneous transplants in rats. The supportive in vivo effects of ASCs from young donors were compared with the effects of ASCs from old donors and ASCs "aged" in long-term in vitro cultures. Fat grafts enriched with ASCs (regardless of their age) retain their volume longer than fat grafts without ASCs supplementation. Vascular expansion in cell-enriched fat grafts was more intense when compared with the controls. It may be concluded that the aging of ASCs does not substantially reduce their ability for the support of the survival of adipose tissue grafts.

EVALUATION OF MINERALIZED PLASMATIC MATRIX DURING SINUS LIFT WITH THE SIMULTANEOUS PLACEMENT OF DENTAL IMPLANTS

Objectives:Mineralized plasmatic matrix is reported to improve the quality of the bone/fibrin mixture, creating a stable and easy to handle homogeneous material. However, few studies evaluate the use of the mineralized plasmatic matrix during sinus lift with the simultaneous placement of dental implants. Purpose: This study evaluated the efficiency or not of MPM compared to the xenograft bone grafting in the maxillary sinus lift. Patients and methods:This study was conducted randomly on patients selected for treatment with a total of sixteen lateral windows sinus lift with simultaneous implant placement. Their ages ranged between 20 and 60 years old. Participating patients were divided into two groups equally and randomly The control group: eightsinus floor elevation was performed using simultaneous implant placement. As a grafting material, Xenograft was used. The study group: eight Sinus floor elevation was achieved with simultaneous implant placement. Xenograft has been used in the form of MPM as a grafting material. CBCT taken before and after sinus augmentation to measure bone volume and height after 1 week of baseline (T0), after 6 months (T1), and after 12 months of baseline (T0) (T2). The Osstell(PT) was used for assessment implant stability at implant insertion (PT0) as well as for loading visit (PT1). Result:A significant difference was observed between the two groups in bone volume (p=0.049). No significant difference was observed between the two groups (p=0.129) in height of graft. Conclusion:MPM eliminated the need for barrier membranes when a guided bone regeneration procedure is considered.The useofMPM as a grafting bone offered greater graft stability and handling.

Failure Analysis of TEVG's I: Overcoming the Initial Stages of Blood Material Interaction and Stabilization of the Immune Response.

Vascular grafts (VG) are medical devices intended to replace the function of a diseased vessel. Current approaches use non-biodegradable materials that struggle to maintain patency under complex hemodynamic conditions. Even with the current advances in tissue engineering and regenerative medicine with the tissue engineered vascular grafts (TEVGs), the cellular response is not yet close to mimicking the biological function of native vessels, and the understanding of the interactions between cells from the blood and the vascular wall with the material in operative conditions is much needed. These interactions change over time after the implantation of the graft. Here we aim to analyze the current knowledge in bio-molecular interactions between blood components, cells and materials that lead either to an early failure or to the stabilization of the vascular graft before the wall regeneration begins.

Bone augmentation with autologous tooth shell in the esthetic zone for dental implant restoration: a pilot study

ObjectivesTo investigate the outcome and short-term follow-up of autogenous tooth shell (TS) grafting for bone augmentation in the esthetic zone, as well as stability and esthetics of implant-supported restoration.Materials and methodsA total of 8 patients with 11 implants in 11 sites were enrolled in this study. All the horizontal and/or vertical bone defects in the esthetic zone were augmented by tooth shells, which were fixed laterally to the residual bone with osteosynthesis screws. The gap between the shell and residual bone was filled with Bio-Oss® granules. Four months after bone augmentation, dimensionally sufficient dental implants were inserted and implants-supported prostheses were made 3 months later. The esthetic outcome was evaluated by pink esthetic score (PES) and white esthetic score (WES) one year after prosthetic restoration. Horizontal ridge width (HRW) was assessed before and immediately after bone augmentation, as well as 4 and 19 months post-augmentation by radiography. The stability and absorption of TS grafts were evaluated at the 4th and 19th months post-augmentation.ResultsThough wound dehiscences occurred in 3 cases, secondary healings were obtained after TS modification and irrigation. The other 5 cases went through uneventful healing during the whole observation period. Radiographic examination showed that HRW was 8.01 ± 0.93 mm (median: 7.80, 95% CI 7.38, 8.64) 4 months after TS augmentation, which was statistically different compared to HRW (2.72 ± 1.73 mm) at the baseline. Mean HRW gain was 5.29 ± 2.03 mm (median: 4.60, 95% CI 3.92, 6.66). Three-dimensional bone volume in all the augmented sites was sufficient for dental implants insertion and prosthetic restoration. Follow-up of one year showed stable marginal bone around dental implants. The implant survival rate was 100%. HRW losses were 0.65 ± 0.43 mm (the 4th month) and 1.05 ± 0.54 mm (the 19th month) compared to HRW immediately after augmentation. The PES and WES of final prosthetic restorations were 8.09 ± 0.70 and 8.91 ± 0.54, respectively.ConclusionsAutogenous tooth shell grafting is a reliable approach for bone augmentation in the esthetic zone for dental implant treatment, allowing for favorable stability and esthetic outcome of implant-supported prosthesis within the one-year follow-up period.

Assessment of sheep knee joint after ACL replacement with Achilles tendon autograft and PLA-based implant

In this study, we propose a new approach in the anterior cruciate ligament (ACL) replacement to provide stability and integration with bone tunnel. A polylactide (PLA)-based tubular implant was used to support the graft stabilization in femoral and tibial bones and to stimulate the healing process after (ACL) replacement on a sheep model. The ACL was replaced with an autologous Achilles tendon split graft. The tendon-to-bone healing in the model was analyzed after 6 and 12 weeks. Two groups of animals were compared, i.e. the group with the PLA-based implant used in the ACL replacement and the control group without the implant. The knee joints were mechanically and clinically evaluated, including the histopathology tests, to determine their stability and integrity. The results indicated that the bioresorbable PLA-based tubular implant may facilitate integration of the tendon graft with bone. Remodeling the allograft inside the implant improves the joint mobility from the first week of healing: no pathological changes were observed at the surgery site and in the animals’ mobility. After 6 and 12 weeks of healing no significant changes in the mechanical parameters of the knee joint were observed, regarding the joint failure force, knee displacement, angular mobility range and joint stiffness. Relatively small values of the non-destructive tests in the knee displacement, already 6 weeks after surgery, indicated the early stabilization of the knee joint. The studies showed that the failure forces of knee joints after the ACL replacement with the PLA-based implant are lower than those of an intact joint, although their biomechanical features, including strain-at- failure, are similar.The biomechanical parameters of the knee joint were significantly improved due to the selected method of attaching the autograft ends to the femoral and tibial bone surfaces. After 12 weeks the intra-tunnel tendon-bone site with the PLA implant revealed the better tibia-femur joint mechanical stability, linear force-strain function and the decreasing strain-to-failure value, as compared to the control group.

Radiographic and Histomorphometric Evaluation of Biomaterials Used for Lateral Sinus Augmentation: A Systematic Review on the Effect of Residual Bone Height and Vertical Graft Size on New Bone Formation and Graft Shrinkage.

The aim of the present systematic review was to investigate the effect of residual bone height (RBH) and vertical bone gain on new bone formation (NBF) and graft shrinkage after lateral sinus lifts using different biomaterials. Methods: An electronic search was conducted on three databases to identify randomized controlled trials (RCTs) published until January 2021 with at least one follow-up at 6 months and at least five patients treated, comparing biomaterials used for maxillary sinus augmentation with a lateral approach. Graft volumetric changes, RBH, vertical bone gain, implant failure, and post-operative complications were evaluated. The risk of bias was assessed using the Cochrane tool. Results: We used 4010 identified studies, of which 21 were RCTs. Overall, 412 patients and 533 sinuses were evaluated. Only three publications had an overall low risk of bias. After 6 months, xenograft (XG) showed the least volume reduction (7.30 ± 15.49%), while autogenous graft (AU) was the most reabsorbed (41.71 ± 12.63%). NBF appeared to not be directly correlated with RBH; on the contrary, the overall linear regression analysis showed that NBF significantly decreased by 1.6% for each mm of postoperative vertical graft gain. This finding suggests that the greater the augmentation, the lower the NBF. A similar tendency, with a regression coefficient even higher than the overall one, was also observed with alloplast (AP) and XG. Conclusions: The present results suggested that NBF was essentially independent of preoperative bone height. On the contrary, the smaller the volume was of the graft placed, the higher the amount of new bone formed, and the smaller the graft shrinkage was. Minimizing the augmentation volume might be beneficial to graft healing and stability especially when using AP and XG.

Arthroscopic proximal carpal row replacement by semitendinosus and gracilis graft (CArpus Row Plasty Using the Semitendinosus: CARPUS procedure). An anatomical study of 16 cases

IntroductionPost-traumatic lesions of the carpus (scapholunate rupture, scaphoid non-union) frequently evolve into disabling osteoarthritis (scapholunate advanced collapse or scaphoid non-union advanced collapse: SLAC or SNAC wrist). Proximal row carpectomy (PRC) is a reliable option but with poorer prognosis in case of osteoarthritis of the distal radius or capitate head. In such situations, radiocarpal arthrodesis may be necessary, sacrificing wrist motion. To circumvent this limitation, we propose a new procedure consisting in arthroscopic PRC and replacing the proximal row by tendon graft. MethodsThis was a study on 16 cadaver specimens. A scapholunate pin was introduced via an approach into the anatomical snuffbox and used as a guide for a cannulated drill bit (9mm) to create a tunnel through the proximal row. The arthroscope and a reamer were introduced into the tunnel via its radial and ulnar ends. PRC was performed under arthroscopic control. The gracilis and semitendinosus tendons were harvested and folded so as to obtain a graft with the same length and diameter as the proximal row. The graft was threaded through the radial approach and fixed to the capsule. ResultsMean procedure time was 68min. There was no pre- to postoperative difference in joint motion or carpal height. On radiocinematography, the graft was stable between the radius and the second row of the carpus. The radial and ulnar sensory branches, median nerve and radial artery were intact at end of procedure. DiscussionThis technique could be a solution in SLAC or SNAC wrist with osteoarthritis of the capitate head or radial glenoid. It also conserves carpal height. Being arthroscopic, the procedure avoids the major edema observed after a dorsal approach of the carpus, and also ensures graft stability, since the radiocarpal ligaments are conserved. Harvesting from a second anatomical site and the in vivo fate of the transplant are two issues that need to be discussed. ConclusionThis anatomical study paves the way for clinical experimentation. Level of evidenceIV.

Comparison of Polymeric Cyanoacrylate Adhesives with Suturing in Free Gingival Graft Stability: A Split Mouth Trial.

The aim is to compare the use of Cyanoacrylate adhesives (CAA) to the conventional suturing technique in terms of free gingival grafts (FGG) stability and healing in lower anterior and premolar regions. A split mouth design was initiated on 22 participants. Each side (from 2nd premolar to central incisor) was randomized to either the control or test groups. In the control group, sutures were used to stabilize the FGG, while, in the test group, the FGG was stabilized with butyl-cyanoacrylate. Full-periodontal clinical parameters were employed to assess the periodontal health. FGG-related parameters assessed included the keratinized tissue width (KTW), gingival tissue thickness (GTT), FGG shrinkage% and pain using the VAS score. No significant differences in the mean values of the KTW nor FGG shrinkage% across six time points (p < 0.05) were observed, whereas highly significant differences in the mean values of GTT across six time points (F = 3.32; p = 0.008) were observed. The use of CAA in FGG stability and healing is comparable to conventional suturing for soft tissue grafts in terms of success outcomes. With its cost effectiveness, lesser time consumption, post-operative pain and comparable graft stability and dimensions, the use of CAA may be a promising alternative for conventional and microsurgical techniques for the stabilization of FGG in the oral cavity.

Long-Term Stability of Alveolar Bone Graft in Cleft Lip and Palate Patients: Systematic Review and Meta-Analysis.

Alveolar bone grafts are the golden standard in treating patients with oral cleft and hence, the long-term success of this treatment is the subject of many studies. The aim of this study was to systematically review literature that examined the long-term stability of alveolar bone grafting in patients with cleft lip and palate. In this study, data was collected via a comprehensive search of random and nonrandom studies evaluating the success of bone grafts in patients with cleft lip and palate in ISI Web of Science, EMBASE, Scopus, Medline, and Cochrane Central Register of Controlled Trials from the beginning until July 3, 2020. Also, a search was conducted for ongoing studies in the trial registry and a hand search of related gray literature and references of the relevant studies. The relevant data of the included studies were extracted using predefined extraction forms. Meta-analysis was performed using inverse-variance for calculating the pooled outcome of outcome measures. The pooled mean success rate of alveolar bone graft and mean difference of cleft volume after 1 year was presented as the outcome of the analysis. Eight studies (1 randomized clinical trial study and 7 controlled prospective studies) were included in this meta-analysis. The results of the analyses showed that the total percentage of secondary alveolar success in the follow-up period of at least 1 year according to the Bergland index was 76.52% (pooled success = 76.52%, 44.92-98.10). Also, bone defect in the cleft area reduced significantly after bone grafting (MD = 0.62 cm3, 0.48-0.75, P < 0.00001). The total percentage of bone filling after 1 year and according to CBCT (cone beam computed tomography) was about 63.38%, and the rate of definite natural eruption of canine within the graft was 80.89%. The total success rate of secondary alveolar bone grafting in the follow-up period of at least 1 year was clinically significant and alveolar bone grafting significantly reduced bone defect volume. Also, there was no difference in the amount of bone remaining after 1 year in patients whose canine had erupted through the grafted bone and in those whose canine had not erupted.

All-Inside Arthroscopic Anterior Cruciate Ligament Reconstruction and Internal Brace With Recycling Suture

Anterior cruciate ligament (ACL) rupture is a common injury of the knee. Arthroscopic ACL reconstruction is a standard treatment for this condition. All-inside ACL reconstruction has many advantages compared with conventional techniques. However, there are still concerns regarding graft elongation and stability with all-inside ACL reconstruction. Here, we propose an arthroscopic technique using the shortening strands of a flexible suspensory button as an internal brace. This method provides the advantages of increased stability and ACL graft protection while using the same implant as the all-inside ACL reconstruction technique.

Double Layer Lateral Crural Perichondrial Flap for Coverage and Stabilization of Tip Graft.

Tip plasty is the most important step of rhinoplasty. To achieve symmetrical cartilages with ideal tip rotation, projection and supratip break many techniques were defined. Besides suture techniques, tip grafts still maintain their importance and widely used among surgeons. However, graft visibility and distortion are the main drawbacks of this technique. In this study double-layered lateral crural perichondrial flap technique was introduced to prevent graft visibility and distortion as a novel technique. A total of 16 patients who underwent rhinoplasty with this novel technique were enrolled in this retrospective study. Patient satisfaction was assessed with Rhinoplasty Outcome Evaluation Questionnaire (ROE-Q). Graft visibility and asymmetry of tip defining point as an indicator of graft distortion were evaluated by two independent Plastic, Reconstructive and Aesthetic surgeons. Pre and postoperative photographs were taken and used for evaluation. A three-point Likert scale was used for assessment. Cohen's Kappa statistic and percent agreement test were usedtotest inter-rater reliability RESULTS: The mean follow-up time was 15 months (ranging between 12 and 19 months). According to the ROE-Q score, the mean total preoperative score was 6,25 and the mean total postoperative score was 18,06 (p<0,05). No or minimal evident graft visibility and asymmetry of tip defining point was observed in 12 patients and 10 patients, respectively. Mild evident graft visibility was observed in only 1 patient with thin skin. Severe evident graft visibility or asymmetry of tip defining point was not observed in none of the patients. The double-layer crural perichondrial flap was an effective and sufficient method for preventing graft visibility and graft distortion. Features like easy and fast flap elevation, no additional comorbidity, being autologous tissue and sufficient flap length and thickness make this technique valuable and useful. This journal requires that authors assign a level of evidence to each article. 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 .

Direct Perfusion Improves Redifferentiation of Human Chondrocytes in Fibrin Hydrogel with the Deposition of Cartilage Pericellular Matrix

Articular cartilage has limited potential for self-repair, and cell-based strategies combining scaffolds and chondrocytes are currently used to treat cartilage injuries. However, achieving a satisfying level of cell redifferentiation following expansion remains challenging. Hydrogels and perfusion bioreactors are known to exert beneficial cues on chondrocytes; however, the effect of a combined approach on the quality of cartilage matrix deposited by cells is not fully understood. Here, we combined soluble factors (BMP-2, Insulin, and Triiodothyronine, that is, BIT), fibrin hydrogel, direct perfusion and human articular chondrocytes (HACs) to engineer large cartilage tissues. Following cell expansion, cells were embedded in fibrin gels and cultivated under either static or perfusion conditions. The nature of the matrix synthesized was assessed by Western blotting and immunohistochemistry. The stability of cartilage grafts and integration with native tissue were also investigated by subcutaneous implantation of human osteochondral cylinders in nude mice. Perfusion preconditioning improved matrix quality and spatial distribution. Specifically, perfusion preconditioning resulted in a matrix rich in type II collagen but not in type I collagen, indicating the reconstruction of hyaline cartilage. Remarkably, the production of type VI collagen, the main component of the pericellular matrix, was also increased, indicating that chondrocytes were connecting to the hyaline matrix they produced.

Evaluation of early bone recovery in grafted jaw with anterior iliac bone: a retrospective study

Aims Atrophic jaws make implant planning difficult due to the lack of bone, and this situation directs the surgeon to advanced surgical methods. Today, autogenous grafts are still the gold standard. The aim of this study was to evaluate the bone stability of horizontal bone grafts taken from the iliac crest. Materials and metods Twenty patients receiving horizontal bone grafts were included in this retrospective cohort study. All patients were treated with bone harvested from the anterior iliac crest. The measurements were made by means of a caliper. Screw heads reference point taken. Resorption rate was followed up in a total of 188 edentulous areas. Results Graft resorption rate was 34.66% (± 20.53), 32.42% (± 19.39) in the maxilla and 48.03% (± 22.34) in the mandible. It was observed that the average bone thickness increased from 2.38 mm to 7.22 mm. Conclusions The result of the present study highlight that thicker block grafts, which were applied due to the expected resorption rate, result in a higher resorption rate after recovery. Therefore, by considering soft tissue margins, the importance of harvesting a sufficient, but not excessive, amount of grafting is underscored.

Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Background: The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable. Hypothesis: Compared with bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies. Results: A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure (P = .36), the International Knee Documentation Committee (IKDC) subjective score (P = .39), or the side-to-side difference in stability (P = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; P < .001). No significant differences in graft failure (P = .57), the IKDC subjective score (P = .25), or the side-to-side stability difference (P = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; P = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies. Conclusion: The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly lower with the QT autograft than with BPTB and HT autografts.

Transplantation of 3D bio-printed cardiac mesh improves cardiac function and vessel formation via ANGPT1/Tie2 pathway in rats with acute myocardial infarction

A novel tissue engineering strategy using 3D bio-print technology has become a promising therapeutic method for acute myocardial infarction (AMI) in an animal model. However, the application of 3D bio-printed tissue remains limited due to poor graft survival. Therefore, it is a scientific priority to enhance graft survival by precisely adjusting the 3D environment of encapsulated cells. In this study, novel transplantable 3D cardiac mesh (cMesh) tissue with a porous mesh structure was presented using human cardiomyocytes, human cardiac fibroblasts, and gelatin-methacryloyl–collagen hydrogel. Cardiomyocytes and cardiac fibroblasts were well spreaded. The cardiomyocytes were connected with a gap junction channel in bio-printed cMesh and a 3D cardiac patch with an aggregated structure. Porous cMesh demonstrated structural advantages by increased phosphorylation of mTOR, AKT, and ERK signals associated with cell survival. Transplanted cMesh in rats with AMI improved long-term graft survival, vessel formation, and stabilization, reduced fibrosis, increased left ventricle thickness, and enhanced cardiac function. Our results suggest that porous cMesh provides structural advantages and a positive therapeutic effect in an AMI animal model.

THE ONE-STAGE PREMAXILLARY REPOSITIONING AND BONE GRAFT ALVEOLOPLASTY IN BILATERAL ALVEOLAR CLEFT; A PRELIMINARY STUDY

Background: The bilateral alveolar cleft associated with markedly prominent premaxillary segment always possessed a surgical challenge because of the paucity of local flaps for watertight closure and high bone graft alveoloplasty failure rate. The orthodontic workup alone to mold unrestricted growing premaxillary segment could not optimize its position with the unfavorable functional and aesthetic outcome. In addition, the repeated surgical intervention may add burden on patient suffering and affect maxillary growth rate.Objective: Evaluation of the premaxillary viability, position, bone graft stability, and early growth after simultaneous premaxillary repositioning and alveolar bone grafting in alveolar cleft patients. Patients & Methods: Seven patients aged between 6 and 11 years were subjected to perioperative orthodontic workups to optimize the position of the premaxilla for its surgical correction before bone grafting. Then, the simultaneous premaxillary repositioning and bone graft alveoloplasty technique was done. Surgical indications, contraindications with orthodontic role were evaluated and discussed. Results: This prospective clinical study presents the outcome of seven consecutive pediatric patients who complained of alveolar clefts with severe premaxillary segment protrusion. It was conducted during the period between 2014 and 2020 in the Plastic Surgery Department-Aswan University Hospitals. The results were assessed by clinical examination and cephalometric tracing for at least two years for evaluating the premaxillary position, functional outcome, upper jaw stability, and early growth affection. Conclusion This technique proved to be a safe procedure in appropriately selected patients. It can produce an early stable maxillary arch with good aesthetic results besides less surgical interventions. No relapse or significant complications were documented. Clinical relevance The treatment of wide bilateral cleft alveolus patients is still based on experience and expert opinions. This preliminary study deals with markedly protruded premaxilla with bilateral alveolar cleft by combined orthodontic and one-stage premaxillary repositioning with bone graft alveoloplasty. An extended study period assessment for midfacial and maxillary growth is necessary to continue until adulthood or beyond.