Use Of Allograft Material Research Articles

Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction.

Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction.

Total hip arthroplasty in patients with fibrous dysplasia: a modern update.

Fibrous dysplasia (FD) results from an abnormality in lamellar bone formation and most frequently involves the proximal femur. This can lead to the development of osteoarthritis requiring total hip arthroplasty (THA). Such cases are challenging, and there is a lack of information guiding best management. As such, we devised a study assessing the outcomes and complications in patients with FD undergoing THA with modern implant technology, and we outlined our preferred surgical technique. A search of our institutional arthroplasty database was performed to identify patients who underwent THA for FD between January 2001 and July 2018 at Mount Sinai Hospital in Toronto, Canada. Data regarding implants used and the use of allograft material or metal augments or both were obtained. Complications and revision requirements were noted. Radiographic and clinical leg length discrepancies were assessed. A total of 10 hips in 9 patients who underwent THA for FD were identified. Mean follow-up time was 6.0 years (range 0.5 to 10.3 yr). The majority of patients underwent THA using uncemented femoral and acetabular components with large femoral heads on highly cross-linked polyethylene liners. Most cases (80% of hips) required allograft to the proximal femur. A single complication requiring revision was noted. In 90% of hip surgeries, the patient required transfusion of packed red blood cells. Mean radiographic and clinical leg length discrepancies were 0.9 cm (range -2.4 to 2.4 cm) and 0.9 cm (range -4 to 0 cm), respectively. Contrary to previous reports, low complication and revision rates were observed with cementless components and routine use of allograft material. The challenging nature of such cases warrants use of an experienced arthroplasty treatment team.

Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm.

To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on current best evidence and surgeon experience. Recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews and meta-analyses. These studies have focused on understanding how lesion characteristics such as size, location, and appearance on advanced imaging can predict treatment success. Current literature continues to support nonoperative management for stable lesions. Operative intervention is generally required for unstable lesions and treatment strategies are largely dictated by lesion size and location: debridement or reparative techniques for small lesions while larger lesions or those in high-stress locations are better served by bone and/or cartilage restoration procedures. There has been a rising interest in the use of allograft materials and cell-based therapies. Overhead athletes are uniquely predisposed to capitellar OCD due to the nature of forces applied to the radiocapitellar joint during repeated activity in the overhead position. Despite improvements in operative techniques, successful use of alternative graft materials, and a better understanding of how lesion characteristics influence results, there is still much to learn about this challenging disorder. Future research should focus on comparing operative techniques, refining their indications, and further developing a reliable treatment algorithm that best serves the overhead athlete.

Prevention of Frey syndrome

Frey syndrome (gustatory sweating) is a common and often times significant consequence of parotid gland surgery. The classic signs and symptoms include facial sweating, flushing, rubor, and sensation of heat over the preauricular region during oral stimulation. These clinical findings may provoke quality of life changes, and thus, are considered significant. Both surgical and nonsurgical treatment modalities have been advanced in the treatment of this disorder. Surgical treatment is aimed at prevention of the development of Frey syndrome and consists of a constellation of techniques which are designed to interpose tissue in the parotid surgical bed to act as a barrier to prevent aberrant parasympathetic fiber ingrowth and innervation to facial skin eccrine sweat glands. These techniques include: limiting the extent of parotid surgery when possible, use of local tissue as advancement or rotational flaps, autologous transfer of tissue, and use of allograft material.

A Modified Technique for Occipitocervical Fusion Using Compressed Iliac Crest Allograft Results in a High Rate of Fusion in the Pediatric Population.

In children, high rates of occipitocervical (OC) fusion have been demonstrated with the use of rigid instrumentation in combination with harvested autograft, with or without bone morphogenetic protein (BMP). Historically, the use of allograft materials demonstrated inferior OC fusion outcomes compared with autograft. However, autograft harvest harbors an increased risk of patient morbidity, and the use of BMP is costly and controversial in children. Thus, there remains a need for safer, less costly, yet efficacious techniques for OC fusion in the pediatric population. We retrospectively reviewed the charts of patients younger than 21 years of age who underwent OC fusion with structural allograft placement at our institution from 2010 to 2015. Data collected included age, sex, follow-up duration, fusion outcomes, and postoperative complications. A total of 19 patients (8 female and 11 male) underwent OC fusion with our surgical technique. Mean age was 8.5 ± 4.3 years. Radiographic follow up data were available for 18 of 19 patients. One patient was lost to clinical follow up but had radiographic confirmation of fusion. Thus, 18 of 18 (100%) of patients with radiographic follow-up achieved successful arthrodesis as determined by computed tomography. Median duration to documented fusion was 4.5 months. Clinical follow-up was available for 17 of 19 patients and was on average 18.8 ± 13.5 months. One patient required reoperation for graft fracture 8 months after radiographic confirmation of successful fusion. There were no vertebral artery injuries or other postoperative complications. We demonstrate a modified technique for OC fusion in children with unique structural allograft shaping and affixation, leading to excellent fusion outcomes at follow up. This technique obviates the need for autograft harvest or BMP, and may decrease postoperative morbidity.

Safety of cyanoacrylate-based adhesives in creating layered septal cartilage grafts during open structure septorhinoplasty

PurposePatients having suffered severe nasal trauma or having undergone prior septal surgery present particular problems during open structure septorhinoplasty. Septal cartilage deficient noses often require costal or conchal cartilage grafting or the use of allograft material, resulting in secondary donor site morbidity, longer operative times and variable results. The present study evaluated the utility of cyanoacrylate-based adhesives (CBA) in creating layered septal cartilage grafts from remnant septal cartilage for L-strut reconstruction during open septorhinoplasty. Study designA retrospective clinical review was performed at a university-based facial plastic and reconstructive surgical practice, identifying patients undergoing open structure septorhinoplasty performed by the senior authors. Procedures involved construction of a layered caudal or dorsal L-strut graft from at least two smaller autologous septal cartilage grafts. The grafts were adhered together with CBA with 5-0 polydioxanone suture (Ethicon, Somerville, NJ) used for reinforcement. Stability of the final construct was assessed postoperatively. ResultsFifteen patients were included with mean age of thirty-nine years (range: 15–65). Fifty-three percent of the patients had undergone prior nasal surgery: Seven had undergone at least one prior external septorhinoplasty and one had undergone prior endonasal septoplasty. Median follow-up was 144 days (range: 45–405). Postoperatively, one local infection was noted and two patients complained of post-operative columellar deviation. No other complications were encountered. ConclusionCBAs provide a safe technique in the crafting of layered grafts to provide reliable tip/dorsal support when performing open structure septorhinoplasty among patients with cartilage deficient or severely traumatized septa.

Allograft Materials in Phalloplasty

Allograft use has increased recently with the rising use of allograft materials in breast surgery. There are few data that compare the performance of the various allograft materials in this application, despite marketing efforts by the manufacturers to present one allograft material as superior to another. Phalloplasty is a procedure that uses allografts for penis girth augmentation. Preparation of these grafts differs with each manufacturer. We report our experience with 3 different types of allografts for this procedure. This allows for the comparison of these materials in their performance with a single model. Forty-seven patients who underwent penis girth enhancement with allograft material were reviewed. All patients underwent circumferential grafting to the shaft of the penis at the level of Buck's fascia. Graft materials included AlloDerm (n = 9), Belladerm (n = 20), and Repriza (n = 21). Charts were reviewed for material type, presence and type of infection, wound exposure, and graft loss with attention to the type of allograft material that was used. Follow-up ranged from 1 to 120 months with an average of 11.25 months. Infection, defined as an open wound with graft exposure, occurred in 20 (42%) of 47 patients. Of these, graft exposure only occurred in 17 (36%) patients, whereas 3 (6%) patients sustained total graft loss. Graft exposure or loss occurred in 3 patients who had AlloDerm, 9 patients with Belladerm, and 8 patients with Repriza. No patients with AlloDerm sustained graft loss, whereas 2 patients with Belladerm and 1 patient with Repriza sustained graft loss. There were no statistical differences among these graft types with regard to infection or graft loss. Three different brands of allograft material were used in 1 surgical procedure and followed up for their performance with regard to exposure and infection. In this model, there is no difference in the rate of infection in these materials despite their different methods of preparation. Implications of this fact are discussed in the approach surgeons should consider when using these materials.

Pediatric Coronary Allograft Vasculopathy-A Review of Pathogenesis and Risk Factors

Coronary allograft vasculopathy is the current leading cause for late graft loss following cardiac transplantation. Its pathogenesis is multifactorial, including immune, constitutional and genetic factors, metabolism, infection, as well as potential injury from routine immunosuppressive therapy. Children represent a patient group with unique differences: their pretransplant history rarely includes ischemic heart disease and risk factors for atherosclerotic heart disease, but many are presensitized from use of allograft material during reconstructive cardiac surgeries. Compared with older children and adults, infants and young children show significantly lower rates of graft vasculopathy that may be related to the relative immaturity of their immune system. This review summarizes the current concepts of coronary allograft vasculopathy derived mainly from animal models and adult clinical observations. It provides an overview of confirmed risk factors and explains their interactions. The characteristics and unique clinical findings among pediatric transplant recipients will be explored within the context of recent, albeit limited, scientific investigations.

Effect of Graft Selection on the Incidence of Postoperative Infection in Anterior Cruciate Ligament Reconstruction

Background Knee joint infection is a potentially devastating complication of anterior cruciate ligament (ACL) reconstruction. There is a theoretical increased risk of infection with the use of allograft material. Hypothesis An allograft ACL reconstruction predisposes patients to a higher risk of bacterial infection. Study Design Cohort Study; Level of evidence, 3. Methods All primary ACL reconstructions performed at our institution between January 2002 and December 2006 were reviewed; 3126 total procedures were identified. A retrospective medical record review was performed to determine the incidence of infection, offending organism, time after surgery until presentation, infection treatment, and graft salvage as an outcome of graft choice. Results Of the 3126 ACL reconstructions, 1777 autografts and 1349 allografts were performed. Eighteen infections were identified (0.58%). Infections occurred in 6 of the 1349 allografts (0.44%), 7 of the 1430 bone-patellar tendon-bone (BPTB) autografts (0.49%), and 5 of the 347 hamstring autografts (1.44%). Five grafts were removed because of graft incompetence or loosening: 3 hamstring tendon, 1 BPTB, and 1 allograft. The most common organism isolated was Staphylococcus aureus. Hamstring tendon autograft had an increased incidence of infection compared with both BPTB autograft and allograft (P < .05), with a trend toward a more common need for graft removal (P = .09). Allograft reconstructions were equally likely to have graft salvage as autograft reconstructions. Conclusion Hamstring tendon autografts have a higher incidence of infection than BPTB autografts or allografts. The use of allograft material in ACL reconstructions does not increase the risk of infection or the need for graft removal with infection.

Factors Affecting Patient Selection of Graft Type in Anterior Cruciate Ligament Reconstruction

The purpose of this study was to assess factors associated with patient selection of graft type for anterior cruciate ligament (ACL) reconstruction. We retrospectively identified 1,038 patients who underwent ACL reconstruction over a 5-year period. Surgery was performed by 5 different surgeons. A questionnaire was sent to patients at a minimum of 24 months' follow-up to determine which type of graft was used, why they chose that graft, whether they were satisfied with their graft and outcome, and whether they would choose another graft and, if so, which one; it also included a visual analog scale to rate their recovery. Questionnaires were received from 240 patients. The mean follow-up from the time of surgery was 41.3 months (range, 24 to 96 months). There were a variety of allografts and autografts used. Overall, allograft was used in 63.3% of patients and autograft in 35.4%. The most common factor influencing graft selection was physician recommendation (74.2%). Patients rated their recovery on average as 8.48 (+/-1.8) out of 10 on the visual analog scale (range, 0 to 10). Of the patients, 93% were satisfied with their graft selection. Only 12.7% would choose another graft if in the situation again. Of these patients, 63.3% would change from an autograft to allograft. This study suggests that the most important factor for a patient choosing a graft for ACL reconstruction is physician recommendation. Our study has shown an increasing trend in our group toward the use of allograft materials for ACL reconstruction (63.3% of all graft materials selected). Of the individuals who were dissatisfied with their graft, 63% who originally chose autograft would choose allograft as a source in the future. Level III, prognostic case-control study.

Meniscus Replacement: From Allograft to Tissue Engineering

Summary The surgical treatment of meniscal lesions is the most common procedure in the orthopaedic field today. The majority of these lesions results in a (partial) meniscectomy while only a small percentage can be successfully repaired. Meniscus substitution by an allograft has been shown to result reliably in satisfactory clinical results in a high number of meniscectomized patients. A chondroprotective potential has been observed in a subpopulation of these patients. Because of drawbacks related to the use of allograft material, tissue engineering has gained interest in the scientific field. The authors present their clinical and biological experience using viable and deep frozen meniscus allografts and more novel techniques such as meniscus scaffold in the treatment of partial and total meniscus defects.

Cancellous bone donor site regeneration.

Patients requiring cancellous bone grafting of an extensive deficit or multiple grafting procedures often lack a sufficient quantity of autogenous cancellous donor bone. This study was designed to determine the potential for reharvesting autogenous cancellous bone donor sites in a canine model. Fixed-sized cancellous bone grafts were harvested from the ilium of 12 mature, conditioned dogs. Ilia containing the donor sites were removed from groups of 3 dogs at intervals of 6 weeks, 3 months, 6 months, and 1 year. The donor sites were evaluated by roentgenograms, histology, and histomorphometric analysis and were compared to the opposite, nonoperated ilia, which served as controls. The analysis revealed a gradual replacement of the surgical defect with new cancellous bone by 1 year. Donor site reharvesting is a potential alternative to multiple site grafting or the use of allograft material.

Human lymphocyte reaction to freeze-dried allograft and xenograft ligamentous tissue

Decisions made before reconstruction of the ACL include patient selection, choice of operative procedure, and selection of proper reconstructive material. Research in the use of allograft material for reconstructive grafts is of great interest for many reasons, including the advantage of not violating the patient's normal anatomy for donor tissue. A group of eight patients who received arthroscopically inserted freeze-dried bone-patellar tendon-bone allograft tissue for ACL reconstruction were selected for a prospective study. These patients were matched against a group of four autograft controls. Immunologically, the lymphocyte blast transformation test was used to evaluate the host reaction to implanted donor graft. Lymphocytes drawn from each patient were tested for their reaction against a panel of human allograft tendon and goat xenograft tendon homogenates. A stimulation index of greater than 3 was considered a positive reaction. It was hypothesized that a consistent lack of antigenicity would be observed with allograft extracts and that an antigenic reaction would be observed with the xenograft extracts. Six patients (75%) showed an immunologic reaction to the goat xenograft, and four patients (50%) showed an immunologic reaction to at least one human allograft test cell after allograft insertion. One patient had such an intense clinical immunologic response that she required removal of the allograft. All four of the autograft controls had a nonimmunogenic response to testing, as had been expected.(ABSTRACT TRUNCATED AT 250 WORDS)