COMMENTARY

A 'Game Changer' for Patients With Joint Damage?

James P. Stannard, MD

Disclosures

April 17, 2015

Editor's Note

Currently, physicians must discard over 80% of donated tissue used for joint replacements because the tissue does not survive long enough to be transplanted. Now, following a recent study, University of Missouri School of Medicine researchers have developed a new technology that more than doubles the life of the tissue. This new technology was able to preserve tissue quality at the required level in all of the donated tissues studied, the researchers found.

"It's a game changer," says study coauthor James Stannard, MD, chair of MU's Department of Orthopaedic Surgery and medical director of the Missouri Orthopaedic Institute in Columbia. "The benefit to patients is that more graft material will be available and it will be of better quality. This will allow us as surgeons to provide a more natural joint repair option for our patients."

The technology more than doubles the storage life of bone and cartilage grafts from organ donors compared with the current preservation method used by tissue banks.

Medscape asked Dr Stannard to explain the novel system, which was presented in Clinical Orthopaedics and Related Research, a publication of the Association of Bone and Joint Surgeons, in November 2014.[1] His discussion follows.

Overcoming the Limitations of Osteochondral Allografting

Osteochondral allografting (OCA) is a biologic technique that can functionally restore even very large articular cartilage defects with viable hyaline cartilage and subchondral bone. This method has been in use clinically for more than 30 years, primarily in the knee.

Numerous studies have reported that osteochondral allografts are associated with 10-year survivorship between 71% and 85%, and up to 74% at 15 years. Overall, outcomes after osteochondral allograft treatment have been good to excellent, even in the athletic population in which 88% of patients returned to sport. In fact, 79% return to their pre-injury level of sport.

Although OCA has proven clinical safety and efficacy, its use is limited by availability and logistical issues involving graft procurement, disease testing, and storage before implantation. These issues depend on the relatively short time for which sufficient chondrocyte viability in the grafts can be maintained using current tissue storage protocols. Chondrocyte viability has been reported to be critically important for maintaining the biochemical and biomechanical properties of osteochondral allografts, which correlate directly to the clinical success of the surgery.

Several storage methods have been investigated to try to optimize chondrocyte viability, with each showing noticeable declines in chondrocyte viability after day 14, falling below acceptable levels (typically considered to be 70% viable cells) by 28 days after procurement.

Mandatory disease testing procedures require 14 days before tissues can be released from the tissue bank to the surgeon for implantation. As such, a narrow window of time (eg, 14 days) for size matching, scheduling surgery, and transporting tissues exists to allow for optimal use of donor tissues.

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