Affiliation:
1. Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Abstract
Background: Distal femoral osteochondral allograft transplantation (OAT) is an effective treatment of osteochondral lesions in the knee measuring >2 cm2 in select patients. Prior studies have demonstrated that the morphology of the plug can affect graft-host interference fit. To our knowledge, there are no data comparing the initial biomechanical stability of standard cylindrical plugs with multiple-plug and oblong-plug morphologies. Hypothesis: Large cylindrical single-plug (LCSP) and oblong single-plug (OSP) grafts will have greater pull-out strength, and therefore greater initial stability, than multiple-plug (MP) grafts in a cadaveric porcine femur model. Study Design: Controlled laboratory study. Methods: A total of 55 porcine distal femurs were divided into 3 groups—LCSP (n = 18), OSP (n = 19), and MP (n = 18)—according to the plug morphology used. The method of graft harvesting and implantation was based on technique guides for the respective implant systems. The sizes (length × width × depth) of the osteochondral defects created in each of the groups were approximately 20.2 × 20.2 × 9.4–mm for the LCSP group, 14.4 × 30.5 × 7.9–mm for the OSP group, and 14.8 × 14.8 × 9.9–mm for the MP group. Tensile testing was performed on each graft to determine pull-out strength. Results: The pull-out strength was significantly lower in the OSP group (65.7 N) versus the LCSP (133 N; P = .0005) and the MP (117.6 N; P = .001) groups. There was no statistically significant difference in pull-out strength between the LCSP and MP groups ( P = .42). There were no statistically significant differences in displacement at maximum load among any 2 of the 3 groups. Conclusion: These findings suggest that while initial stability may play a role in the clinical outcomes of osteochondral allograft (OCA) implantation, the biological milieu in vivo for each graft setting perhaps has a greater impact on the success of an OAT procedure. Further study is needed on the relationship between OCA biomechanics and clinical outcomes of OAT.
Subject
Orthopedics and Sports Medicine
Cited by
3 articles.
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