Donor bone + own bone marrow
Biological restoration of joints using donor tissue instead of traditional metal or plastic implants may be a good option for active patients with joint injuries.
Despite the fact that joint integration after biological recovery usually takes longer than after traditional interventions, if successful, this procedure allows patients to return to full activity. However, in some cases, the transplanted bone does not take root properly.
Researchers from the University of Missouri School of Medicine, working under the guidance of Dr. James Cook, have found that the processing of donor material with an autologous (proprietary) bone marrow extract concentrate before surgery improves the integration of bone tissue and accelerates recovery.
According to the authors, before surgery, surgeons usually wash the donor bone tissue to remove the bone marrow. After implantation, for the success of the procedure, the recipient's bone tissue must "germinate" into the donor bone. At the heart of this integration is a lengthy process known as "creeping graft replacement," which can drag on for a whole year. The first six months are the most important for successful integration, so the aim of the work was to find approaches that would speed up this process and increase its efficiency.
A preclinical study conducted earlier showed that bone marrow concentrate promotes the infiltration of recipient cells into the donor bone and releases proteins that promote the healing of bone tissue damage.
As part of a clinical study, the authors compared the results of the integration of donor femoral condyles implanted in 17 patients without treatment with bone marrow concentrate with the results of implantation of 29 donor condyles that underwent pretreatment. To do this, they performed an X-ray examination of the patients' joints 6 weeks later, as well as 3 and 6 months after surgery.
6 months after transplantation, the level of integration of bone marrow concentrate-treated bone implants was 43%, whereas for untreated implants, this figure was only 25%. After 3 months, these figures were 67% and 50%, and after 6 months – more than 84% and 74%, respectively.
The bone marrow used for processing the bone implant is taken at the beginning of the operation, after which a concentrate enriched with cells and proteins is extracted from it in laboratory conditions using centrifugation. This concentrate is injected into the donor bone tissue immediately before its implantation into the patient's joint.
The authors note that, despite promising results, the work done has a number of limitations, including the size of the graft. In the future, they hope to reproduce the results obtained on a larger cohort of patients, as well as apply a new approach to the restoration of other joints, including hip, shoulder and ankle.
Article by Lasun O. Oladeji et al. Effects of Autogenic Bone Marrow Aspire Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts is published in The American Journal of Sports Medicine.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru
28.09.2017