A Patient-Tailored Graft System for Surgical Repair of Osteochondral Defects
Abstract
In the U.S. Army active duty population, combat arms Soldiers, Rangers, and Special Forces members are all considered to the equivalent of elite-level athletes because of the extreme rigors required by their military profession. Articular cartilage injuries in the high-demand military and athletic population remain a clinical challenge. For these patients, fresh osteochondral allograft (OCA) transplantation is evolving into a primary treatment option for large, symptomatic lesions. Traditionally, hemicondyle-specific size matching is performed to ensure similar geometric dimensions exist between the donor allograft and recipient condyle to minimize graft incongruity at the articular surface and avoid detrimental contact stress that could compromise graft healing. Currently, tissue banks only provide two-dimensional sagittal and coronal dimensions of the OCA, which makes donor-host matching difficult and imprecise. Moreover, although a higher incidence of injuries occurs on the medial femoral condyle (MFC), the majority of OCAs that become available are lateral femoral condyle (LFC) grafts. To minimize surgical delays associated with the match process, a novel practice of using non-orthotopic grafts (e.g., LFC hemicondyle graft for an MFC defect) has been recently adopted; however, the long-term clinical implications of this practice are unknown. Furthermore, to avoid chondrocyte death, matrix degradation, and graft failures, an OCA should be implanted within 28 days. The challenge of graft matching can contribute to viable grafts being wasted if they are not utilized within this narrow period. A clinical need exists for the development of an integrated system to allow surgeons to match patient and OCA more effectively, thereby minimizing surgical delays and reducing graft waste by optimizing the use of the overall number of available grafts. We propose to engineer such a system by integrating a 3D scanning apparatus, a topographical optimization algorithm and associated cartilage stresses and strains model, and 3D-printed surgical guides. The use of such a system will allow complete digitization of the graft surface to facilitate a more precise graft matching process that could include non-orthotopic grafts, thus providing more rapid and efficient use of available fresh OCA. Moreover, in the setting of the unique demands of active duty Soldiers, the optimization of OCA transplantation may restore the patient to their pre-injury level of activity, facilitating the return to active duty and increasing readiness.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910185
Entities
People
- Fabrizio Billi
Organizations
- United States Army
- University of California, Los Angeles