allograft

Bone Grafts

Bone Healing

 

Bone healing requires 3 things

- osteoconduction - scaffold / matrix

- osteoinduction - growth factors

- osteogenesis - cells  to produce osteoid

 

Osteoconduction

 

Definition

- property of a matrix that supports the attachment of bone forming cells for subsequent bone formation

 

Substances

Acute PLC Management

Scenarios

 

1.  Isolated LCL injury

2.  Isolated Posterolateral Corner

3.  PCL + posterolateral corner

4.  ACL / posterolateral corner

5.  ACL / PLC / posterolateral corner


Repair versus Reconstruction

 

Levy et al. Am J Sports Med 2010

- failure in 4/10 knees treated with acute primary repair

Quadriceps Tendon Rupture

Epidemiology

 

Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness

 

Younger patient on steroids / growth hormone

 

Occasionally occurs in young athlete with excessive contracture

 

Aetiology

 

Often preceded by quadriceps tendinosis

 

Surgical Reconstruction Issues

Timing of Surgery

 

Issue

- reported higher incidence with immediate reconstruction in acute phase

- reduced by settling inflammation / effusion and obtaining FROM

- always best to delay if not professional athlete

- problematic if patient has locked bucket handle mensical tear

 

Results

 

Bottoni et al Am J Sports Med 2008

- RCT of early (average 9 days) v late reconstruction (average 85 days)

BPTB Allograft

Graft Preparation

 

BPTB Allograft Initial

 

Defrost

- in 2 litres normal saline

- can add vancomycin powder

 

Choose which part of graft to use

- usually central third

- can take either side

- try to leave sufficient graft in case of disasters

- i.e. dropping or rupturing graft

 

Revison ACL Surgery

Graft selection

 

A.  Synthetic Grafts

 

Good initial results but unacceptably high failure rate with longer follow-up

 

Problems

 

1.   Too stiff (low ultimate strain) 

- poor resistance to abrasion

- ligament failure by attrition most common

 

2.  Recurrent synovitis, infection, loosening and osteolysis

 

B.  Autograft

 

Revision Shoulder Arthroplasty

Issues

 

Rule out infection

Assess rotator cuff / bone stock preoperatively

Approach

- difficult / scarring +++

- very difficult to restore any loss of ROM

Removal of prosthesis

Glenoid

- may not be able to revise

Humeral component

- long stem

 

Investigations

 

Rule out infection

- CRP / ESR

- ultrasound or xray guided aspiration