Doğu Anadolu Bölgesi Araştırmaları; 2008
Ali Said DURMUŞ, Yesari ERÖKSÜZ
*LOCAL AUTOGENOUS OSTEOCHONDRAL GRAFT
APPLICATIONS: AN EXPERIMENTAL STUDY IN DOGS
KNEE JOINTS
*Ali Said DURMUŞ, **Yesari ERÖKSÜZ
*Firat University, Veterinary Faculty, Surgery Department– ELAZIG
**Firat University, Veterinary Faculty, Pathology Department– ELAZIG
__________________________________________________________________________________________________________________________________________________
ABSTRACT
The aim of this study was to investigate applicability of local autogenous osteochondral grafts for the
repairment of osteochondral defects in knee joints of dogs.
The material consisted of 18 healthy adult mongrel dogs. Osteochondral defects in standard cylindrical shape
(0.5 cm x 0.5 cm) were created on both lateral and medial femoral condyles.The defects were filled with
autogenous osteochondral grafts harvested from upper surface of lateral and medial labium of femoral
trochlea in treatment group (9 dogs). Nine dogs were kept as control group.
Clinical and radiographical evaluations were carried out at the 15 days intervals. Histopathological
examinations were carried out at the 15th, 30th and 60th days in each group.
Consequently, the results indicated that autogenous osteochondral grafts harvested from upper surface of
lateral and medial labium of femoral trochlea could be applied in treatment of osteochondral defects in knee
joints of dogs.
Keywords: Autogenous Osteochondral Graft, Dog.
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LOKAL OTOJEN OSTEOKONDRAL GREFT UYGULAMALARI:
KÖPEKLERDE DİZ EKLEMİNDE DENEYSEL ÇALIŞMA
ÖZET
Yapılan bu çalışmanın amacı köpeklerde diz eklemindeki osteokondral defektlerin onarımında lokal otojen
osteokondral greftlerin uygulanabilirliğini araştırmaktı.
Çalışmada 18 adet sağlıklı, yetişkin melez köpek kullanıldı. Osteokondral defektler, standart silindir biçiminde (0.5 cm x 0.5 cm) femurun lateral ve medial kondyluslarının her ikisinde de oluşturuldu. Oluşturulan
defektler 9 köpekte (tedavi grubu) femoral trochlea’nın lateral ve medial kısımlarının üst yüzeylerinden elde
edilen otojen osteokondral greftlerle dolduruldu. Dokuz köpek ise kontrol grubu olarak tutuldular.
Klinik ve radyolojik kontroller 15 gün aralıklarla gerçekleştirildi. Histopatolojik kontroller ise 15, 30 ve 60.
günlerde gerçekleştirildi.
Sonuç olarak, bulgular köpeklerin diz eklemindeki osteokondral defektlerin, lateral ve medial femoral
trochlea’nın üst kısımlarından elde edilen otojen osteokondral greftlerle sağaltımlarının gerçekleştirilebileceğini göstermiştir.
Anahtar Kelimeler: Otojen Osteokondral Greft, Köpek.
*II. Ulusal Küçük Hayvan Hekimliği Kongresi'nde (10-13 Nisan 2003, Bursa) Sözlü Bildiri Olarak Sunulmuştur.
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1. INTRODUCTION
Articular cartilage is a unique tissue with a
limited ability to respond to injury (Karataglis et al.,
2006; Yaylaoğlu et al., 1999). Mature articular
cartilage has minimal regenerative ability owing to
its intrinsic properties, such as low chondrocyte
mitotic rate and numbers (Hangody et al., 1997;
2008; Mahadev et al., 2001). It has been generally
accepted that cartilage defects cannot be repaired by
the chondrocytes adjecant to the lesion. However
when the defect reaches the subchondral bone,
repair is initiated by “creeping substition” similar to
that of bone healing (Yaylaoğlu et al., 1999).
Several materials, including autogenous
(Marcacci et al., 1999; Sammarco and Makwana,
2002), fresh or conserved osteochondral grafts
(Desjardins et al., 1991; Hurtig, 1988), autogenous
osteochondral grafts harvested ribs (Oka and Ikeda,
2001), sternum (Stover et al., 1989), lateral trochlear rim of talus (Huber et al., 1992), autogenous
cartilage grafts harvested sternum (Vachon et al.,
1992), autolog condrocyte transplantation (Yıldız et
al., 2001), and autogenous periosteal grafts (Vachon
et al., 1991) were used for reconstruction of
osteochondral defects.
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Doğu Anadolu Bölgesi Araştırmaları; 2008
Ali Said DURMUŞ, Yesari ERÖKSÜZ
Autogenous osteochondral graft has gained in
clinical popularity because of its technical feasibility
and cost effectiveness. However only a few series
have been reported in the literature, many of them
are case reports (Dew and Martin, 1991; 1992;
Hangody et al., 1997; 2008; Karataglis et al., 2006).
recipient sites by press-fit technique in treatment
group (9 dogs) (Figure 2). Special attention was
paid to avoid fracture or breakage of the osteochondral plugs during the course of transplantation.
Nine dogs were kept as control group.
The purpose of this study was to investigate
applicability of local autogenous osteochondral
grafts harvested from upper surface of lateral and
medial labium of femoral trochlea for the
repairment of osteochondral defects and evaluate the
incorporation of autogenous osteochondral graft in
osteochondral defects in knee joint of dogs.
2. MATERIAL AND METHODS
Animal experiments were conducted in the
Animal Hospital of Veterinary Faculty of the Firat
University of Turkey in accordance with usual
guidelines.
Eighteen adult mongrel female clinically
healthy dogs aged between 2 and 4-y-old (mean 3-yold) were used in this study. General anaesthesia
was induced in animals by intramuscular
administration of Xylazine hydrochloride 3 mg/kg
(Rompun, Bayer, 23.32 mg/ml), and ketamine
hydrochlorur 15 mg/kg (Ketalar, Parke-Davis, 50
mg/ml). Dogs were divided into two equal groups.
Figure 2. Autogenous osteochondral plugs were
transplanted into the defect in condylus by press-fit
technique.
Operation wounds were closed in a routine
manner (Piermattei and Greeley, 1979). The related
limbs were supported with a bandage reinforced by
plastic casts, and the bandages were kept for two
weeks by renewing every week. Postoperative
medications included procaine peniciline G (22.000
IU/kg, IM, q 12 h) administered for 5 days. Skin
sutures were removed 10 days after the surgery.
Clinical and radiographical evaluations were
carried out at 15 days intervals. Three dogs in each
group were sacrificed by overdose sodium
penthobarbital at 15th, 30th, and 30th days. At
postmortem, the articular surfaces were evaluated
for color, homogenity, and amount and demarcation
of repair tissue. Each speciemen, a block consisting
of repair area and surrounding tissues, was bisected
centrally through the defect. The samples was fixed
in 10% neutral buffered formalin for 5 days and
decalcifed in a decalcification solution (15 ml
HNO3+10 ml 10% neutral buffered formalin+85 ml
distilled water). The samples were cut into 5 µm
sections after complete decalcification and stained
with Hematoxylin and Eosin (H&E) and examined
by light microscopy.
Figure 1. Autogenous osteochondral plugs were
harvested from the upper surface of lateral labium of
femoral trochlea.
Surgically, the knee joints was exposed using
lateral parapatellar approach as reported by
Piermattei and Greeley (1979). Osteochondral
defects in standard cylindrical shape (0.5 cm x 0.5
cm) were created on both lateral and medial femoral
condyles. Then autogenous osteochondral plugs of
the same length were harvested from the upper
surface of lateral and medial labium of femoral
trochlea (Figure 1), and were transplanted into the
3. RESULTS
In this study, clinical, radiographical and
histopathological results were evaluated at the 15th,
30th, and 60th days postoperation.
Clinical examinations showed the occurrence
of lameness in all cases at the 15th day of experi73
Doğu Anadolu Bölgesi Araştırmaları; 2008
Ali Said DURMUŞ, Yesari ERÖKSÜZ
ment. Whereas, lameness was completely resolved,
and the joints were stabilized and there were not
limitation of movement, crepitation and muscular
atrophy in the further examination.
Radiographical examinations indicated that
grafted regions were determined slightly after surgery (Figure 3). Periarticular tissue thickness and
articular space width were in normal ranges, and
incorporation of grafts was completely fulfilling in
the treatment group at the 60th day postoperation
(Figure 4). The fulfilling of defects continued in the
course of time but could not completed in the
control group (Figure 5, Figure 6).
Figure 5. Radiographic appearence of a case of the
control group after surgery.
Figure 3. Radiographic appearence of a case of the
treatment group after surgery.
Figure 6. Radiographic appearence of the former
case at postoperative 60th day.
Macroscopical evaluations revealed that the
grafts determined surrounding tissue at the 15th day,
morphologic zones could not be discerned, the
grafted defects had healed with congruent, smooth
and intact surfaces at the 30th day. The grafted
defects had healed with congruent and smooth
surfaces of the same colour and texture as the
adjacent normal cartilage at the 60th day of
postoperation. All ungrafted defects had irregularity
in the femoral condyle.
Histopathologic evaluations, at the 15th day
of postoperation, revealed that graft was alive and
regenerative attempts were initated in osseous and
cartilaginous components in treatment group (Figure
7). At 30th and 60th days of postoperation, reperation
Figure 4. Radiographic appearence of the former
case at postoperative 60th day.
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Doğu Anadolu Bölgesi Araştırmaları; 2008
Ali Said DURMUŞ, Yesari ERÖKSÜZ
in osseous component of graft was not completed,
and cartilaginous component of the graft included
fibrous cartilago (Figure 8). Eburnation and
synovial membrane proliferation were detected as
the main complications in all the control group
animals.
1993). The goal was to penetrate the subchondral
zone of vascularization within the cartilage defect,
allowing a conduit and site for clot formation
containing mesenchymal stem cells capable of
forming fibrocartilage repair tissue. In this study,
the model of defect and methods were the same as
reported by other investigators (Delcogliano et al.,
2002; Kold and Hickman, 1986; Marcacci et al.,
1999; Yıldız et al., 2001).
Osteochondral grafting or mosaicloplasty is a
technique in which dowels of bone and cartilage are
taken from a non weight-bearing portion of the
femoral trochlea or condyle and press-fit into a
recipient hole made by removing the cartilage defect
with its underlying bone (Delcogliano et al., 2002;
Marcacci et al., 1999). In this study, we preferenced
osteochondral grafts harvested from the upper
surface of lateral and medial labium of femoral
trochlea, non weight-bearings portion in the knee
joint to eliminate to donor site morbidity. In
addition, donor region is neighborhood to the lesion,
and required no second operation and additional
anaesthesia for harvesting of osteochondral grafts.
Figure 7. Histopathologic appearence of a case of
the treatment group at postoperative 15th day. N:
Normal cartilage, G: Grafted cartilage, R: Resorbed
bone, K: Callus. (H.E.x 40).
In this study, a bandage reinforced by plastic
casts was placed on the releated limb for 15 days the
same as reported by Fallon (1990). This application
was useful for success of the treatment.
Some investigators (Desjardins et al., 1991;
Hurtig et al., 1988; 2001; Oka and Ikeda, 2001;
Scranton and McDermott, 2001; Stevenson, 1986;
Sullins et al., 1989; Vachon et al., 1991), reported
that postoperatively the knee is often painful when
the dog walked. In this study, lameness was
observed in all dogs in the first 15 days, but it was
completely resolved later examination.
It is reported that crepitus (Fallon, 1990), and
limitation of movement (Dew and Martin, 1992;
Howard et al., 1994; McIIwraith et al., 1994) may
be present in the patients with osteochondral lesions.
In this study, there were not crepitus, muscular
atrophy, and limitation of motion of the knee. This
results indicated that this treatment method was
successful clinically.
Radiology is essential for an early diagnosis
(Fallon, 1990). Definitive diagnosis is made by
radiographic examination of the affected joint
(Manley et al., 1990). A standard craniocaudal view
usually shows an irregularity in the countour of the
femoral condyle. The medial aspect of the lateral
condyle is most often affected; the lesion appears as
a radiolucent concave defect with sclerotic margins
(Fallon, 1990). In the present study, periarticular
tissue thickness, joint space, and osteophyte
formation evaluated radiographically, and results of
the treatment group was satisfactory to control
group as reported by Dew and Martin (1991;1992).
Figure 8. Histopathologic appearence of a case of
the treatment group in postoperative 60th day. R:
Resorbed bone, K: Cartilage. (H.E.x 40).
4. DISCUSSION
Focal chondral defects of the articular surface
of the knee are a complex clinical problem because
of the inability of articular cartilage to initiate any
clinically appreciable healing response. When
indicated, treatment should ideally prevent defect
progression, reduce symptoms and restore function.
Indications to proceed with options considered
palliative, reparative, or restorative are evolving.
Although biological resurfacing of a partially
damaged joint surface is clinically desirable, it is
difficult to achieve consistent and lasting results.
Repair of large osteochondral defects, larger than 3
mm in diameter and 3 mm deep, must include
support of the bone as well as the articular surface
tissue (Shahgaldi, 1998; Messner and Gillquist,
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Doğu Anadolu Bölgesi Araştırmaları; 2008
Ali Said DURMUŞ, Yesari ERÖKSÜZ
In this study, histopathologically, local
autogenous osteochondral grafts was useful in
osteochondral defects due to grafts was alive and
regenerative and reparative attempts were observed
in treatment group. In contrast, eburnation and
synovial membran proliferation were observed in
control group.
Consequently, it was indicated that
autogenous osteochondral grafts harvested from
upper surface of lateral and medial labium of
femoral trochlea could be applied in treatment of
osteochondral defects in knee joints of dogs.
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