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J Knee Surg 2021; 34(01): 030-038
DOI: 10.1055/s-0040-1721670
Special Focus Section

Systematic Review of Osteochondral Allograft Transplant Immunology: How We Can Further Optimize Outcomes

Josephine Luk
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Aaron M. Stoker
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Emma Teixeiro
3   Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, Missouri
,
Keiichi Kuroki
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
Anna J. Schreiner
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
4   BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
,
James P. Stannard 
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Robert Wissman
5   Department of Radiology, University of Missouri, Columbia, Missouri
,
James L. Cook 
1   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Abstract

Despite the growing success for osteochondral allograft (OCA) transplantation in treating large articular cartilage lesions in multiple joints, associated revision and failure rates are still higher than desired. While immunorejection responses have not been documented, the effects of the host's immune responses on OCA transplantation failures have not been thoroughly characterized. The objective of this study was to systematically review clinically relevant peer-reviewed evidence pertaining to the immunology of OCAs to elucidate theragnostic strategies for improving functional graft survival and outcomes for patients undergoing OCA transplantation. This systematic review of Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, and EMBASE suggests that host immune responses play key roles in incorporation and functional survival of OCA transplants. OCA rejection has not been reported; however, graft integration through creeping substitution is reliant on host immune responses. Prolonged inflammation, diminished osteogenic potential for healing and incorporation, and relative bioburden are mechanisms that may be influenced by the immune system and contribute to undesirable outcomes after OCA transplantation. Based on the safety and efficacy of OCA transplantation and its associated benefits to a large and growing patient population, basic, preclinical, and clinical osteoimmunological studies on OCA transplantation that comprehensively assess and correlate cellular, molecular, histologic, biomechanical, biomarkers, diagnostic imaging, arthroscopic, functional, and patient-reported outcome measures are of high interest and importance.

Keywords

osteochondral allograft - transplantation - immunology - knee - cartilage


Publication History

Received: 25 September 2020

Accepted: 03 November 2020

Article published online:
03 January 2021

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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