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Revista Medica Del Instituto Mexicano... Sep 2023The anterior cervical discectomy and fusion (ACDF) is the gold standard in the treatment of cervical compression pathology and the titanium cage for fusion represents...
BACKGROUND
The anterior cervical discectomy and fusion (ACDF) is the gold standard in the treatment of cervical compression pathology and the titanium cage for fusion represents the most used procedure at an institutional level. A technique using fibular autograft has been described, with good results, lower morbidity and lower cost.
OBJECTIVE
To compare the rate of fusion, subsidence and functional clinical results after discectomy with titanium cage and fibular autograft.
MATERIAL AND METHODS
A clinical trial with follow-up at 3 and 6 months was carried out in patients diagnosed with cervical spondylosis, candidates for ACDF. 2 groups were formed: fibular autograft and titanium cage. Pre and post functional evaluation using the cervical disability score was made, as well as radiographic fusion and subsidence evaluation. Descriptive statistics, Fisher's exact test, t-test and ANOVA were obtained, establishing p < 0.05.
RESULTS
A sample of 20 patients with an average age of 56 years was obtained, finding a fusion rate of 90% for fibular autograft and 30% for titanium (p = 0.02) at 3 months. 10% of patients with fibular autograft presented subsidence and 70% with titanium cage at 3 and 6 months (p = 0.02). In the functional results was not found difference between both procedures (p = 0.874).
CONCLUSIONS
The use of autologous fibular graft offers a better rate of fusion and subsidence compared to the titanium cage, as well as similar functional results at 3 months of follow-up. It represents an excellent treatment option for cervical spondylosis.
Topics: Humans; Middle Aged; Autografts; Cervical Vertebrae; Fibula; Retrospective Studies; Spinal Fusion; Spondylosis; Titanium; Transplantation, Autologous; Treatment Outcome; Follow-Up Studies
PubMed: 38011687
DOI: No ID Found -
Biomechanics and Modeling in... Oct 2023The pulmonary autograft in the Ross procedure, where the aortic valve is replaced by the patient's own pulmonary valve, is prone to failure due to dilatation. This is...
The pulmonary autograft in the Ross procedure, where the aortic valve is replaced by the patient's own pulmonary valve, is prone to failure due to dilatation. This is likely caused by tissue degradation and maladaptation, triggered by the higher experienced mechanical loads in aortic position. In order to further grasp the causes of dilatation, this study presents a model for tissue growth and remodeling of the pulmonary autograft, using the homogenized constrained mixture theory and equations for immuno- and mechano-mediated mass turnover. The model outcomes, compared to experimental data from an animal model of the pulmonary autograft in aortic position, show that inflammation likely plays an important role in the mass turnover of the tissue constituents and therefore in the autograft dilatation over time. We show a better match and prediction of long-term outcomes assuming immuno-mediated mass turnover, and show that there is no linear correlation between the stress-state of the material and mass production. Therefore, not only mechanobiological homeostatic adaption should be taken into account in the development of growth and remodeling models for arterial tissue in similar applications, but also inflammatory processes.
Topics: Animals; Humans; Transplantation, Autologous; Autografts; Dilatation; Aortic Valve; Pulmonary Artery; Computer Simulation; Inflammation
PubMed: 36764979
DOI: 10.1007/s10237-023-01694-6 -
The Journal of Thoracic and... Jan 2024Autograft durability and remodeling are thought to be superior in younger pediatric patients after the Ross operation. We sought to delineate the fate of autografts...
BACKGROUND
Autograft durability and remodeling are thought to be superior in younger pediatric patients after the Ross operation. We sought to delineate the fate of autografts across the pediatric age spectrum in patients with primary aortic stenosis (AS).
METHODS
We retrospectively reviewed patients age ≤18 years with primary AS who underwent the Ross operation between 1993 and 2020. Patients were categorized by age. The primary endpoint was autograft dimensional change, and secondary endpoints were severe neo-aortic insufficiency (AI) and autograft reintervention.
RESULTS
A total of 119 patients underwent the Ross operation, including 37 (31.1%) in group I (age <18 months), 24 (20.2%) in group II (age 18 months-8 years), and 58 (48.7%) in group III (age 8-18 years). All groups exhibited similar annular growth rates within the first 5 postoperative years, followed by a collective decrease in annulus growth rates from year 5 to year 10. Group III experienced rapid sinus dilation in the first 5 years, followed by stabilization of the sinus z-score from year 5 to year 10, whereas groups I and II demonstrated stable sinus z-scores over 10 years. There were 4 early deaths (3.4%) and 2 late deaths (1.7%) at a median follow-up of 8.1 years (range, 0.01-26.3 years). At 15 years, the incidences of severe neo-AI (0.0 ± 0.0% vs 0.0 ± 0.0% vs 3.9 ± 3.9%; P = .52) and autograft reintervention (8.4 ± 6.0% vs 0.0 ± 0.0% vs 2.4 ± 2.4%; P = .47) were similar in the 3 groups.
CONCLUSIONS
Age at the time of Ross operation for primary AS does not influence long-term autograft remodeling or durability. Other physiologic or technical factors are likely greater determinants of autograft fate.
PubMed: 38266984
DOI: 10.1016/j.jtcvs.2024.01.022 -
Archives of Orthopaedic and Trauma... Aug 2023Total hip arthroplasty (THA) with an acetabular component and an autogenous femoral head graft for acetabular reconstruction in developmental dysplasia of the hip was... (Review)
Review
PURPOSE
Total hip arthroplasty (THA) with an acetabular component and an autogenous femoral head graft for acetabular reconstruction in developmental dysplasia of the hip was first described by Harris et al. in 1977. While a number of studies have addressed the aforementioned scenario over the last decades, most lack sufficient numbers and follow-up. As such, we analyzed long-term outcomes of THAs with femoral autograft for arthrosis secondary to hip dysplasia.
METHODS
A systematic review was performed using a structured PubMed, Web of Science, Ovid MEDLINE, and Cochrane analysis, based on the PRISMA criteria. All original studies from 1977 to 2022 with a mean follow-up of 10 or more years were included. Methodological Index for Nonrandomized Studies (MINORS) were used for quality assessment.
RESULTS
A total of 26 studies with 1316 patients (87% females) undergoing 1543 THAs with femoral autograft (2 times neck graft, 24 times head graft) were included. Mean age was 52 years (range, 28-73) and the mean follow-up was 13 years (range, 9-18). The revision rate was 8.3% (n = 129), and 73% of revisions were for loosening. Rate of infection (0.5%) and dislocations (1%) were low. Radiographic analysis revealed 167 loose acetabular components (11%) and 118 cases of graft resorption (7.6%). Mean Harris Hip Score increased from 42 to 85. Mean MINORS score was 11, and no study was level of evidence I or II.
CONCLUSIONS
Femoral autograft with THA may be a viable long-term option for hip reconstruction in developmental dysplasia of the hip. However, moderate loosening rates and low level of evidence must be acknowledged before drawing the final conclusions.
LEVEL OF EVIDENCE
Therapeutic Level III.
Topics: Female; Humans; Middle Aged; Male; Femur Head; Autografts; Developmental Dysplasia of the Hip; Retrospective Studies; Acetabulum; Arthroplasty, Replacement, Hip; Hip Dislocation, Congenital; Treatment Outcome; Follow-Up Studies; Hip Prosthesis
PubMed: 36581773
DOI: 10.1007/s00402-022-04736-3 -
International Journal of Spine Surgery Dec 2023Formation of bony fusion after arthrodesis depends on osteoinduction, osteoconduction, and osteogenesis. Traditionally, the patient's own bone, or autograft, has been...
Formation of bony fusion after arthrodesis depends on osteoinduction, osteoconduction, and osteogenesis. Traditionally, the patient's own bone, or autograft, has been used to provide biological material necessary for these steps. However, the amount of autograft obtainable is often inadequate. Modern spine surgery has adopted the use of many autograft extenders or replacements, such as demineralized bone matrix or fibers. The present article covers the history of bone grafting, the production and technical details of demineralized bone matrix, and the evidence supporting its use in spine fusions.
PubMed: 38135444
DOI: 10.14444/8558 -
Arthroscopy : the Journal of... Feb 2024To review patient-reported outcomes (PROs) and survivorship in patients undergoing osteochondral autograft or allograft transplantation (OAT) of the femoral head. (Review)
Review
PURPOSE
To review patient-reported outcomes (PROs) and survivorship in patients undergoing osteochondral autograft or allograft transplantation (OAT) of the femoral head.
METHODS
PubMed, Cochrane Center for Register of Controlled Trials, and Scopus databases were searched in November 2022 with an updated search extending to December 2023 using criteria from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the following keywords: (hip OR femoral head) AND (mosaicplasty OR osteochondral allograft OR osteochondral autograft OR osteochondral lesion). Articles were included if they evaluated postoperative PROs in patients who underwent OAT of the femoral head and had a study size of 5 or more hips (n ≥ 5). Survivorship was defined as freedom from conversion to total hip arthroplasty. For PROs evaluated in 3 studies or more, forest plots were created and I was calculated.
RESULTS
Twelve studies were included in this review, with a total of 156 hips and a mean follow-up time ranging between 16.8 and 222 months. In total, 104 (66.7%) hips were male while 52 (33.3%) were female. Age of patients ranged from 17.0 to 35.4 years, while body mass index ranged from 23.3 to 28.1. Eight studies reported on osteochondral autograft transplantation and 4 studies on osteochondral allograft transplantation. Three studies reported significant improvement in at least 1 PRO. Survivorship ranged from 61.5% to 96% at minimum 2-year follow-up and from 57.1% to 91% at minimum 5-year follow-up. At a follow-up of less than 5 years, osteochondral allograft transplantation studies showed 70% to 87.5% survivorship, while autograft varied from 61.54% to 96%.
CONCLUSIONS
Patients with osteochondral lesions of the femoral head who underwent osteochondral autograft or allograft transplantation demonstrated improved PROs but variable survivorship rates.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
PubMed: 38365122
DOI: 10.1016/j.arthro.2024.02.008 -
The Journal of Foot and Ankle Surgery :... 2024Distal tibial autograft harvesting has been studied in the past, but morbidity at the level of the donor site is unclear. The purpose of this retrospective review is to...
Distal tibial autograft harvesting has been studied in the past, but morbidity at the level of the donor site is unclear. The purpose of this retrospective review is to assess morbidity in distal tibial autograft harvesting associated with foot and ankle arthrodesis procedures. A retrospective analysis was performed utilizing patients treated in the last 13 years at a large, multicenter, academic, tertiary referral, research institution. Included patients were between the ages of 18 and 80 years old. One-hundred and seven patients (39 male; 68 female) underwent ipsilateral distal tibial bone graft (n = 110) harvesting to augment the index procedure. Patients were followed for an average of 11.2 months after surgery (Range: 1-73 months). The incidence rate of distal tibial stress fractures was 4.5%, with an overall postoperative complication rate of 8.2%. Overall, low complication rates associated with distal tibial autograft harvesting were found, supporting the use of the distal tibia as an appropriate site for autograft harvesting in foot and ankle surgery.
Topics: Humans; Male; Female; Retrospective Studies; Middle Aged; Adult; Tibia; Aged; Tissue and Organ Harvesting; Bone Transplantation; Adolescent; Autografts; Arthrodesis; Aged, 80 and over; Young Adult; Transplantation, Autologous; Postoperative Complications; Fractures, Stress
PubMed: 38246336
DOI: 10.1053/j.jfas.2024.01.002 -
Plastic and Reconstructive Surgery.... Jan 2024Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies... (Review)
Review
Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.
PubMed: 38250207
DOI: 10.1097/GOX.0000000000005333 -
Dental Research Journal 2023This study compared the effect of various grafting materials on the area and volume of minerals attached to dental implants.
BACKGROUND
This study compared the effect of various grafting materials on the area and volume of minerals attached to dental implants.
MATERIALS AND METHODS
In this animal study, 13 dogs were divided into three groups according to the time of sacrificing (2 months, 4 months, or 6 months). The implants were placed in oversized osteotomies, and the residual defects were filled with autograft, bovine bone graft (Cerabone), or a synthetic substitute (Osteon II). At the designated intervals, the dogs were sacrificed and the segmented implants underwent micro-computed tomography analysis. The bone-implant area (BIA) and bone-implant volume (BIV) of bone and graft material were calculated in the region of interest around the implant. The data were analyzed by two-way analysis of variance (ANOVA) at < 0.05.
RESULTS
There was no significant difference in BIA and BIV between the healing intervals for any of the grafting materials ( > 0.05). ANOVA exhibited comparable BIA and BIV between the grafting materials at 2 and 4 months after surgery ( > 0.05), although a significant difference was observed after 6 months ( < 0.05). Pairwise comparisons revealed that BIA was significantly greater in the autograft-stabilized than the synthetic-grafted sites ( = 0.035). The samples augmented with autograft also showed significantly higher BIV than those treated by the xenogenic ( = 0.017) or synthetic ( = 0.002) particles.
CONCLUSION
All graft materials showed comparable performance in providing mineral support for implants up to 4 months after surgery. At the long-term (6-month) interval, autogenous bone demonstrated significant superiority over xenogenic and synthetic substitutes concerning the bone area and volume around the implant.
PubMed: 38020252
DOI: No ID Found -
Arthroscopy : the Journal of... Jul 2024To compare clinical outcomes, knee stability and complications, failure, and revision rates after anterior cruciate ligament repair (ACLr) with dynamic intraligamentary... (Review)
Review
Anterior Cruciate Ligament Repair Augmented With Dynamic Intraligamentary Stabilization Is Equivalent to Hamstring Autograft Reconstruction at Short- and Mid-Term Follow-Up: A Systematic Review.
PURPOSE
To compare clinical outcomes, knee stability and complications, failure, and revision rates after anterior cruciate ligament repair (ACLr) with dynamic intraligamentary stabilization (DIS) versus anterior cruciate ligament reconstruction (ACLR) with hamstring autograft for primary ACL ruptures at short and mid-term follow-up.
METHODS
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of PubMed/MEDLINE and Scopus was performed. Studies that evaluated patients undergoing ACLr with DIS or ACLR with hamstring autograft were considered for inclusion. Studies were excluded if patients were affected by concomitant meniscal, ligamentous, or chondral injuries needing surgical treatment, because of their potential confounding effect on postoperative outcomes. The Risk of Bias-2 tool was used to assess the risk of bias in the included studies. The quality of available evidence was rated according to Grading of Recommendations Assessment, Development, and Evaluation recommendations. The study protocol was registered in the PROSPERO database (ID: CRD42023394558).
RESULTS
Five randomized controlled trials comparing the outcomes of ACLr with DIS versus ACLR with hamstring autograft met the inclusion criteria. No major differences in terms of patient-reported outcomes (International Knee Documentation Committee subjective form, Lysholm score, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score, visual analog scale satisfaction) or rates of complications, revisions, and failures were found in included studies at all time points. Repair showed greater International Knee Documentation Committee subjective form scores at 5 years in one study, whereas ACLR displayed significantly increased knee stability at 6 months and 5 years in 2 different studies, although the clinical relevance of these differences is doubtful.
CONCLUSIONS
The results of this study suggest that ACLr with DIS is not inferior to ACLR with hamstring autograft in terms of rates of clinical outcomes, knee stability, risk of failure, complications, and revision surgery. Therefore, ACLr with DIS may be a viable alternative to ACLR with hamstring autograft in selected patients.
LEVEL OF EVIDENCE
Level I, systematic review of Level I studies.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries; Autografts; Hamstring Tendons; Transplantation, Autologous; Treatment Outcome; Follow-Up Studies; Joint Instability
PubMed: 38417640
DOI: 10.1016/j.arthro.2023.12.011