Abstract
Objectives:
Osteochondral allografts (OCA) transplantation is often utilized for treating osteochondral lesions of the knee due to limited cartilage regenerative capabilities. The use of concentrated bone marrow aspirate (cBMA) has gained traction as a method to enhance OCA incorporation and healing. Pulse lavage and pressurized carbon dioxide lavage are cleaning methods used during OCA preparation to rid native marrow elements and improve graft porosity, but their isolated and combined effects are not fully understood. This study aimed to assess the impact of incorporating pressurized carbon dioxide lavage as an adjunct to pulse lavage during OCA preparation. Our hypothesis was that adding pressurized carbon dioxide lavage would enhance the OCA absorption capacity for liquid-based materials like cBMA.
Methods:
OCA plugs were harvested from medial hemi-condyles. The plugs were divided into two groups: one group underwent pulse lavage alone, and the other group underwent pulse lavage followed by pressurized carbon dioxide lavage (sequential group). The plugs were weighed before and after each cleaning step and a liquid dye solution with consistency similar to cBMA was added by dripping over the cancellous portion of the graft. Next, the liquid content was determined by centrifugation and spectrophotometry. Results were analyzed statistically.
Results:
Thirty-four OCA plugs with a 14 to 18 mm diameter were harvested. After the cleaning phase, the sequential group showed a significant weight reduction of 107 ± 21.92% (p < 0.0001) and subsequent weight gain of 96.32 ± 18.99% (p < 0.0001) after the cleaning and dye-dripping procedures. In contrast, the pulse lavage-only group exhibited minimal weight loss and a small weight gain of 10.55 ± 3.86% after the dye-dripping procedure.
Conclusions:
Adding pressurized carbon dioxide lavage to reduce marrow elements and improve graft porosity significantly improved the OCA cleaning process and created more vacant space enhancing OCA absorption capacity for orthobiologic agents such as cBMA. The study findings highlight the potential of incorporating pressurized carbon dioxide lavage as an adjunct to pulse lavage during OCA preparation. These findings may contribute to the surgical procedure of incorporating cBMA or other orthobiologics to promote the integration and healing of OCA plugs.