Background

Based on decellularisation and cleaning processes of trabecular bone and fibrocartilage, an osteochondral allograft has been developed.

Background

The objective was to evaluate the benefit that could be obtained in terms of pain and efficacy with processed segmental allografts on 20 patients in meniscal repair treatment.

Background

Meniscal tears are among the most common knee injuries. To preserve as much as possible the joint, partial and total meniscal replacements are necessary. To combine the biocompatibility and mechanical resistance of meniscus allograft with the disponibility of synthetic substitutes, an acellular, viroinactivated and sterile scaffold with well-preserved structure has been developed based on PHOENIX process.

Amniotic membrane (AM) and amnion/chorion foetal membranes (ACM) are mainly composed of collagen & laminin layers and constitute relatively new materials to the dental market. They have proven effective for periodontal treatments such as Guided Tissue Regeneration (GTR) [1–3].

Based on our expertise in the field of lyophilisation & securisation of human bone allograft (Phoenix® process), we aimed to develop our own process applied to ACM and to control its in vivoefficacy in GTR indication.

Human placentas were donated under informed consent. ACM were separated from placenta and processed with a proprietary AMTRIX (TBF) Process. Resulting product was called ACMTRIX.

The effectiveness of ACMTRIX in GTR was evaluated using an in vivorat calvaria defect model as followed:

Empty defect (2 animals),

One animal per study group was sacrificed after 8 weeks, all others after 8 weeks.

Evaluations were performed by: macroscopic observations, X Ray micro-CT, and histological analysis.

For all groups using ACMTRIX, no major sign of inflammation were observed macroscopically and histologically. Moreover, bone tissue was already mature from 8 weeks and bone filling was slight to moderate.

The higher mean rate of mineralization was obtained for the group associating DBM cancellous block + ACMTRIX.

Although a xenogenic material, ACMTRIX was very well integrated without significant inflammatory reaction compared to empty defect and fully integrated in subcutaneous area.

The mineralization was superior with DBM cancellous block probably thanks to the stabilization of the material in the defect. Used alone, ACMTRIX has no osteogenic potential.

In conclusion, ACMTRIX has the potential to function as barrier for GTR and the unique properties associated with this material can augment its potential as a matrix for periodontal regeneration.

Purpose: Prosthetic hip surgery (150,000 total hip arthroplasties in France including 10–12% revision procedures) have required the development of bone banks to have graft material readily available. Safety and tracability requirements have led to the disappearance of local banks and the creation of validated tissue banks. The French tissue bank (TBF), which received its official authorization from the AFSSAPS in January 2001, began operating in 1992, collecting femoral heads (FH) procured during hip arthroplasties.

Material and methods: Material collection has increased steadily over the last five years. In 2002, 5004 FH were collected in 126 public or private centres. The number of FH which were rejected for regulatory, health (clinical and biological selection) and harvesting quality remained relatively stable around 20% from 1997 to 2000. Rejection for socioclincal reasons, which varied from 3 to 5%, included, in decreasing order, cancer, transfusion history, systemic disease and/or history of neurodegenerative disease, long-term corticosteroid treatment, and notion of infectious risk (mainly viral). Secondary rejection because regulatory tests could not be performed varied from 3 to 6% and included haemolysis, insufficient quantity for assay or preservation in the serum bank, ALAT assay impossible, serology suggestive of recent or former viral infection: HCV, HBV, HIV, HTLV. The FH underwent chemical treatment (viral and prion inactivation), mechanical treatment (production of bone shreads, cancellous blocks, wedges, whole heads, heads without neck), radiosterilisation and lyophylisation.

Results: Sixty percent of the grafts were used for hip arthroplasty, mainly during revision procedures (80%) (1.4 grafts on average, whole heads and blocks and more recently shredded bone); 8.5% were used for knee arthroplasty and 11.5% (blocks) for spinal surgery, 11% for fractures (in decreasing order femur, distal tibia, tibial plateau, ankle, foot, shoulder, arm, other), 4% for nonunions, 5% for osteotomies (blocks or wedges).

Conclusion: More and more grafts are used for osteotomy and spinal fusion procedures. Use of shredded bone is increasing. We are currently working on a cancellous bone paste combined with bone substitute.