Calcification and ossification have been described in artery wall in pathologic conditions and aging. We previously described the use of cryopreserved arterial allografts as membranes for guiding bone regeneration. We hypothesize that artery is as good as synthetic membranes (e-PTFE, gold-standard in guided bone regeneration) due to the osteogenic potential of cells from its medial layer.

A comparative study was made creating 10 mm mid-diaphyseal radial defects in 15 New Zeland rabbits (30 forearms): 10 defects were covered with an e-PTFE membrane and 10 defects with no membrane (control group). Studies: X-rays, CT, MR, morpho-densitometric analysis, electronic and optical microscopy.

To demonstrate the cellular arterial stock, cryopre-served and fresh rabbit thoracic aorta specimens were studied. Medial layer was isolated and cultured as explants in normal medium. Cells were harvested and added to a 3-D scaffold based on plasmatic albumin in osteogenic medium. Immunocitochemical study was made. Radial defects surrounded by cryopreserved arterial membranes showed total regeneration in nine of 10 defects versus seven of 10 defects in e-PTFE group (no statistically significant differences were detected between them). No tissue layer was found between bone and artery while a connective tissue layer was observed between e-PTFE and bone. Neither radiological nor histological healing were detected in the control group.

Cells cultured had smooth muscle features as they showed immunofluorescence with anti-smooth muscle alpha-actin, anti-calponin and anti-vimentin antibodies. When cells were added to a 3-D matrix, they showed chondro and osteogenic differentiation, as they stained positive for types II and X collagen, alkaline phosphatase and von Kossa.

Although no statistically significant differences between artery and e-PTFE groups were detected, histological and cellular findings suggest a superiority of cryopreserved arterial allografts when compared with synthetic membranes of e-PTFE, with a contribution of the cellular stock of the medial layer in the healing process.

INTRODUCTION: In guided tissue regeneration a membrane is used for defect isolation to protect it against invasion from surrounding tissues and to keep intrinsic healing factors ‘in situ’. This technique has been successfully used in maxillo-facial surgery, but short experience has been reported in long-bone defects, with synthetic membranes and with variable results. In the other hand, calcification and ossification inside the arterial wall have been described.

OBJECTIVE: The aim of the study was to evaluate the use of cryopreserved aorta allografts as membranes for guided tissue regeneration in comparison with expanded poly-tetra-fluoro-ethylene (e-PTFE) synthetic membranes.

MATERIAL & METHODS: Prospective, randomized, blinded study in 15 New-Zeland rabbits. 10 mm mid-diaphyseal defects were created in both radii: 10 defects were covered with a cryopreserved aortic allograft as a tube, 10 with an e-PTFE membrane and 10, with no barrier membrane, served as controls. Animals sacrifice at 6–12–24–30 months. Studies: X-rays, CT, MR, morpho-densitometric analysis, electronic and optical microscopy. Immuno-cytochemistry on tissues and arterial wall cells cultured.

RESULTS: None of the control defects healed. Nine defects covered with an artery completely reconstituted, but only six of those covered with e-PTFE, with a nearly normal cortical-medullar pattern and with progressive increasing in density and thickness of medullar and cortical to values similar to those of the normal bone. Histological studies showed no inflammatory response to the arterial graft, direct union between the artery and the regenerated bone and even mature bone between the elastic laminae of the arterial wall, suggesting superior biocompatibility properties. Immuno-cytochemistry and ultrastructural studies suggest that arterial allografts could act not only as membrane barriers, with additional osteoinductive properties due to trans-differentiation of viable arterial wall cells (endothelial, smooth muscle and/or tissue specific stem cells) towards osteoblastic cells, and also due to ossification secondary to changes in proteins of the arterial extracellular matrix. This could be the application of the process of arterial wall calcification and ossification (usually seen in arteriosclerosis, gender, diabetes or kidney failure) for regeneration of long-bone defects.

CONCLUSION: Cryopreserved aortic allografts can be used as membrane barriers for guided bone regeneration, with superior results to e-PTFE membranes.

Background and objective: In guided tissue regeneration a membrane is used for defect isolation to protect it against invasion from surrounding tissues and to keep intrinsic healing factors ‘in situ’. This technique has been successfully used in maxillo-facial surgery, but short experience has been reported in long-bone defects, with synthetic membranes and with variable results. In the other hand, calcification and ossification inside the arterial wall have been described. The aim of the study was to evaluate the use of cryopreserved aorta allografts as membranes for guided tissue regeneration in comparison with expanded poly-tetra-fluoro-ethylene (e-PTFE) synthetic membranes.

Methods: Prospective, randomized, blinded study in 15 New-Zeland rabbits. 10 mm mid-diaphyseal defects were created in both radii: 10 defects were covered with a cryopreserved aortic allograft as a tube, 10 with an e-PTFE membrane and 10, with no barrier membrane, served as controls. Animals sacrifice at 6-12-24-30 months. Studies: X-rays, CT, MR, morpho-densitometric analysis, electronic and optical microscopy. Immuno-cytochemistry on tissues and arterial wall cells cultured.

Results: None of the control defects healed. Nine defects covered with an artery completely reconstituted, but only six of those covered with e-PTFE, with a nearly normal cortical-medullar pattern and with progressive increasing in density and thickness of medullar and cortical to values similar to those of the normal bone. Histological studies showed no inflammatory response to the arterial graft, direct union between the artery and the regenerated bone and even mature bone between the elastic laminae of the arterial wall, suggesting superior biocompatibility properties. Immuno-cytochemistry and ultrastructural studies suggest that arterial allografts could act not only as membrane barriers, with additional osteoinductive properties due to trans-differentiation of viable arterial wall cells (endothelial, smooth muscle and/or tissue specific stem cells) towards osteoblastic cells, and also due to ossification secondary to changes in proteins of the arterial extracellular matrix. This could be the application of the process of arterial wall calcification and ossification (usually seen in arteriosclerosis, gender, diabetes or kidney failure) for regeneration of long-bone defects.

Conclusion: Cryopreserved aortic allografts can be used as membrane barriers for guided bone regeneration, with superior results to e-PTFE membranes.

Aims: Clinical and radiographic evaluation of retinacular lateral releases using an arthroscopic approach, for anterior knee pain in cases with slight patelar axial malposition Methods: Prospective study in 34 patients. Evaluation according to the Insall clinical score, patient opinion, and change in radiographic angles and index from pre-operative to post-operative. Results: Postoperative clinical score (Insall 1983): 82% excellent; 6% good; 6% poor; 6% bad. Angular values: patelar index (Cross 1976) of 7,1 and sulcus angle (Brattstrom 1964) of 139,6∞. Radiographic correction: from 15,7 to 17,9 in patello-femoral angle (Laurin 1978); from −5,6 to −5,3∞ in congruency angle (Merchant 1974); and from 1,37 to 1,12 in patello-femoral index (Laurin 1978). Conclusions: Clinical results, patient satisfaction, and radiographic correction of congruency angle, patello-femoral angle and patello-femoral index make justifiable the use of arthroscopic lateral releases in the treatment of selected cases of patello-femoral pain.