Effects of surgical angiogenesis on segmental bone reconstruction with cryopreserved massive-structural allografts in a porcine tibia model

Cryopreserved bone allografts (CBA) used to reconstruct segmental bone defects provide immediate structural stability, but are vulnerable to infection, non-union and late stress fracture as the majority of the allograft remains largely avascular. We sought to improve the bone vascularity and bone fo...

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Main Authors: Visser, Noortje (Author) , Rezaie, Elisa S. (Author) , Friedrich, Patricia F. (Author) , Kotsougiani-Fischer, Dimitra (Author) , Shin, Alexander Y. (Author) , Bishop, Allen T. (Author)
Format: Article (Journal)
Language:English
Published: 17 May 2019
In: Journal of orthopaedic research
Year: 2019, Volume: 37, Issue: 8, Pages: 1698-1708
ISSN:1554-527X
DOI:10.1002/jor.24318
Online Access:Verlag, Volltext: http://dx.doi.org/10.1002/jor.24318
Verlag, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/jor.24318
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Author Notes:Noortje J. Visser, Elisa S. Rezaie, Patricia F. Friedrich, Dimitra Kotsougiani, Alexander Y. Shin, Allen T. Bishop

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520 |a Cryopreserved bone allografts (CBA) used to reconstruct segmental bone defects provide immediate structural stability, but are vulnerable to infection, non-union and late stress fracture as the majority of the allograft remains largely avascular. We sought to improve the bone vascularity and bone formation of CBAs by surgical angiogenesis with an implanted arteriovenous (AV) bundle, using a porcine tibial defect model. Cryopreserved tibial bone allografts were transplanted in swine leukocyte antigen (SLA) mismatched Yucatan minipigs to reconstruct a 3.5 cm segmental tibial defect. A cranial tibial AV-bundle was placed within its intramedullary canal to induce angiogenesis. The AV bundle was patent in eight pigs and ligated in a control group of eight pigs. At 20 weeks neo-angiogenesis was evaluated by micro-angiography. Bone formation was measured by quantitative histomorphometry and micro-computed tomography. Seven of eight AV-bundles in the revascularized group were patent. One had thrombosed due to allograft displacement. Total vascular volume was higher in the revascularized allografts compared to the ligated group (p = 0.015). Revascularized allografts had increased levels of bone formation on the allograft endosteal surface compared to the ligated control group (p = 0.05). Surgical angiogenesis of porcine tibial CBAs by intramedullary implantation of an AV-bundle creates an enhanced autogenous neoangiogenic circulation and accelerates active bone formation on allograft endosteal surfaces. 
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