Influence of Osteochondral Allograft Harvest Irrigation Technique and Graft Characteristics on Temperature-Related
Cade C Smelley1, Edouard Augustin1, Divesh Sachdev1
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Background:
Long-term clinical success and graft integration after osteochondral allograft (OCA) transplantation rely on chondrocyte viability, which can be compromised by thermal injury during graft harvest.
Hypothesis:
It was hypothesized that handheld cold saline irrigation and cold saline submersion would reduce thermal injury during OCA harvest and preserve chondrocyte viability compared with dry harvest, and that submersion would provide superior protection than handheld irrigation.
Study Design:
Controlled laboratory study.
Methods:
Ten fresh human femoral condyles (from 7 donors) were used to harvest a control sample of trochlear cartilage and three 18-mm OCA plugs per specimen under 3 irrigation conditions: no irrigation (Dry), handheld cold saline irrigation (Cold Bulb), and cold saline submersion (Cold Submerged). Temperatures internal and external to the reamer were recorded during each harvest, along with total reaming time, and donor bone density via computed tomography scan. Chondrocyte viability was assessed using calcein/ethidium homodimer staining and confocal microscopy.
Results:
Chondrocyte viability differed significantly by technique (P < .001): Control, 69.5% ± 6.8%; Dry, 58.7% ± 9.7%; Cold Bulb, 64.6% ± 9.7%; and Cold Submerged, 75.2% ± 6.7%. Cold Submersion preserved viability equivalent to Control and was superior to both Dry (P = .0003) and Cold Bulb (P = .001). Dry harvest produced the highest internal maximum temperature (34.8°C ± 15.8°C), followed by Cold Bulb (16.9°C ± 3.5°C) and Cold Submerged (8.9°C ± 0.9°C). Maximum internal temperature negatively correlated with viability (R2 = 0.31; P = .0015), and donor bone density was positively correlated with reaming time (R2 = 0.15; P = .035). Within the Dry group, bone density correlated with maximum internal temperature (Spearman ρ = 0.66; P = .038).
Conclusion:
Maximum temperature during OCA harvest was identified as a key determinant of graft viability, and was most effectively mitigated by cold saline submersion. Cold submersion minimized temperature rise within and surrounding the reamer and preserved chondrocyte viability at levels comparable to controls, outperforming handheld cold irrigation and dry harvest. These results underscore the importance of temperature control during OCA harvest and identify cold submersion as a readily implemented method to optimize graft quality and improve the long-term durability of OCA transplantation.
Clinical Relevance:
Cold saline submersion during OCA harvest is a simple, reproducible method to mitigate thermal injury and chondrocyte loss, and may improve long-term graft survival and clinical outcomes.
