THE ROLE OF A COMPOSITE, DEMINERALIZED BONE MATRIX AND BONE MARROW IN THE TREATMENT OF OSSEOUS DEFECTS
165
Citation
25
Reference
10
Related Paper
Citation Trend
Abstract:
The efficacy of demineralized bone matrix (DBM) used alone and with bone marrow as a graft material in the treatment of osseous defects was evaluated in 48 patients. Of these 48 patients, 39 were available to follow up and review. Follow up averaged 19 months for all patients. In the entire series, 30 of 39 patients demonstrated osseous union for a 77% success rate. Patients with fracture nonunion represented the most recalcitrant group clinically, with union achieved in only 61% of these cases. Overall, the 39 patients grafted with DBM demonstrated healing that was comparable to results achieved with standard iliac crest bone graft. The results indicate the DBM and marrow composite grafting is a suitable alternative to autologous iliac crest bone graft for use in certain clinical situations, such as bone defects in children, comminuted fractures with associated bone loss, nonunited fractures, or to augment an intended arthrodesis site.Keywords:
Demineralized bone matrix
Iliac crest
Bone marrow aspirate
Bone grafting
The Role of Intraoperative Bone Marrow Aspirate Stem Cell Concentration as a Bone Grafting Technique
Despite the recapitulative nature of bone, a large percentage of nonunions still occur. Many exogenous substances have been administered to aid in the arthrodesis process, yet few have proven efficacious relative to time and cost. With recent advancements in bone biology involving cellular and molecular signaling, it is now possible to selectively retain bone progenitor cells from a patient's bone marrow. The commercially available product, CellectTM Cellect selective cell retention device has gained attention for its fast and cost-effective intraoperative concentration of these bone progenitor cells from bone marrow aspirate. Application of this concentrate within a bone graft matrix of either tricalcium phosphate granules or demineralized bone matrix is a novel grafting technique that facilitates bony bridging of osseous defects.
Bone grafting
Demineralized bone matrix
Bone marrow aspirate
Cite
Citations (8)
Introduction Osteochondral defects (OCDs) of the talus are treated initially by arthroscopic bone marrow stimulation. For both large and secondary defects, current alternative treatment methods have disadvantages such as donor site morbidity or two-stage surgery. Demineralized bone matrix (DBM) was published for the treatment of OCDs of rabbit knees. Autologous platelet-rich plasma (PRP) may improve the treatment effect of DBM. We previously developed a goat model to investigate new treatment methods for OCDs of the talus. The aim of the current study was to test whether DBM leads to more bone regeneration than control OCDs, and whether PRP improves the effectiveness of DBM. Methods A standardized 6-mm OCD was created in 32 ankles of 16 adult Dutch milk goats. According to a randomized schedule, 8 goats were treated with commercially available DBM (Bonus DBM, Biomet BV, Dordrecht, the Netherlands) hydrated with normal saline, and 8 were treated with the same DBM but hydrated with autologous PRP (DBM+PRP). The contralateral ankles (left or right) were left untreated and served as a control. The goats were sacrificed after 24 weeks and the tali were excised. The articular talar surfaces were assessed macroscopically using the international cartilage repair society (ICRS) cartilage repair assessment, with a maximum score of 12. Histologic analysis was performed using 5-μm sections, and histomorphometric parameters (bone% and osteoid%) were quantified on representative areas of the surface, center, and peripheral areas of the OCDs. Furthermore, μCT-scans of the excised tali were obtained, quantifying the bone volume fraction, trabecular number, trabecular thickness, and trabecular spacing in both the complete OCDs and the central 3-mm cylinders. Results All goats recovered well and were able to bear full weight within 24 hours after surgery. The mean ICRS-score of the ankles treated with DBM was 8.0 ± 1.0, compared to a score of 8.4 ± 1.5 in the contralateral ankle (NS); those treated with DBM+PRP scored 6.9 ± 2.4, compared to 7.4 ± 2.0 in the contralateral ankle (NS). Histologic analysis showed four different patterns of healing, distributed evenly over the treatment and control groups: type 1 (n = 4), almost completely healed; type 2 (n = 11), restoration of the subchondral bone with a cystic lesion underneath; type 3 (n = 14), superficial defect with regeneration from the margins and bottom; type 4 (n = 3), no healing tendency. Histomorphometry and μCT revealed no statistically significant difference between treatment (DBM or DBM+PRP) and contralateral control or between both treatment groups in any of the parameters investigated. Conclusion No treatment effect of DBM was found compared to control defects, and the addition of PRP was not beneficial.
Demineralized bone matrix
Subchondral bone
Bone marrow aspirate
Osteoid
Cite
Citations (0)
Demineralized bone matrix
Matrix (chemical analysis)
Bone matrix
Human bone
Cite
Citations (4)
Iliac crest
Demineralized bone matrix
Cite
Citations (1)
Demineralized bone matrix (DBM) is one of the most widely used bone graft materials in dentistry. However, the ability of DBM to reliably and predictably induce bone regeneration has always been a cause for concern. The quality of DBM varies greatly depending on several donor dependent factors and also manufacturing techniques. In order to standardize the quality and to enable reliable and predictable bone regeneration, we have generated a biomimetically-enhanced version of DBM (BE-DBM) using clinical grade commercial DBM as a control. We have generated the BE-DBM by incorporating a cell-derived pro-osteogenic extracellular matrix (ECM) within clinical grade DBM. In the present study, we have characterized the BE-DBM and evaluated its ability to induce osteogenic differentiation of human marrow derived stromal cells (HMSCs) with respect to clinical grade commercial DBM. Our results indicate that the BE-DBM contains significantly more pro-osteogenic factors than DBM and enhances HMSC differentiation and mineralized matrix formation in vitro and in vivo. Based on our results, we envision that the BE-DBM has the potential to replace DBM as the bone graft material of choice.
Demineralized bone matrix
Matrix (chemical analysis)
Cite
Citations (9)
Iliac crest
Demineralized bone matrix
Cite
Citations (0)
The efficacy of demineralized bone matrix (DBM) used alone and with bone marrow as a graft material in the treatment of osseous defects was evaluated in 48 patients. Of these 48 patients, 39 were available to follow up and review. Follow up averaged 19 months for all patients. In the entire series, 30 of 39 patients demonstrated osseous union for a 77% success rate. Patients with fracture nonunion represented the most recalcitrant group clinically, with union achieved in only 61% of these cases. Overall, the 39 patients grafted with DBM demonstrated healing that was comparable to results achieved with standard iliac crest bone graft. The results indicate the DBM and marrow composite grafting is a suitable alternative to autologous iliac crest bone graft for use in certain clinical situations, such as bone defects in children, comminuted fractures with associated bone loss, nonunited fractures, or to augment an intended arthrodesis site.
Demineralized bone matrix
Iliac crest
Bone marrow aspirate
Bone grafting
Cite
Citations (165)
Demineralized bone matrix (DBM) is the most commonly used allograft material. DBM has been applied in various fields because its healing effects are similar to those of autografts, with fewer side effects. Efforts to enhance its convenience have explored the use of human acellular dermal matrix (AM) as a carrier graft material for defective soft tissue, given the difficulty of using solid particles of DBM. The induction ability of AM combined with the osteoinduction ability of DBM is considered to have a synergistic effect. This study evaluated the outcomes of treatment with various ratios of a DBM/AM mixture in defects in rat skulls. Imaging measurements and histological analyses were performed 4 and 8 weeks after treatment to investigate the characteristics and formation of new bone in treated and untreated groups. Groups treated with 7:3 and 5:5 DBM: AM ratios showed no difference in osteogenetic ability compared with the group treated with DBM alone. This finding indicates that the use of a proper DBM: AM ratio maintains osteogenetic ability, providing a convenient and sufficient clinical application. This DBM/AM mixture is the first graft material developed in Korea.
Demineralized bone matrix
Matrix (chemical analysis)
Bone matrix
Human bone
Cite
Citations (0)
Demineralized bone matrix
Bone marrow aspirate
Cite
Citations (22)
Demineralized bone matrix
Matrix (chemical analysis)
Subchondral bone
Bone matrix
Cite
Citations (0)