Optimization of the properties of allogeneic bone grafts

BACKGROUND: Various materials of both biological and non-biological origin are used to replace a bone defect formed as a result of injury. The N.V. Sklifosovsky Research Institute of Joint Venture uses allogeneic bone for bone grafting in intraarticular fractures. However, if a particular graft has weak osteoconductive properties, then cysts may form in its place, which reduces the quality of the bone. To prevent such problems, we have developed a combined bone-collagen allogeneic lyophilized graft.

AIM: To determine the optimal graft for the replacement of traumatic defects of spongiose bone by comparing the regenerative properties of allogenic bone and combined bone-collagen grafts.

MATERIALS AND METHODS: A prospective randomized trial was conducted with the formation of 2 groups of patients. The first group (n=34) underwent osteosynthesis with bone grafting from allogeneic non-mineralized lyophilized bone in the form of a block. In the second group (n=34), bone grafting was performed with an allogeneic bone-collagen perforated lyophilized graft in the form of a block. All patients underwent computed tomography at admission, after plastic surgery, 1.5 months after surgery, 6 and 12 months later. Based on computed tomography data performed after 12 months, bone quality and the process of osseointegration were evaluated.

RESULTS: Higher bone quality was significantly noted in the second group (82%) of patients. At the same time, in the second group there were no patients with the lowest bone quality (grade 4), while in the first group this was noted in 6 cases, of which in two cases the total volume of cavities and cysts was over 50% of the volume of the condyle. Adequate osseointegration by the end of the 12^th month of the postoperative period in the first group was noted in 16 patients (47%), in the second group — in 27 (79%), which was statistically significantly more than in the first group (p=0.006; VC). At the same time, graft osseointegration in patients of groups 1 and 2 (16+27=43 out of 68=63%) occurred statistically significantly more often/more often than in patients of groups 3 and 4 (p=0.002; VC).

CONCLUSIONS: Objective and statistically confirmed data on the restoration of bone tissue in the area of a traumatic defect of the outer condyle of the tibia have been obtained. As a result of the analysis of these data, it can be concluded that the regenerative potential of a combined bone-collagen graft is higher than the regenerative potential of an allogeneic bone graft without collagen.