Title: AlloSource: An Update
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2AlloSource Parts is Parts
- Ross M Wilkins MD
- Senior Medical Director
3AlloSource
- Owned by OPOs
- Doesnt buy donors
- Highest donor criteria of any facility
- Largest provider of burn skin
- 2008 processed 4000 donors
- Worlds largest not for profit tissue bank
consortium - Largest processor of stem cells
- Distributed 100,0000 grafts in 2008
4AlloSource
- InternationalFrance, England, Netherlands,
Italy, China, Korea - Innovative ProductsSpine fusion cortical
graftsOsiris stem cell based bone grafting
materialComposite ligament grafts for sports
injuriesFresh Skin - Joint Restoration FoundationFresh osteochondral
graftsMeniscus transplantsTendon/ligament
grafts
5The Mother Ship
6AlloSource New TechnologyConfidential
- Tissue contamination Extractionmillions vs
dozens of bacteria - Tissue cleaning and processingRICA
- CT donor planning
- Preservation of fresh articular cartilage
- Preservation of fresh, live skin
- Stem cells
- Amnion
7The Gold Standard
8JBJS Review Article 2002
- Autograft references 1892-1950, 60, 64, 62, 79
9No new autograft research
- 30 years old
- Non-inductive!!!!!!
- ? Cell viability
- May actually interfere with bone propagation
- 5-30 complication rate.PAIN
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11Jay Leiberman - UCLA
- No one wants to do autografts
12Types of Autograft Substitutes
- Protein-based
- Collagen
- Bone matrix
- BMPs
- Ceramic-based
- Tricalcium phosphate
- Hydroxyapatite
- Combinations
- Calcium SulfateAutologous Growth Factors
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14Allografts
- Sports
- Ligaments
- Tendons
- Osteoarticular
- Cryopreserved
- Fresh
- Traditional
- Cancellous
- Cortical
- DBM
15Structural Allografts
- 1881 MacEwen humerus
- 2003 800,000 allografts
- Why?
- Strongest material for its size and weight
- Used to replace bone loss for trauma, tumor,
infection and osteolysis where the only other
alternative may be limb loss
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20It hurts when I pee.
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23Local control
- Radiation
- Surgery
- Intercalary allograft spares both growth plates
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34Clinical Cases
- 22 yo 150,000 volt injurybilateral UE and LE
amputations.Right AE with only humeral head
present.
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39Demineralized Bone Matrix
- Naturally occurring bone proteins extracted from
cortical bone - Concentrated, correct proportions
40Human Bone-Derived Growth Factors
- Bioassayed in human bone cell culture (SaOS)
- Must meet minimal criteria for release based on
known bioactivity
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42Below 18 months post-op shows return of normal
bony architecture.
3 weeks post op
Above X-ray view of the pelvis of a 14-year-old
female with an aneurysmal Bone cyst 3-weeks
post-op after grafting with a combination of
OSTEOSET pellets and DBM.
18 months post-op
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44EMT, shot by dog
- Soft tissue loss
- Bone loss
- Arterial damage
- Nerve damage
- Amputation suggested
- Dog re-named Trigger
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56Stem Cells
- Able to isolate bone forming cells from adipose
tissue ( yes, fat!) - Better
- Higher numbers
- Can add these cells to already existing bone
products
57Osteochondral Joint Transplantation Evolution
1983 - 2009
- Ross M. Wilkins, M.D., M.S.
- Colorado Limb Consultants
- Denver Clinic for Extreities at risk
- _at_ P/SL Medical Center
- Denver, Colorado
- Medical Director AlloSource,
58Osteo - bone(5mm )Chondral - cartilage
59Indications
- OCD
- Trauma
- Tumor
- Failure of other techniques
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61Indications
- Geographic areas of bone cartilage loss
- Minimum 2 cm diameter
- Minimum 1 cm depth
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67- 24-48 hours from recovery
- Donor recovered, shipped, processed.
- Minimum of consent, recovery summary sheet and
either serologies or med/soc screening to
process. - Day 3-7 (from processing)
- Donor documentation completed, serologies
completed, 7 day recovery cultures - Day 8-10
- Pre-processing cultures, offering of grafts to
surgeons - Day 14
- Graft release and shipment
- Day 28 (from donor death)
- Graft expiration
68Grafts Produced from the Femur
Hemi-condyle
Partial-condyle
Fresh Femoral Head
Whole Fresh Condyle
Cryopreserved Distal Femur
69Confocal Microscopy Images Viability Assessment
1-Day Image Superficial Layer
28-Day Image Superficial Layer
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7222 year old shot in leg.
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8030 year old female. Fractured talus fixed with
two screws.
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82One year post-op. Healed and running 5 miles
per week.
83Ankle Allografts
Post-traumatic Arthrosis
Alternative to Arthrodesis
or Arthroplasty
84Humeral Head Replacement
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87The future
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91Its not That wont happen
- Its How can we make it happen?
92Invest in the Future!
93Thank you
- Questions?drrmw_at_aol.com
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96History
- Cosmos / Damien
- 1800's - dog/human
- Otolenghi
- Mankin et al
- Myers / Gross / Bugbee
97Osteochondral Transplants
- Large lesions
- Salvage procedure
- Repair surface
- Restore bone stock
98Osteochondral Allografts
- History
- Graft types
- Indications
- Technique
- Results
99Graft Types
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104Graft Types
105Graft TypesCryopreserved
- Glycerol
- DMSO
- Combinations
106Technique
- Exposure
- Resection of damaged area
- Modeling of graft
- Bone matrix filler
- Fixation
- Postoperative regime
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108Conclusions
- Cryopreserved osteochondral grafts are effective
in treating deep, geographic bone/cartilage
defects requiring major bone support.
109Can we do better???
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117Grafts Produced from the Tibia
Special order bone tendon bone
Frozen Cryopreserved Tibia
Fresh Tibial Plateau
Fresh patella bone
118Grafts from Humeri
OA FFC Proximal Humeri
Elbow Set
Humeral Head
119Fresh graft storage and handling
- Grafts stored at 1-10 Celsius.
- Grafts not distributed by day 28 are reunited to
be processed as freeze-dried grafts. - Cannot return grafts once they leave AlloSource.
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