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AlloSource: An Update

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Title: AlloSource: An Update


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AlloSource Parts is Parts
  • Ross M Wilkins MD
  • Senior Medical Director

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AlloSource
  • 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

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AlloSource
  • 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

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The Mother Ship
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AlloSource 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

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The Gold Standard
  • Autologous Iliac Graft

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JBJS Review Article 2002
  • Autograft references 1892-1950, 60, 64, 62, 79

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No 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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Jay Leiberman - UCLA
  • No one wants to do autografts

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Types of Autograft Substitutes
  • Protein-based
  • Collagen
  • Bone matrix
  • BMPs
  • Ceramic-based
  • Tricalcium phosphate
  • Hydroxyapatite
  • Combinations
  • Calcium SulfateAutologous Growth Factors

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Allografts
  • Sports
  • Ligaments
  • Tendons
  • Osteoarticular
  • Cryopreserved
  • Fresh
  • Traditional
  • Cancellous
  • Cortical
  • DBM

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Structural 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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It hurts when I pee.
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Local control
  • Radiation
  • Surgery
  • Intercalary allograft spares both growth plates

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Clinical Cases
  • 22 yo 150,000 volt injurybilateral UE and LE
    amputations.Right AE with only humeral head
    present.

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Demineralized Bone Matrix
  • Naturally occurring bone proteins extracted from
    cortical bone
  • Concentrated, correct proportions

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Human 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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Below 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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EMT, shot by dog
  • Soft tissue loss
  • Bone loss
  • Arterial damage
  • Nerve damage
  • Amputation suggested
  • Dog re-named Trigger

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Stem Cells
  • Able to isolate bone forming cells from adipose
    tissue ( yes, fat!)
  • Better
  • Higher numbers
  • Can add these cells to already existing bone
    products

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Osteochondral 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,

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Osteo - bone(5mm )Chondral - cartilage
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Indications
  • OCD
  • Trauma
  • Tumor
  • Failure of other techniques

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Indications
  • Geographic areas of bone cartilage loss
  • Minimum 2 cm diameter
  • Minimum 1 cm depth

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  • 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

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Grafts Produced from the Femur
Hemi-condyle
Partial-condyle
Fresh Femoral Head
Whole Fresh Condyle
Cryopreserved Distal Femur
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Confocal Microscopy Images Viability Assessment
1-Day Image Superficial Layer
28-Day Image Superficial Layer
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22 year old shot in leg.
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30 year old female. Fractured talus fixed with
two screws.
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One year post-op. Healed and running 5 miles
per week.
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Ankle Allografts
Post-traumatic Arthrosis
Alternative to Arthrodesis
or Arthroplasty
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Humeral Head Replacement
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The future
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Its not That wont happen
  • Its How can we make it happen?

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Invest in the Future!
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Thank you
  • Questions?drrmw_at_aol.com

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History
  • Cosmos / Damien
  • 1800's - dog/human
  • Otolenghi
  • Mankin et al
  • Myers / Gross / Bugbee

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Osteochondral Transplants
  • Large lesions
  • Salvage procedure
  • Repair surface
  • Restore bone stock

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Osteochondral Allografts
  • History
  • Graft types
  • Indications
  • Technique
  • Results

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Graft Types
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Graft Types
  • Frozen
  • Cryopreserved
  • Fresh

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Graft TypesCryopreserved
  • Glycerol
  • DMSO
  • Combinations

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Technique
  • Exposure
  • Resection of damaged area
  • Modeling of graft
  • Bone matrix filler
  • Fixation
  • Postoperative regime

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Conclusions
  • Cryopreserved osteochondral grafts are effective
    in treating deep, geographic bone/cartilage
    defects requiring major bone support.

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Can we do better???
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Grafts Produced from the Tibia
Special order bone tendon bone
Frozen Cryopreserved Tibia
Fresh Tibial Plateau
Fresh patella bone
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Grafts from Humeri
OA FFC Proximal Humeri
Elbow Set
Humeral Head
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Fresh 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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