Summary
To develop the surgical model, whole knee joints including the distal femur, proximal tibia, and joint capsule, were raised on a vascular pedicle and then replanted at the same site. Rigid fixation of the bones was achieved using two mini-plates on the tibia and femur. Revascularization of the knee was accomplished by end-to-end anastomosis of the popliteal vessels using standard microvascular techniques, and the vascular and neural supplies to the lower leg and foot were preserved. A total of 21 vascularized whole knee allografts were then similarly performed on a microvascular pedicle between two incompatible strains of rabbit. In a control group of six adult animals, no immunosuppression was administered. Two of these joints were harvested at 1 week and had patent popliteal arteries. The remaining four joints were harvested at 2–3 weeks when they were deteriorating and were found to have occluded popliteal vessels by arteriography. Eight adult allograft recipients were immunosuppressed with cyclosporin A (CyA) at 15 mg/kg per day. One allograft failed at 10 days due to femoral fracture. None of the remaining seven were rejected acutely, and three of them had patent vessels by arteriography and live bone and cartilage by light microscopy when harvested 100 days after transplantation. In another group, seven knee joints were allografted into immature rabbits immunosuppressed with CyA. Again, none rejected acutely, and 90 days later two of the seven allografts had patent vessels by arteriography, growth by serial radiographs, and live bone and cartilage by histological examination. This pilot study suggests that CyA will be useful as an immunosuppressive agent in the study of vascularized bone and cartilage transplantation, and that experimental epiphyseal plate allografting is possible in rabbits.
Zusammenfassung
Für die Entwicklung eines operativen Modells wurden ganze Kniegelenke — einschließlich des distalen Femurendes, des proximalen Tibiaendes und der Gelenkkapsel — mit einem Gefäßstiel isoliert, aus der Gliedmaße herausgehoben und an der gleichen Stelle wieder reimplantiert. Eine stabile Fixation der Knochen wurde mit zwei Miniplatten an Tibia und Femur durchgeführt. Die Revaskularisation des Kniegelenkes wurde durch End-zu-End-Anastomosen der Poplitealgefäße mit den standardisierten mikrochirurgischen Techniken erreicht. Die Gefäß- und Nervenversorgung von Unterschenkel und Fuß wurden erhalten. Insgesamt wurden dann 21 vaskularisierte Ganz-Knie-Transplantationen mit einem mikrochirurgisch versorgten Gefäßstiel zwischen zwei inkompatiblen Hasenrassen vorgenommen. In einer Kontrollgruppe von sechs erwachsenen Tieren wurden keine Immunosuppressiva verabreicht. Zwei dieser Gelenke wurden nach 1 Woche entnommen und zeigten offene Poplitealarterien. Die restlichen vier Gelenke wurden nach 2–3 Wochen entnommen, als sie Zerfallserscheinungen aufwiesen und arteriographisch ein Verschluß der Poplitealgefäße festgestellt wurde. Bei acht erwachsenen Empfängern von allogenen Transplantaten wurde eine immunosuppressive Behandlung mit Cyclosporin A (CyA) mit 15 mg/kg pro Tag durchgeführt. Bei einem Allotransplantat trat nach 10 Tagen ein Versagen wegen einer Femurfraktur auf. Bei keinem der übrigen sieben Transplantate kam es zu einer akuten Abstoßungsreaktion, und drei Transplantate zeigten nach 100 Tagen arteriographisch offene Gefäße und lichtmikroskopisch vitalen Knochen und Knorpel. In einer anderen Gruppe wurden sieben allogene Kniegelenke bei wachsenden Kaninchen transplantiert und mit CyA immunosuppressiv behandelt. Wiederum trat keine akute Abstoßung auf, und nach 90 Tagen zeigten drei der sieben Allotransplantate arteriographisch offene Gefäße, Wachstum in Röntgenserienaufnahmen und lichtmikroskopisch vitalen Knochen und Knorpel. Diese Pilotstudie legt nahe, daß CyA ein nützliches Immunosuppressivum darstellt für die Untersuchung vaskularisierter Knochenund Knorpeltransplantate. Außerdem zeigt die Studie, daß eine experimentelle Transplantation von allogenen Epiphysenplatten bei Kaninchen möglich ist.
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Siliski, J.M., Simpkin, S. & Green, C.J. Vascularized whole knee joint allografts in rabbits immunosuppressed with cyclosporin A. Arch. Orth. Traum. Surg. 103, 26–35 (1984). https://doi.org/10.1007/BF00451315
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DOI: https://doi.org/10.1007/BF00451315