Skeletal allografts for synovial joint reconstruction.

A principle of reconstructive surgery is to replace lost tissue with similar tissue. This principle is applicable particularly to traumatic and orthopaedic surgery in which autografts are now used widely to replace bone, tendon, nerve and skin. Articular cartilage, as a component of a synovial joint, is rarely transplanted as an autograft in man. When used as an autograft articular cartilage is employed in one of three ways : as a shell or plaque composed of cartilage and a thin layer of subchondral bone (Lagrange Rigault and Guyonvarch 1969); as a half-joint transplant attached to the shaft ofa long bone; or as a whole-joint transplant (Lexer 1925 vide Burwell 1969). The use of skeletal allografts (homografts) for the reconstruction of synovial joints in man was explored first by Lexer (1925), who performed eleven half-joint and twenty-three whole-joint transplantations, using as donor tissue fresh material procured from amputation specimens or from the fresh cadaver. Apparently the results of these procedures were not impressive enough tojustify their popularisation (Chase and Herndon 1955), although sporadic reports of the clinical method continued to be published (May 1942, Capurro and Pedemonte 1953). It is only in the last few years and with increasing knowledge in several fields, namely the immunology of tissue transplantation, the preservation and sterilisation of tissues, the internal fixation of the skeleton and the control of infection, that interest in joint allotransplantation has reawakened. The fresh skeletal allograft for synovial joint replacement, like the autograft, may be employed in one of three ways: as a shell or plaque of cartilage and subchondral bone; as a partial or half-joint transplant; or as a whole-joint transplant. In man, at the present time, only the chondro-osseous shell is worthy of study as a fresh skeletal allograft to replace a joint surface, for encouraging experimental results have been gained recently in using such chondro-osseous shell allografts in the hip and knee joints of animals (Gibson 1965, 1969; Chesterman 1965, 1968; Laurence 1969a, Smith 1969); and preliminary reports of the clinical application have been published (Storig 1968, Laurence l969b). However, many problems, mainly mechanical and immunological, await solution in the laboratory before the method is applied more fully to man. Fresh half-joint and whole-joint skeletal allografts continue to be studied in the laboratory