J Orthop Res. 2022 Jul 26. doi: 10.1002/jor.25422. Online ahead of print.
Cryopreserved bone allografts(CBA) are susceptible to infection, nonunion and late stress fracture. While surgical revascularization by intramedullary implantation of an arteriovenous-bundle generates a neoangiogenic blood supply, there is potential for vascular ingrowth-mediated bone resorption to weaken the graft. For this reason, we have evaluated changes in CBA mechanical properties of structural tibial allografts with and without surgically induced angiogenesis. Cryopreserved tibia bone allografts were transplanted to reconstruct a 3.5 cm segmental tibial defect in 16 Yucatan mini pigs. Surgical revascularization was performed in half by implantation of a cranial tibial arteriovenous bundle, revascularization group. A control group of identical size had a ligated AV bundle implanted, ligated group. At 20 weeks micro-computed tomography measured Bone Mineral Density as well as bone union, Reference Point Indentation (RPI) compared cortex material properties, and axial compression determined the allotransplant compressive modulus. Seven of 8 tibiae in the angiogenesis group were healed at both junction points at 20 weeks. Only 4 of 8 tibiae healed in the ligated control group. There was no significant difference between the revascularization and ligated control groups in bone mineral density and axial compression test. Similarly, RPI parameters were statistically equal. In paired comparisons with contralateral tibias, however, some RPI values were significantly worse in the ligated control group tibiae. This study demonstrates no adverse effect of surgical angiogenesis on cryopreserved structural bone allograft biomechanical properties in a large animal orthotopic segmental tibial defect model. These data suggest the potential value of surgical angiogenesis in clinical limb-sparing reconstructive surgery. This article is protected by copyright. All rights reserved.