OREF Clinical Research Award Honors Research on Osteochondral Allograft Transplantation

The 2025 Orthopaedic Research and Education Foundation (OREF) Clinical Research Award was presented to Brian J. Cole, MD, MBA, FAAOS, for his collaborative effort over the past 25 years to advance osteochondral allograft (OCA) transplantation to treat cartilage and bone defects in the knee. Dr. Cole and his team applied translational basic science and clinical research to study allograft procurement, processing, preservation, implantation, surgical technique, and decision making.

Dr. Cole is an endowed professor and acting chair of the Department of Orthopaedics at Rush University Medical Center and director and founder of the Rush Cartilage Restoration Center in Chicago. He and his team—Jorge A. Chahla, MD, PhD; Susanna G. Chubinskaya, PhD; Ron Gilat, MD; and Adam Yanke, MD, PhD, all associated with Rush University Medical Center; and Rachel M. Frank, MD, FAAOS, with the University of Colorado, Denver—spent more than two decades studying virtually every aspect of the procedure. They aimed to enhance clinical understanding and technical precision for better results by addressing questions about graft preservation, handling, instrumentation, sizing, donor analysis, and patient outcomes.

By studying the effects of time on OCA health during the cold-preservation process, the team discovered that cell viability was >95 percent at 14 days, 75 to 98 percent at 21 days, and 65 to 90 percent at 28 days, suggesting that cold-preserved OCA material should be implanted within 28 days of harvest. This discovery was awarded a Career Development Award in 2001 by OREF as a testament to the future impact of this work.

The graft must also be removed from cold preservation, raising the critical question of the optimal rewarming process. The team discovered that gradually rewarming the graft in stages (4 degrees to 25 degrees to 37 degrees Celsius) and reducing nitric oxide production through nitric oxide synthase inhibition at the time of implantation can minimize the loss of chondrocytes’ metabolic function. As a result, the gradual rewarming of fresh OCA grafts has now become the standard practice in surgical procedures, and the team is investigating further methods to enhance cell viability at the time of graft implantation.

A concern with the use of allograft tissue is the potential for an antibody-based immunogenic response, which may develop postoperatively and compromise graft integrity and longevity. To address this, the team explored techniques to remove immunogenic elements from the bone marrow by cleansing the graft in the OR. Based on their work, methods such as pulse lavage with irrigation fluid and high-pressure carbon dioxide are now used to clean the graft thoroughly.

The team looked at ways to improve how donor bone heals within the recipient socket, specifically using growth-factor therapy, mainly concentrated bone marrow aspirate (cBMA). Their studies showed that patients whose plugs were soaked in cBMA have less pain at 1 year postoperatively with fewer cysts identified by CT scan at 6 months. In a separate laboratory collaboration, they found that deep cleaning of the OCA with high-pressure carbon dioxide better removes moisture and increases graft porosity, leading to greater cBMA saturation and uptake, optimizing graft biology and subsequent bone integration.

References

1. Williams JM, Virdi AS, Pylawka TK, et al: Prolonged-fresh preservation of intact whole canine femoral condyles for the potential use as osteochondral allografts. J Orthop Res 2005;23(4):831-7.
2. Pylawka TK, Virdi AS, Cole BJ, et al: Reversal of suppressed metabolism in prolonged cold preserved cartilage. J Orthop Res 2008;26(2):247-54.
3. Elias TJ, Allahabadi S, Haneberg E, et al: Osteochondral allograft reaming significantly affects chondrocyte viability. Am J Sports Med 2024;52(11):2874-81.
4. Allahabadi S, Haneberg EC, Elias TJ, et al: Osteochondral allografts: pearls to maximize biologic healing and clinical success. Arthrosc Tech 2023;12(12):e2281-7.
5. Atzmon R, Chang W, Chan C, et al: The effect of pressurized carbon dioxide lavage on osteochondral allograft preparation: a comparative study. Submitted for publication, 2024.