The long-term success of massive osteochondral allografts depends not
only on the incorporation of the transplanted articular cartilage.
Osteochondral allografts are immunogenic, and, once an immune response is
stimulated by exposure to donor cellular antigens, the cartilage becomes
vulnerable to direct injury by cytotoxic antibodies or by lymphocytes, or
to indirect injury by inflammatory mediators and enzymes induced by the
immune response. To clarify the role of histocompatibility antigen-matching
on the health of transplanted articular cartilage, we orthotopically
implanted canine leukocyte antigen-matched and mismatched proximal
osteochondral allografts of the radius, both fresh and cryopreserved, in
beagles. Four groups of dogs received: (1) canine leukocyte
antigen-mismatched frozen allografts, (2) canine leukocyte
antigen-mismatched fresh allografts, (3) canine leukocyte antigen-matched
fresh allografts, or (4) canine leukocyte antigen-matched frozen
allografts. In twelve of the dogs, the contralateral leg was subjected to a
sham operation, and in ten of the dogs, the proximal part of the radius was
removed and replaced as an autogenous graft control. All animals were
followed for eleven months after the operation and then were killed. The
cartilage of the grafts was evaluated grossly, histologically, and
biochemically. The biochemical analysis consisted of measurement of dry
weight, content of glycosaminoglycan and hydroxyproline, and
galactosamine-to-glucosamine ratios. Analyses of variance were used to
study the effect of tissue antigen-matching and freezing on degradation of
cartilage. During the study, no dog had grossly obvious clinical
abnormalities, all host-graft interfaces healed, and no joints dislocated.
The gross appearance of the cartilage was normal for both the joints that
had an autogenous graft and those that were subjected to the sham
operation. The cartilage of all allografts was thinned, dull, and
roughened. The synovial membrane of all of the joints that had been
operated on was mildly fibrotic and hyperplastic, but only that of the dogs
that had an allograft was severely fibrotic and hyperplastic and
demonstrated an inflammatory response. The inflammatory response was most
severe in joints that had received a fresh canine leukocyte
antigen-mismatched allograft. Invasive pannus was more frequent in joints
that had received a fresh graft, particularly those that had received a
canine leukocyte antigen-mismatched allograft, and cartilage was sometimes
eroded to subchondral bone. Freezing was harmful to the cartilage. Very few
cells survived the freezing procedure, and frozen grafts received s
significantly worse histological scores had significantly less
glycosaminoglycans and had a lower ratio of galactosamine to glucosamine
than fresh grafts.