Radiographic and histological studies of sixteen massive retrieved human
allografts were carried out after the allografts had been in situ for four
to sixty-five months. The studies demonstrated that union between the
allograft and the host took place slowly at cortical-cortical junctions by
the formation of an external callus derived from the cortex of the host,
and it took place more rapidly at cancellous-cancellous junctions by
internal callus advancing from the host into the allograft. Internal repair
took place very slowly, was confined to the superficial surface and the
ends of the graft, and had involved only 20 per cent of the graft by five
years. The deep unrepaired portions of the graft retained their
architecture, and where bone cement had been used to fix a prosthetic stem
or an intramedullary rod to the allograft, there was no evidence of
resorption of bone or loosening of the device. Soft tissues of the host
became attached to the graft by deposition of a thin seam of new bone on
the surface of the graft. A previous fracture of two grafts had healed
before the time of retrieval. Analysis of the articular cartilage revealed
no evidence that any chondrocytes had survived, even when the graft had
been cryoprotected before it was preserved by freezing. The necrotic
cartilage functioned well for as long as five years, and as it degenerated,
it was covered by a pannus of fibrovascular reparative tissue. Two
allografts that had been removed because of rejection were surrounded by an
envelope of chronic inflammatory tissue that prevented union, adherence of
soft tissue, and internal repair. Internal repair was more advanced about
sites of fracture and adjacent to recurrent tumors than in other portions
of the graft. These findings suggest that large frozen allografts in humans
are osteoconductive rather than osteoinductive.