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Ankle Bipolar Fresh Osteochondral Allograft Survivorship and Integration: Transplanted Tissue Genetic Typing and Phenotypic Characteristics
Simona Neri, PhD1; Francesca Vannini, MD1; Giovanna Desando, BSc1; Brunella Grigolo, PhD1; Alberto Ruffilli, MD1; Roberto Buda, MD1; Andrea Facchini, MD1; Sandro Giannini, MD1
1 SC Laboratorio di Immunoreumatologia e Rigenerazione Tissutale/Laboratorio RAMSES (S.N., G.D., B.G., A.F.), SC Clinica Ortopedica Traumatologica I (F.V., A.R., R.B., S.G.), Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy. E-mail address for S. Neri: simona.neri@ior.it. E-mail address for F. Vannini: francesca.vannini@ior.it. E-mail address for G. Desando: giovanna.desando@ior.it. E-mail address for B. Grigolo: brunella.grigolo@ior.it. E-mail address for A. Ruffilli: aruffilli@tiscali.it. E-mail address for R. Buda: roberto.buda@ior.it. E-mail address for A. Facchini: andrea.facchini@unibo.it. E-mail address for S. Giannini: sandro.giannini@ior.it
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Investigation performed at the Istituto Ortopedico Rizzoli, Bologna, Italy

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 16;95(20):1852-1860. doi: 10.2106/JBJS.L.01715
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Fresh osteochondral allografts represent a treatment option for early ankle posttraumatic arthritis. Transplanted cartilage survivorship, integration, and colonization by recipient cells have not been fully investigated. The aim of this study was to evaluate the ability of recipient cells to colonize the allograft cartilage and to assess allograft cell phenotype.


Seventeen ankle allograft samples were studied. Retrieved allograft cartilage DNA from fifteen cases was compared with recipient and donor constitutional DNA by genotyping. In addition, gene expression was evaluated on six allograft cartilage samples by means of real-time reverse transcription-polymerase chain reaction. Histology and immunohistochemistry were performed to support molecular observations.


Of fifteen genotyped allografts, ten completely matched to the host, three matched to the donor, and two showed a mixed profile. Gene expression analysis showed that grafted cartilage expressed cartilage-specific markers.


The rare persistence of donor cells and the prevailing presence of host DNA in retrieved ankle allografts suggest the ingrowth of recipient cells into the allograft cartilage, presumably migrating from the subchondral bone, in accordance with morphological findings. The expression of chondrogenic markers in some of the samples argues for the acquisition of a chondrocyte-like phenotype by these cells.

Clinical Relevance: 

To our knowledge, this is the first report describing the colonization of ankle allograft cartilage by host cells showing the acquisition of a chondrocyte-like phenotype.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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