The Journal of Bone and Joint Surgery, Vol 66, Issue 1 7-20, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Free physeal transplantation in the rabbit. An experimental approach to focal lesions
A Olin, C Creasman and F Shapiro
We have developed a procedure to transplant free autogenous iliac-crest
physeal grafts into defects created in the lateral aspect of the distal
femoral physis of rabbits. Excision of a portion of the lateral part of the
physis led consistently to formation of a bone bridge, growth arrest, and
valgus deformity. There was no evidence of increased activity by the
persisting physis to fill the defect or of differentiation of mesenchymal
cells into a functioning physeal layer. We carried out preliminary studies
to define the optimum conditions for obtaining and transplanting a free
autogenous iliac-crest physeal graft into the femoral physeal defect. The
iliac apophysis is composed of a fibrocartilaginous layer, cartilage
similar to epiphyseal cartilage, and a physis. The graft included the
physis and some overlying epiphyseal cartilage but the outermost
fibrocartilaginous layer and the surrounding perichondrium were removed, as
these two tissues were believed to inhibit diffusion. The graft was
separated gently from the metaphysis. Histological studies showed that the
separation occurred at the lower hypertrophic-chondrocyte zone. After
optimum techniques had been developed for transplantation and the
feasibility of the procedure had been established in twenty-one rabbits,
the capacity of the physeal transplants to prevent bone-bridge formation,
growth arrest, and valgus deformity was evaluated in thirty-nine rabbits,
three to four months old, using the standardized transplantation procedure.
The results were assessed in terms of the gross and radiographic appearance
of the femur, measurements of length, and histological characteristics. The
transplanted physis retained its normal morphology, united with the
residual part of the original femoral physis, and participated in
endochondral bone formation. Bone-bridge formation between the femoral
epiphysis and metaphysis, growth arrest, and valgus deformity were
prevented or minimized in most animals, and the physeal transplants yielded
good or excellent results in 60 per cent of the procedures using stringent
criteria. The results of this study show that free physeal transplants into
focal defects can remain viable and function satisfactorily if they are
fashioned properly and inserted gently. CLINICAL RELEVANCE: This study
demonstrated that transplantation of an iliac-crest physis into a defect of
the lateral aspect of the distal femoral physis can prevent bone-bridge
formation, growth arrest, and the development of valgus deformity.(ABSTRACT
TRUNCATED AT 400 WORDS)
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