In March 2017 I went to Denver, Colorado with some other surgeons to visit AlloSource - one of the largest tissue banks in the USA and now one of the leading allograft centres.
I went with a team of individuals including another leading UK surgeon, Ram Venkatesh, and my knee fellow, Rags (Raghbir Khakha), to discover more about AlloSource and the services that they are providing, including how the tissue is procured. We flew out to see the facilities and I met the AlloSource team and we were given a tour of the factory.
It's simply incredible how much work goes into human tissue donation, and processing, and making it work for everyone. It's all done so professionally and to such a high standard. The detailed process that is followed to make sure it is done safely is amazing.
One service that they provide, in particular, to most of the US and to most of the world, is the provision of fresh osteochondral grafts. So this is cartilage that is taken from a donor and checked, both in terms of the quality of the tissue and also of the individual, and if it passes all the rigorous tests is released for use in the US and also indeed in the UK. The tissue is either cartilage and bone or just the cartilage surface itself and this is one of the products that I was very interested in seeing. They call the product ProChondrix [this link will give you more information] and it is "an intact, living cellular, fresh cartilage matrix processed from adult donors and designed to aid in the repair and regeneration of damaged cartilage tissues."
There are effectively 80 'mini' operating-theatres in which two or three technicians work in ultra-clean environments to clean and prepare the grafts and make them suitable and useful for surgery.
ProChondrix is a really innovative idea where discs are varying different sizes typical of the lesions we see are removed from the cadaveric donor tissue and carefully prepared and washed with anti-microbial antibiotic solutions and when they have passed the tests that are employed to make sure that it is safe it is released for sale.Then you can take a patient with a full thickness cartilage defect where the bone is still good - as is often the case - and you can use these discs of fresh cartilage which have viable cartilage cells to insert into these defects once they have been prepared and the result is normal cartilage.
The ProChondrix discs being placed into position and covered in fibrin glue
Their prepared plugs are truly innovative. A cylinder of bone and cartilage is gently tapped in, which would be the osteochondral tissues as opposed to the superficial cartilage layer.
I think that that is going to be a fantastic treatment option for patients and something that I want to offer to my patients.
One person that donates their body can benefit 200 other people depending on what the grafts are used for.
It's an amazing thing that you can do by giving your body to help others.
The effort and expertise that goes into preparing grafts is also an eye-opening experience.
The graft materials are very expensive but it is not surprising given the amount of energy and effort that goes into making the grafts useful and safe. It was very impressive.
The question then is - how do you get these preparations into the patient within 24 days of taking the tissue?
What you need is for the patient to be signed up the concept that they will get a phone call and will just have to drop everything and come in for the surgery at very short notice. And this is what happens now routinely in the States and in other centres where fresh cartilage and osteochondral grafts are employed.
Link to ProChondrix commercial video - https://youtu.be/x7VfNlzHs7k
Oh, and we also had time for a bit of fun!