Theodore Malinin MS MD
Professor of Orthopedics and Director Emeritus University of Miami Tissue Bank Miller School of Medicine University of Miami
Miami, Florida, USA
H Thomas Temple MD
Professor of Orthopedics and Director University of Miami Tissue Bank Miller School of Medicine University of Miami
Miami, Florida, USA
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Musculoskeletal Tissue Transplantation and Tissue Banking
First Edition: 2013
9789350905067
Printed at
5Dedicated to
Our parents:
Ivan M Malinin MD and Olga A Malinin
and
Harry A Temple and Jeri M Temple
7Preface
Today's understanding and utilization of the principles of musculoskeletal tissue transplantation will lead to tomorrow's new treatment of patients with disorders of the skeletal system. Nearly all principles of biomedical research are applicable to musculoskeletal tissue transplantation. Most significant advances in the fundamental studies of the skeletal system expose how much is still unknown about bone, cartilage, tendons, ligaments and other structures comprising the musculo- skeletal system. With further advances, it is hoped, unsolved orthopedic problems will become fewer. It is sad to note that the gospel of bone transplantation reached its first mass acceptance in World War I, but then declined. In World War II, the same bone grafting principles operated on a wider scale. As a consequence “amputation cases” were diminished. More and more surgeons saw their efforts justified as many men were returned to normal life.
Tissue banking, as practiced today, originated in the Korean War with the formation of the US Navy Tissue Bank which served as a prototype for civilian tissue banks in North America. One of the first successes of the US Navy Tissue Bank dealt with a Naval aviator who suffered a compound fracture of the right forearm when his plane crashed in Korea in 1952. Despite conventional treatment, an osseous ridge developed between the radius and the ulna. This resulted in his inability to rotate the forearm. This disability forced him from active flight status. Following an operation in which newly formed bone was excised, freeze-dried fascia lata was placed between the radius and ulna, full motion of the arm was restored and the aviator returned to full flight status.
In the middle of the last century, tissue banking became an important adjunct to orthopedics and other surgical specialties by promoting the concept of stored material ready for transplantation.
This book presents a summary of pertinent information on bone biology, theory and practice of tissue transplantation and of experimental results from which practical aspects of human allograft preparation, storage and transplantation have been extrapolated. The experience gained from the organization and continuous operation of a clinical tissue bank has aided us in this endeavor. It provided a philosophical and practical workshop needed for the implementation of a full service tissue bank that served, and continues to serve, a broad national and international interest. The success of the University of Miami Tissue Bank was a catalyst to the rapid growth of tissue banking in both the United States and abroad.
Bone and tissue transplantation began and evolved to satisfy patient needs. Initially, clinical success prefaced scientific discovery, but in the last several years the situation has begun to change. This book notes a momentous event in bone physiology, the isolation of several bone growth proteins, named bone morphogenetic proteins, BMP 1-7 which are members of a family of growth and differentiation factors (TGF-B). Although research involving BMPs was conducted for more than 30 years, clinical application of these powerful molecules is still in the investigational stage. Bone grafts do not simply provide support, but play an important part in osteogenesis, and to this end, growth factors play a critical role. Osteoprogenitor cells are needed as well as scaffolding to promote new bone formation.
The future is difficult to predict, but the pendulum in musculoskeletal medicine appears to be in full swing toward orthobiologics. Careful science and prudent clinical observation are needed to realize and harness the enormous potential of tissue and cell transplantation.
This book is based on cumulative knowledge as well as personal experience. Our fondest hope is that it will prove to be useful to all discriminating readers committed to the art of musculoskeletal transplantation.
Theodore Malinin
9Acknowledgments