Physeal Allograft Transfer for Physeal Bars: A Safety and Feasibility Study in a Domestic Swine Model

TL;DR

This study explores the safety and feasibility of transferring donor growth plates in pigs to treat growth plate closure, finding high viability but poor integration.

Contribution

The study introduces physeal allograft transfer as a potential treatment for growth plate closure using a large animal model.

Findings

Physeal allografts showed 93% viability after preservation and no gross deformities in treated animals.

Transferred growth plates demonstrated poor integration and incomplete repair despite structural integrity.

Control groups also lacked physeal bar formation, limiting the model's reliability for future studies.

Abstract

Premature physeal closure occurs following trauma, cancer, or infection. Current treatments have poor success rates. With recent pediatric donor tissue availability, physeal allograft transfer (PAT) can now be considered. The purpose of this study was to study the safety and feasibility of PAT in a large animal model. The aim of this study is to gather foundational data to inform future studies into the efficacy of PAT. Physeal defects were created in the distal femur of nine female domestic swine and treated with PAT from two male donor pigs, cementation, or bone autograft. Viability was assessed. After 3 months, physes were visualized using CT and MRI. Integration, tissue composition, donor DNA presence, and microscopic appearance were evaluated. Physeal allografts demonstrated 93% viability after procurement and preservation. All animals reached the 3‐months study endpoint without gross deformations. No physeal bars formed in any group. Cystic changes were seen in experimental and control femurs. All groups showed disorganized tissue architecture without growth plate recapitulation. High allografts viability and structural integrity after procurement support the potential of this treatment. Although no gross deformities were found, transferred physes demonstrate poor integration and incomplete repair. The lack of physeal bar formation in the control group limits the reliability of the animal model for studying physeal allograft transfer. Lastly, this study was designed as a feasibility study and lacks power to compare treatment effects statistically. The efficacy of PAT for preventing growth arrest remains undetermined.

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