Objective: Physical exercise decreases disability and pain associated with chronic articular cartilage degradation. However, understanding of the pathology is lacking. In this study, the levels of 17 biomarkers of inflammation and cartilage degradation were measured in synovial fluid (SF) before and after a 30-minute run in able-bodied and previously-injured individuals. Materials & Methods: Four able-bodied recreational runners (3 men and 1 woman: 24 ± 2 years, 68 ± 7 kg, and 173 ± 9 cm) and 4 recreational runners who had undergone a unilateral anterior cruciate ligament reconstruction (ACLr) (2 men and 2 women: 23 ± 1 years, 71 ± 6 kg, and 175 ± 4 cm) were recruited to participate in this study. Using a saline-assisted method, SF was aspirated before and after both a 30-minute unloading and 30-minute exercise session. Samples were corrected for blood contamination and analyzed for 15 cytokines and 2 matrix metalloproteinases (MMPs). Mixed model analyses were used to determine the main effects of session, case/control status, pre/post aspirations, and the interactions between case/control status and pre/post aspirations. Results: Blood protein contamination was calculated and accounted for in 15 of 32 synovial fluid samples. Granulocyte colony stimulating factor (GCSF) was the only detectable cytokine of the 15 analyzed. No statistical differences were found in GCSF concentrations between pretreatment and posttreatment aspirations (p = 0.45), ACLr and able-bodied control groups (p = 0.60), or unloading and exercise sessions (p = 0.96). MMP-13 was undetectable. No statistical differences were found in MMP-3 between pretreatment and posttreatment aspirations (p = 0.15), ACLr and able-bodied control groups (p = 0.85), or unloading and exercise sessions (p = 0.14).Conclusions: Two (GCSF and MMP-3) of the 17 measured biomarkers were detectable. There were no significant differences in either GCSF or MMP-3 due to a 30-minute run or 30-minute unloading period in either the able-bodied or ACLr participants. Further, there were no significant differences between biomarker concentrations and case-control status. A novel method of controlling for blood contamination in synovial fluid samples was implemented.

Osteoarthritis is a progressive degenerative disease which affects the cartilage in articulating joints. The progression of osteoarthritis is known to be mechanically mediated, though specific mechanical factors have yet to be identified. In particular, the effects of frictional interactions and altered mechanical homeostasis remain unknown, and the inability to link specific mechanisms to disease advancement hinders the development of treatment strategies. The overarching objective of this dissertation is to study the mechanically-mediated fatigue failure process in articular cartilage through a validated computational model to ascertain the relative importance of mechanical factors, including surface friction and bulk cyclic stresses, on progression of osteoarthritis. Fatigue failure in cartilage progresses as a function of multiple mechanical and physicochemical interactions. Collagen fibrils are the primary constituents that fail under fatigue loading. As the collagen fails, homeostasis between osmotic pressure and collagen tension is disrupted and the cartilage imbibes water and swells, producing softening. This entire process occurs under frictional contact loading. From a modeling standpoint, several primary challenges arise: (1) Accounting for the osmotic swelling of cartilage, which has not been sufficiently characterized experimentally; (2) Developing finite element algorithms to handle frictional contact of charged multiphasic (solid-fluid-solute) materials such as cartilage; (3) Modeling fatigue mechanics with observable state variables representing measures of cartilage composition, such that imaging techniques may inform the theory; and (4) Formulating compatible plasticity theories to allow validation of the novel fatigue framework with the extensive literature on fatigue of metals. This dissertation addressed these challenges in pursuit of the overarching objective. Direct experimental measurements revealed the osmotic swelling pressure in cartilage does not obey ideal Donnan law, which significantly overestimates the measured pressure by approximately a factor of three. The aggregate modulus in triphasic theory was found to vary strongly with the external concentration, increasing three- to five-fold between hypertonic and hypotonic solutions. These results allow us to capture the interaction of swelling with damage. The fatigue process is coupled with swelling, and computer modeling must be performed in a multiphasic environment which accounts for flow of charged ions. To address this, a novel surface-to-surface finite element algorithm for frictional contact was developed, providing the capabilities of complex surface-smoothing algorithms while retaining the simplicity of node-to-segment methods. This powerful framework was adapted to model friction between porous-permeable tissues, resulting in the development, implementation, and validation of finite element algorithms for four different types (single-phase elastic, biphasic, biphasic-solute, and multiphasic) of frictional contact. For the latter three, our work represented the first algorithms of this type. These algorithms are applied to model cartilage friction. By using constrained reactive mixture theory, we developed a reactive plasticity framework that reduced to classical Prandtl-Reuss plasticity theory in the limit of infinitesimal deformation, using only scalar state variables representing composition measures. Applying this reaction kinetics-based approach to model fatigue mechanics provided a valid theoretical framework for treating evolving damage, where measures of the mass composition of cartilage served as observable state variables. By incorporating reactive plasticity, our reactive fatigue theory was thoroughly validated against experimental data from metals and biological tissues, including human tendon and human cartilage. These modeling efforts were then synthesized to develop a fully validated computational model of fatigue failure in articular cartilage. For the first time, the role of frictional interactions on the progression of fatigue in articular cartilage was quantified. Results demonstrate that friction has an effect, but it is relatively small compared to the magnitude of the damage which takes place due to contact loads raising the magnitude of stresses in the collagen matrix. The implication of this result is that fatigue accumulation in cartilage is more sensitive to contact loading rather than surface interactions such as friction. This key finding may have clinical implications regarding treatment strategies for early-stage osteoarthritis. This dissertation has generated a novel suite of theoretical and computational tools which have facilitated the development of a fully validated computational model of fatigue failure in articular cartilage. Replicating previous experimental fatigue studies with the model has confirmed that bulk matrix stresses are responsible for the majority of fatigue-induced damage, and that friction plays a relatively minor role. Future work will apply these computational models to further analyze fatigue failure in fibrous biological tissues and study experimentally-generated hypotheses.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21672号 / 医博第4478号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 上杉 志成 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This paper presents a biotribological study on cartilage wear and friction, using a system of cartilage-on-stainless steel. This study is a part of the ongoing biotribology research by Dr. Furey at the Virginia Polytechnic Institute and State University. Two loads (65 N and 20 N) and three lubricants (saline reference, reference + hyaluronic acid, and bovine synovial fluid) were tested and evaluated using several analysis techniques. These techniques included wear analysis by hydroxyproline measurement, scanning electron microscopy (SEM), histologic sectioning and staining, numerical analysis of friction and specimen displacement data, and Fourier transform infrared (FTIR) analysis. Biochemical wear analysis showed that, under high load, the saline reference generated the most wear, hyaluronic acid produced less wear, and bovine synovial fluid produced the least. Wear was sensitive to load with all three lubricants, but was not significantly affected by the lubricant under low load. SEM photographs and histologic sections showed evidence of plowing and surface delamination, as well as another wear mechanism that produced wear markings perpendicular to the direction of sliding. Opaque films remained on the polished stainless steel disks after saline and hyaluronic acid tests, but not after synovial fluid tests. FTIR analysis of these films, as well as fresh and worn cartilage, showed that the cartilage experienced chemical changes during sliding. / Master of Science

During ambulation, lower-extremity joint angles and net moments influence knee joint load. It is unclear which mechanical variables most strongly correlate with acute articular cartilage (AC) catabolism in response to ambulation. Purpose: To determine which mechanical variables are most strongly correlated to acute AC catabolism, and to test the acute effect of ambulation speed on AC catabolism, while controlling for load frequency. Methods: 18 able-bodied subjects (9 male, 9 female; age = 23 ± 2 y; mass = 68.3 ± 9.6 kg; height = 1.70 ± 0.08 m) completed three separate ambulation sessions: slow (preferred walking speed), medium (+50% of walking speed), and fast (+100% of walking speed). For each session, subjects completed 4000 steps on an instrumented treadmill while ten high-speed cameras recorded synchronized video data. Various, discrete, three-dimensional joint kinematic and kinetic variables were averaged across 20 total stance phases (5 stance phases at 1000, 2000, 3000, and 4000 steps). Blood samples were collected pre-, post-, 30-min post-, and 60-min post-ambulation. Serum cartilage oligomeric matrix protein (COMP) concentration was determined using an enzyme-linked immunosorbent assay. A stepwise multiple linear regression analysis was used to evaluate the relationships between serum COMP change and lower-extremity joint angles and moments. A mixed model ANCOVA was used to evaluate serum COMP concentration between sessions across time. Results: Peak ankle inversion, knee extension, knee abduction, hip flexion, hip extension, and hip abduction moment, and knee flexion angle at impact, explained 61.4% of the total variance in serum COMP change (p < 0.001), due to ambulation. COMP concentration increased 28%, 18%, and 5% immediately after ambulation for the running, jogging, and walking sessions, respectively. All sessions were significantly different immediately post-ambulation (p < 0.01). Conclusion: Certain lower-extremity joint mechanics are associated with acute AC catabolism, due to ambulation. Several key mechanical variables (e.g., peak knee extension, knee abduction, and hip abduction moments) explain much regarding the variance in serum COMP increase. These lower-extremity variables can be used to predict acute AC catabolism, allowing researchers and clinicians to better predict and/or understand AC catabolism. Additionally, when load frequency is controlled, increased ambulation speed acutely results in increased AC catabolism. Ambulation speed does not, however, influence serum COMP elevation duration. Joint mechanics and load frequency appear to be responsible for the magnitude of COMP increase, while duration of COMP elevation post-ambulation is dictated by load frequency.

Poly(2-hydroxyethyl) methacrylate, (polyHEMA), hydrogels are synthesized for tribological study to investigate their potential for use as synthetic articular cartilage. A four factor, two level designed experiment was performed to evaluate friction and wear of polyHEMA. Tests were carried out using a friction and wear test device developed for biotribology research. The geometry consisted of a ball on flat; 6mm stainless steel ball and flat polyHEMA discs. Test factors were load, lubrication, hydration and material crosslink density. Linear oscillating sliding contact tests were performed on each polyHEMA disc for approximately 30 minutes per test. Friction coefficients found ranged from 0.05 to 1.7. Linear wear measured ranged from 0.02 mm to 1.32 mm. / Master of Science

Diferenças na espessura e regularidade da cartilagem da articulação temporomandibular (ATM) ocorrem como o resultado de áreas em crescimento ou em remodelamento. Esse aspecto dificulta a interpretação clínica das imagens e geralmente negligencia a presença da fibrocartilagem. O estudo, por meio da Ressonância Magnética utilizando bobinas microscópicas, possibilita uma melhor observação da cartilagem articular. Confirmamos essa evidência por meio do estudo que analisou 20 indivíduos (40 ATM), divididos em grupo sintomático (DTM) com 10 pacientes (20 ATM) apresentando queixa clínica e suspeita diagnóstica de DTM e, o grupo controle com 10 voluntários (20 ATM) assintomáticos ou que não apresentavam sinais e sintomas clínicos de DTM. As imagens de RM sagitais oblíquas ponderadas em DP SPIR da ATM foram capazes de mostrar a cartilagem com melhor evidência tanto na cabeça da mandíbula quanto na eminência articular proporcionado mensurações, as quais se apresentaram estatisticamente iguais entre os grupos e também a avaliação da regularidade com o mesmo comportamento entre os grupos e geralmente acompanhando a morfologia da cortical óssea. Em muitos casos, principalmente quando da presença de deslocamento para anterior do disco articular, a observação se torna mais difícil, requerendo mais prática para esse tipo de avaliação. Observamos que pacientes do grupo controle apresentaram deslocamento de disco. Dessa maneira, consideramos um exame muito útil como auxiliar no diagnóstico da DTM, e com o desenvolvimento de novas terapias para doenças degenerativas e traumas na cartilagem, as imagens de RM com o uso de bobina microscópica são de crescente importância clínica e poderão desempenhar um papel importante na avaliação da eficácia dessas terapias. / Differences in thickness and regularity of the temporomandibular joints (TMJ) cartilage occur as the result of areas of growth or remodeling. This fact leads to misinterpretations on diagnosis and generally neglects the presence of fibrocartilage. The present study, using MRI microscopic coils, allows better observation of the articular cartilage. This evidence was confirmed by this study that examined 20 individuals (40 TMJ), divided into: symptomatic group with temporomandibular dysfunction (TMD) of 10 patients (20 TMJ) presenting clinical complaint and TMD diagnosis; and the control group of 10 volunteers (20 TMJ) that were asymptomatic or who had no clinical signs and symptoms of TMD. On both groups were measured cartilage thickness and if the cartilage was regular or not. The oblique sagital MR images of weighted SPIR protons density (PD\'s) TMJ were able to show the best cartilage images either in the mandibles head or on the articular eminence providing measurements. Both groups presented no statistically significant differences regarding to thickness and the evaluation of the regularity presented the same result. The regularity of the cartilage generally was similar to the morphology of the cortical bone. In many cases, especially when the presence of anterior articular disc displacement, the evaluation was more difficult, requiring practice. The control group with asymptomatic patients was found also to have disc displacements. Thus, we review a very useful tool in the diagnosis of TMD and its importance to evaluate the cartilage to development new therapies for degenerative diseases and trauma. The MRI images with the use of microscopic coil are of increasing clinical importance and might play an important role in assessing the effectiveness of these therapies.

A subnutrição tem sido ao longo dos anos um dos maiores problemas de saúde pública do mundo, que acomete principalmente crianças de países em desenvolvimento. Estima-se que em Moçambique na África Oriental, cerca de 40% das crianças são acometidas pela desnutrição crônica que resulta dentre outras afecções em baixa estatura e diminuição da capacidade física. Este estudo visa avaliar a estrutura óssea de ratos wistar submetidos à dieta básica da população de Moçambique (DM) reproduzida em laboratório. Para isso a DM foi oferecida aos animais em fase pré e pós-natal durante 42 dias. Para alguns desses animais foi fornecida a DM acrescida de 20% de caseína (DMC) subsequentemente os grupos subnutrido de Moçambique (SM) e nutrido de Moçambique (NM). Foi formado também um grupo denominado renutrido (RM) composto por animais que receberão a DMC a partir do 22&ordm; dia e até completarem 42 dias de vida. Após o desmame foram mensurados os parâmetros metabólicos da ingestão alimentar e hídrica, excreção de urina e fezes. A tíbia e o úmero do lado direito foram macerados quimicamente a fim de verificar as medidas ósseas. Esses ossos do lado esquerdo foram processados com técnicas rotineiras histológicas e corados de forma a evidenciar as estruturas cartilagineas. Os dados obtidos foram submetidos a análise de variância paramétrica seguida por comparações múltiplas pelo método de Tukey, com nível de significância p&lt;0,05. Os resultados apontam que a Subnutrição é capaz de modificar a espessura da CA e da LE e os componentes de sua MEC. Embora a inserção de caseína na dieta dos animais SM, tenha reestabelecido parâmetros da osteometria, na LE e na CA a melhora apresentada, não foi o suficiente para atingir seus parâmetros normais apresentados no grupo NM / Undernutrition has been over the years one of the major public health problems worldwide, which affects mainly children in developing countries. It is estimated that in Mozambique in East Africa, about 40% of children are affected by chronic undernutrition resulting from other conditions in stature and diminished physical capacity. This study aims to evaluate the bone structure of Wistar rats submitted to the staple diet of the population of Mozambique (DM) reproduced in the laboratory. To this DM was given to the animals in pre and postnatal 42 days. For some of these animals was provided to DM plus 20% casein (DMC) subsequently the undernourished groups of Mozambique (SM) and nursed Mozambique (NM). Also it has formed a group called renutrido (RM) consists of animals that receive the DMC from the 22nd day until completing 42 days of life. After weaning metabolic parameters were measured food and water intake, urine output and feces. The tibia and the humerus on the right side were chemically macerated in order to verify the bone measurements. These bones on the left side were processed with routine histological techniques, and stained to show the form cartilage structures. The data were subjected to parametric analysis of variance followed by multiple comparisons by the Tukey method, with significance level of p <0.05. The results show that the Malnutrition is able to modify the thickness of the CA and LE and the components of its MEC. Although the inclusion of casein in the diet of animals SM, has reestablished osteometria parameters in LE and CA improvement presented, was not enough to achieve their normal parameters presented in NM group

O objetivo deste trabalho foi avaliar a membrana de celulose bacteriana associada a células mesenquimais, que foram inoculadas juntamente com derivado do ácido hialurônico, hylano G-F 20, em patelas lesadas de suínos. Foram utilizados 12 suínos (24 joelhos) submetidos à raspagem das superfícies articulares das patelas até osso esponjoso; joelhos esquerdos sem tratamento, grupo controle (GC). Joelhos direitos, grupo tratado (GT), tiveram membranas de celulose bacteriana fixadas às superfícies de suas patelas, sendo que as mesmas foram preparadas com inoculação de células mesenquimais, ósseas e cartilaginosas, provenientes das raspagens das superfícies, lavadas em solução fisiológica 0,9%, filtradas e diluídas em 5 ml de solução fisiológica à 0,9% e posteriormente acrescentados 2 ml de hylano G-F 20. Colhidos 5 ml dessa papa que teve contido o volume de 16,35 x \'10 POT.8\' células na sua totalidade, e foram infiltrados na membrana de celulose revestindo a patela, obedecendo a distribuição de 3,27 x \'10 POT.8\' por 1,2 \'CM POT.3\'. Após 2, 4 e 6 meses os animais foram sacrificados para avaliações macroscópicas e histológicas. As superfícies patelares apresentaram aspecto de neoformação de cartilagem aos dois meses; essas membranas evoluíram para tecido fibroso de altíssima resistência, com densidade de fibras conjuntivas aumentando proporcionalmente ao tempo de cirurgia, quatro ou seis meses conforme as células do infiltrado tiveram alterações morfológicas para fibroblastos Ao mesmo tempo, parte do volume dessas células sofreu processo de degeneração e morte celular, semelhante ao mecanismo de apoptose celular. Dessa forma, ofereceu substratos para as células remanescentes, colaborando para a neoformação desse tecido conjuntivo. Não ocorreram processos inflamatórios ou agressão às cartilagens em contigüidade à membrana. Pelo contrário, em relação ao grupo controle não tratado, a membrana de celulose bacteriana utilizada segundo a metodologia aplicada, atuou com uma barreira protetora para agressões maiores à cartilagem da fossa intercondilar do fêmur que manteve a integridade de seus contornos articulares. Desta forma, segundo a metodologia utilizada, concluímos que a membrana de celulose bacteriana apresentou biocompatibilidade para uso articular, hábil para agregar condrócitos e fibroblastos. / The goal of this work was to evaluate the bacterial cellulose membrane associated with mesenchymal cells, which were inoculated with hyaluronic acid derivative, G-F 20 hylano in patelas injured pigs. 12 pigs were used (24 knees) submitted to the scraping of the articular surfaces of spongy bone patelas up; knees left without treatment, group controller (GC). Knees rights, treated group (GT), bacterial cellulose membranes had fixed on their surfaces patelas, being that they were prepared with inoculation of mesenchymal cells, bone and cartilage from sweeps of surfaces, washed in 0.9% saline solution, filtered and diluted in 5 ml of saline solution to 0.9% and subsequently added 2 ml hylano G-F 20. Collected 5 ml that Pope had contained the volume 16.35 x \'10 POT.8\' cells in its entirety, and were infiltrated in the membrane of cellulose coating the patella, obeying distribution 3.27 x \'10 POT.8\' per 1.2 \'CM POT.3\'. After 2, 4 and 6 months the animals were sacrificed to macroscopic and histological evaluations. The surfaces patellar components submitted aspect of neoplasm of cartilage to two months; These membranes evolved into fibrous tissue resistance of high density fibrous tears increasing in proportion to the time of surgery, four or six months as had infiltrated cells for morphological changes while fibroblasts, part of the volume of these cells suffered process of degeneration and cell death, similar to the mechanism of cellular apoptosis. This way, offered substrates for the remaining cells, collaborating for this connective tissue neoplasm. There were no inflammatory processes or aggression on cartilage in adjacency to the membrane. On the contrary, compared to the untreated control group, the bacterial cellulose membrane used according to the methodology applied, served with a protective barrier for larger aggressions of cartilage of the femur intercondilar trench that maintained the integrity of its articular contours. This way, according to the methodology, we found that the bacterial cellulose membrane biocompatibility presented for use articulate, skilled to aggregate condrócitos and fibroblasts.

O tratamento das lesões condrais e osteocondrais do joelho em pacientes jovens ainda permanece um desafio para os médicos ortopedistas. As técnicas de reparo destas lesões atualmente disponíveis no Brasil, como desbridamento, microfraturas e transplante osteocondral autólogo são insuficientes nos tratamentos das lesões condrais e osteocondrais maiores do que 4 cm2. O transplante osteocondral homólogo a fresco (TOF) na articulação do joelho vem sendo usado em outros países com excelentes resultados. Até o presente momento não existem relatos da utilização desta técnica no Brasil, fato que dificulta o tratamento de pacientes jovens ativos que necessitam de reparo biológico. Foram incluídos neste estudo oito pacientes de 15 a 45 anos portadores de lesões osteocondrais maiores que 4 cm2. Os enxertos a fresco foram obtidos de doadores de órgãos, sendo a articulação do joelho captada sem violação da cápsula articular e transportada ao Banco de Tecidos para processamento. O pareamento doador e receptor foi realizado conforme o tamanho, a localização e a prioridade em lista de espera de acordo com os tecidos captados, sendo os mesmos armazenados no meio de preservação Ham F-12 - GIBCO com glutamax (Invitrogen, Life Technologies, Estados Unidos) e com antibióticos. O procedimento cirúrgico foi realizado pelas técnicas de cilindro osteocondral e de superfície, sendo fixados quando necessário. Os pacientes foram avaliados através dos questionários de IKDC objetivo, IKDC subjetivo, KOOS e índice de Merle D\'Aubigne e Postel modificado. Foram realizados oito TOFs de março a outubro de 2012. A média de idade dos pacientes transplantados foi de 30,1 anos (17- 44 anos) e a média da área transplantada foi de 10,6 cm2 (4,6 - 22,4 cm2). O intervalo médio em dias entre captação e transplante foi de 15,3 (14 - 16 dias) e o número médio de cirurgias prévias ao TOF foi de 2 cirurgias (0-4 cirurgias). A pontuação na escala de IKDC objetiva no pré-operatório foi B em 12%, C em 25% e D em 63% dos pacientes; e 12% A e 88% B aos 18 meses de pós-operatório. A média da pontuação da escala IKDC subjetiva pré-operatória foi de 31,99 ± 13,4 e de 81,84 ± 9,25 em 18 meses de pós-operatório, e da escala KOOS pré-operatória foi de 46,8 ± 20,9 e de 89,58 ± 7,06 em 18 meses de pós-operatório, com melhora significativa ao longo do tempo (p < 0,01) pela análise da variância. A média da pontuação pelo índice de Merle D\'Aubigne e Postel modificado foi de 8,75 ± 2,25 no pré-operatório e de 16,75 ± 2,19 em 18 meses de pós-operatório. O resultado do teste de Friedman para amostras não-paramétricas demonstrou melhora significativa ao longo do tempo (p < 0,01). A padronização da captação, processamento e transplante de enxertos osteocondrais a fresco na articulação do joelho depende de um banco de tecidos altamente especializado e leva a excelentes resultados no tratamento de lesões osteocondrais grandes, sendo atualmente uma boa alternativa de tratamento biológico para pacientes jovens no Brasil / Treatment of chondral and osteochondral lesions of the knee in young patients is still a challenge for Orthopedic Surgeons. The techniques available nowadays in Brazil, as debridement, microfracture and autologous osteochondral transplantation are insufficient for the treatment of chondral and osteochondral lesions larger than 4 cm2. Fresh osteochondral allografts on the knee joint have been used in other countries with great success. Until the present days there are no reports of the utilization of this technique in Brazil, a fact that creates boundaries for the treatment of young active patients that need cartilage repair treatment. Eight patients with age ranging from 15 to 45 years old and osteochondral lesions larger than 4 cm2 were included in this study. Fresh grafts were obtained from organ donors and the knee joint was harvest without violation of synovium capsule and then was transported to the tissue bank for processing. Donor and receptor tissue matching occurred according to size, localization and priority on waiting list and tissue was preserved in Ham F-12 - GIBCO media with glutamax (Invitrogen, Life Technologies, United States) and antibiotics. Surgical procedure was achieved with osteochondral plugs or shell techniques, with additional fixation when needed. Patients were evaluated with IKDC objective, IKDC subjective, KOOS and modified Merle D\'Aubigne-Postel outcome scores. Eight fresh osteochondral allografts were performed from march to october, 2012. The average age was 30.1 years old (17-44) and mean graft surface area was 10.6 cm2 (4.6 - 22.4 cm2). Average time from harvest to transplantation was 15.3 days (14-16 days) and mean number of previous surgical procedures was 2 (0 - 4 procedures). Pre-operative objective IKDC score was B in 12%, C in 25% and D in 63% and was A in 12% and B in 88% in 18 months follow-up. Pre-operative IKDC subjective and KOOS score were 31.99 ± 13.4 and 46.8 ± 20.9; and in 18 months follow-up were 81.84 ± 9.25 and 89.58 ± 7.06, respectively, with a significant increase along time on variance analysis (p < 0.01). Pre-operative mean modified Merle D\'Aubigne-Postel scores were 8.75 ± 2.25 and 16.75 ± 2.19 in 18 months follow-up. Non-parametric Friedman test analysis showed a significant progression in follow-up (p < 0.01). Standards of procurement, processing and utilization of fresh osteochondral allografts in the knee joint relay on a high specialized tissue bank and promote excellent results on the treatment of large osteochondral lesions, being a good alternative of a biologic repair for young patients in Brazil