Anterior cruciate ligament reconstruction using freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts

Abstract

Thirty-six of 44 patients (82%) who underwent ACL reconstruction using freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts were evaluated at least 2 years postoperatively. A detailed subjective evaluation using the Lysholm scale was recorded as well as a functional evaluation using the Tegner activity scale. All of the patients received a detailed physical examination that included testing with the KT-1000 ligament arthrometer and the Cybex dynamometer. Complete chart reviews and radiographic evaluations were also obtained. Only 17 patients were considered to be functionally successful and performing at their desired activity level. The average KT-1000 showed a side-to-side difference of 5.9 mm at 30 pounds for the successful group and 7.9 mm for those who had functional failure. The Lysholm scores were 91.6/100 versus 61.1/100 in the failures. Eight patients (22%) at repeat surgery were noted to have complete dissolution of the graft. Large femoral cysts were noted radiographically in all of these patients. It was concluded that freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts have a high failure rate and cannot be recommended for ACL reconstruction.

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

“…However, reports of disease transmission following ACL reconstruction with nonsterilized allografts, even though very limited in number, underline the importance of graft sterilization [31]. Furthermore, current sterilization techniques have been associated with certain disadvantages, such as interference with biological healing or reduction of mechanical properties of such treated grafts [5,6,13,18,19,24,27]. Peracetic acid has been successfully used to sterilized bone allografts [16,17].…”

Pericardial Processing: Challenges, Outcomes and Future Prospects

“…Physical methods can either rely on snap freezing (Jackson et al, 1988;Roberts et al, 1991), mechanical force (Freytes et al, 2004) or mechanical agitation (Schenke-Layland et al, 2003), whereas enzymatic protocols employ nucleases, calcium chelating agents or protease digestion (Teebken et al, 2000;Bader et al, 1998;McFetridge et al, 2004;Gamba et al, 2002). Regarding physical decellularization processes, sonication, based on the use of ultrasounds to disrupt the cell membrane, has been investigated.…”

Adhesions in a murine flexor tendon graft model: Autograft versus allograft reconstruction

“…There are clinical reports that suggest that freeze-dried allografts are of no significant value in the surgical management of certain indications such as chronic massive rotator cuff tears, 29 and may induce intraarticular reaction when used in ACL reconstruction, 30,31 for example. However, other clinical reports indicate that freeze-dried allografts used for ligament and tendon repairs and arthroscopic reconstruction of ACL deficient knees provide satisfactory clinical results.…”