Comparison of clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction: A systematic review update and meta-analysis

Abstract

Background: This study was a systematic review comparing the clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction. Methods: A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane. All databases were searched from the earliest records through August 2019 using the following Boolean operators: irradiated AND nonirradiated AND ACL AND allograft. All prospective and retrospective controlled trials were retrieved that directly compared physical examination and knee function scores and patient-rated outcomes between the nonirradiated and irradiated allograft for ACL reconstruction. Results: Three prospective and 2 retrospective articles were identified by the search, and the findings suggested that the nonirradiated allografts were superior to the irradiated allografts based on improved knee joint functional scores and decreased failure rate, even though there was no significantly difference with respect to overall IKDC, range of motion, vertical jump test, and one-leg hop test. Conclusions: Irradiated allograft should be limited to be used in ACL surgery and further research into new alternative sterilization techniques are needed to avoiding the disease transmission without interference with the biomechanical properties of the grafts.

Graft Choice in Anterior Cruciate Ligament Reconstruction

“…For example, in the study by Wasserstein et al [61] who reported, on seven studies addressing patients aged less than 25 years, higher failure rates of allografts versus autografts, only two studies assessed autograft versus non-irradiated allograft, and in this analysis no statistically significant difference in graft failure was seen. Liu et al [66] showed, in a recent systematic review, that non-irradiated allografts are superior to irradiated allografts based on improved knee joint functional scores and decreased failure rate. Also, Wang et al [67] performed a meta-analysis looking at autograft versus non-irradiated and irradiated allografts.…”

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

“…There is extensive but contradicting evidence comparing graft rupture rates between allograft and autograft. Allografts are thought to have higher rupture and reoperation rates, with an up to sixfold increased risk of failure when compared to autograft, especially in young and active patients [ 18 , 58 , 63 , 72 , 96 , 126 ]. Sterilization using radiation, especially with doses greater than 20 kGy, has been implicated as a likely cause due to unfavorable biomechanical effects on the tissue [ 66 , 115 ].…”

“…[ 58 ]. Thus, although several systematic reviews and meta-analyses comparing autograft to non-irradiated or fresh frozen allograft have reported no significant differences in failure rates in older patients [ 24 , 134 , 136 ], the use of allograft in young and active individuals remains unacceptably high and is therefore not recommended in this age group [ 18 , 50 , 58 , 63 , 72 , 126 ].…”

Worldwide trends on hydroxyapatite from animal waste for biomedical applications – a bibliometric analysis (2012-2022)

“…The use of hydroxyapatite-based scaffolds for hard tissue applications is gaining importance as a reliable option to bone replacements [1][2][3][4][5]. Due to the shortage of donors worldwide [6] and the threat of infection [7], autograft and allograft are not practical options for bone substitutes. Abundantly available and environmentally friendly hydroxyapatite has biological similarities to bone tissue [8][9][10][11], making it an attractive option for hard tissue engineering and biomedical engineering research [12].…”