The Effect of Gamma Irradiation on Anterior Cruciate Ligament Allograft Biomechanical and Biochemical Properties in the Caprine Model at Time Zero and at 6 Months after Surgery

Schwartz, H. E.; Matava, Matthew J.; Proch, Frank S.; Butler, C A; Ratcliffe, Anthony; Levy, Martin S.; Butler, David L.

doi:10.1177/0363546506288851

Cited by 77 publications

(56 citation statements)

References 37 publications

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“…Gamma irradiation reduces mechanical properties of tissues at radiation doses ranging from 25 kGy to 80 kGy on bone-patellar-bone, bone and tendon allografts [1,13,14,17,36,38]. After 50 kGy of radiation, reductions in strength, elastic modulus, and toughness were observed for rabbit tendon allografts [39].…”

Section: Discussionmentioning

confidence: 99%

Improved Tendon Radioprotection by Combined Cross-linking and Free Radical Scavenging

Seto

Gatt

Dunn

2009

Clinical Orthopaedics &Amp; Related Research

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Allograft safety is a great concern owing to the risk of disease transmission from nonsterile tissues. Radiation sterilization is not used routinely because of deleterious effects on the mechanical integrity and stability of allograft collagen. We previously reported several individual cross-linking or free radical scavenging treatments provided some radioprotective effects for tendons. We therefore asked whether a combination of treatments would provide an improved protective effect after radiation exposure regarding mechanical properties and enzyme resistance. To address this question we treated 90 rabbit Achilles tendons with a combination of cross-linking (1-ethyl-3-[3-dimethyl aminopropyl] carbodiimide [EDC]) and one of three scavenging regimens (mannitol, ascorbate, or riboflavin). Tendons then were exposed to one of three radiation conditions (gamma or electron beam irradiation at 50 kGy or unsterilized). Combination-treated tendons (10 per group) had increases in mechanical properties and higher resistance to collagenase digestion compared with EDC-only and untreated tendons. Irradiated tendons treated with EDC-mannitol, -ascorbate, and -riboflavin combinations had comparable strength to native tendon and had averages of 26%, 39%, and 37% greater, respectively, than those treated with EDC-only. Optimization of a crosslinking protocol and free radical scavenging cocktail is ongoing with the goal of ensuring sterile allografts through irradiation while maintaining their structure and mechanical properties.

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Section: Discussionmentioning

confidence: 99%

Improved Tendon Radioprotection by Combined Cross-linking and Free Radical Scavenging

Seto

Gatt

Dunn

2009

Clinical Orthopaedics &Amp; Related Research

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“…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].…”

Section: Discussionmentioning

confidence: 99%

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

Scheffler

Gonnermann

Kamp

et al. 2008

Clin Orthop Relat Res

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Sterilization of allografts for anterior cruciate ligament (ACL) reconstruction has become an important prerequisite to prevent disease transmission. However, current sterilization techniques impair the biological or mechanical properties of such treated grafts. Peracetic acid (PAA) has been successfully used to sterilize bone allografts without these disadvantages and does not impair the mechanical properties of soft tissue grafts in vitro. We asked whether PAA sterilization would influence recellularization, restoration of crimp length and pattern, and revascularization of ACL grafts during early healing. We used an in vivo sheep model for open ACL reconstruction. We also correlated the histologic findings with the restoration of anteroposterior stability and structural properties during load-to-failure testing. PAA slowed remodeling activity at 6 and 12 weeks compared to nonsterilized allografts and autografts. The mechanical properties of PAA grafts were also reduced compared to these control groups at both time points. We conclude PAA sterilization currently should not be used to sterilize soft tissue grafts typically used in ACL reconstruction.

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“…Many published studies (Fideler et al, 1995;Curran et al, 2004;Schwartz et al, 2006;Grieb et al, 2006;Balsly et al, 2008) have shown that gamma irradiation significantly alters the initial biomechanical properties of allografts in a dose-dependent manner. A dose as low as 2.5 mrad commonly used by tissue banks has been shown to reduce the initial stiffness and strength of tendon allografts.…”

Section: Introductionmentioning

confidence: 99%

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

Kim

Tian

Zhang

et al. 2009

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. Methods: All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 mrad of irradiation prior to distribution. A total of 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft groups). The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. Results: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autograft group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examinations of all patients were almost normal. Blood routine was normal, the values of erythrocyte sedimentation rate (ESR) were 5~16 mm/h and the contents of C reactive protein (CRP) were 3~10 mg/L. Conclusion: We conclude that the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate using the gamma irradiation as a secondary sterilizing method.

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The Effect of Gamma Irradiation on Anterior Cruciate Ligament Allograft Biomechanical and Biochemical Properties in the Caprine Model at Time Zero and at 6 Months after Surgery

Abstract: Background: High levels of gamma irradiation are required to eliminate the risk of bacterial and viral transmission during implantation of musculoskeletal allografts. The effects of high levels of gamma irradiation on anterior cruciate ligament allograft biomechanics are still not known.

Cited by 77 publications

References 37 publications

Improved Tendon Radioprotection by Combined Cross-linking and Free Radical Scavenging

Improved Tendon Radioprotection by Combined Cross-linking and Free Radical Scavenging

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

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