Radioprotection provides functional mechanics but delays healing of irradiated tendon allografts after ACL reconstructio
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ORIGINAL PAPER
Radioprotection provides functional mechanics but delays healing of irradiated tendon allografts after ACL reconstruction in sheep Aaron U. Seto • Brian M. Culp • Charles J. Gatt Jr. • Michael Dunn
Received: 19 February 2013 / Accepted: 22 June 2013 Ó Springer Science+Business Media Dordrecht 2013
Abstract Successful protection of tissue properties against ionizing radiation effects could allow its use for terminal sterilization of musculoskeletal allografts. In this study we functionally evaluate Achilles tendon allografts processed with a previously developed radioprotective treatment based on (1-ethyl-3-(3dimethylaminopropyl)carbodiimide) crosslinking and free radical scavenging using ascorbate and riboflavin, for ovine anterior cruciate ligament reconstruction. Arthroscopic anterior cruciate ligament (ACL) reconstruction was performed using double looped allografts, while comparing radioprotected irradiated and fresh frozen allografts after 12 and 24 weeks post-implantation, and to control irradiated grafts after 12 weeks. Radioprotection was successful at preserving early subfailure mechanical properties comparable to fresh frozen allografts. Twelve week graft stiffness and anterior-tibial (A-T) translation for radioprotected and fresh frozen allografts were comparable at 30 % of native stiffness, and 4.6 and 5 times native A-T translation, respectively. Fresh frozen allograft possessed the greatest 24 week peak load at 840 N and stiffness at 177 N/mm. Histological evidence suggested a delay in tendon to bone healing for
A. U. Seto B. M. Culp C. J. Gatt Jr. M. Dunn (&) Department of Orthopaedic Surgery, Robert Wood Johnson Medical School - Rutgers University, 51 French St MEB Rm 424, P.O. Box 19, New Brunswick, NJ 08901, USA e-mail: [email protected]
radioprotected allografts, which was reflected in mechanical properties. There was no evidence that radioprotective treatment inhibited intra-articular graft healing. This specific radioprotective method cannot be recommended for ACL reconstruction allografts, and data suggest that future efforts to improve allograft sterilization procedures should focus on modifying or eliminating the pre-crosslinking procedure. Keywords Allograft Sterilization Ionizing radiation ACL reconstruction In vivo Radioprotection Crosslinking Free radical scavenging
Introduction Anterior cruciate ligament (ACL) injuries represent the most common musculoskeletal injuries resulting in complete tissue failure (Muneta et al. 1999), with an occurrence estimated at 1 in 3,000 in the United States (Fu et al. 1999; Ireland 2002; Shelbourne and Patel 1995; Soderman et al. 2002). Surgical reconstruction has become the standard treatment due to insufficient ability for the ACL to self repair. Use of graft material for reconstructions has been primarily dominated by autogenous tissue (Bartlett et al. 2001; Peterson et al. 2001; Harner et al. 1996; Stringham et al. 1996), although greater consideration and use of allogenic
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