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Medical References & Research

If you are interested in learning more about allografts, tissue donation or sterilization, you can find information in the following sources:

Anterior Cruciate Ligament Reconstruction With Bone–Patella Tendon–Bone Graft: Comparison of Autograft, Fresh-Frozen Allograft, and ?-Irradiated Allograft
Lin Guo, M.D. , Liu Yang, M.D., Ph.D., Xiao-jun Duan, M.D., Rui He, M.D., Guang-xing Chen, M.D., Fu-you Wang, M.D., Ying Zhang
Arthroscopy: The Journal of Arthroscopic and Related Surgery (2011)

The purpose of this study was to compare clinical follow-up results of anterior cruciate ligament (ACL) reconstruction using (1) autologous, (2) fresh-frozen allogeneic, and (3) ?-irradiated allogeneic bone–patellar tendon–bone (BPTB).

The study showed a statistically poorer KT-1000 result and higher failure rate in the ?-irradiated allograft group compared with the autograft and fresh-frozen allograft groups. This may suggest that ?-irradiated allograft is not a good candidate graft for reconstruction.

The “Ligamentization” Process in Human Anterior Cruciate Ligament Reconstruction with Autogenous Patellar and Hamstring Tendons
K. Marumo, M. Saito, T. Yamagishi, K. Fujii
American Journal of Sports Medicine (AJSM) (2005) 33.8: 1166-1173

The purpose of this study was to determine if ligamentization occurs in autografts in anterior cruciate ligament (ACL) reconstruction by analyzing and comparing the biochemical properties of BTB and semitendinosus and gracilis autografts to the native ACL. (When grafts undergo ligamentization, they become similar to the native ACL.)

Results showed that at one year, the biochemical properties of the grafts resembled those of the native ACL. The process of ligamentization did occur, and continued for at least one year post surgery.

Allograft Compared with Autograft Infection Rates in Primary Anterior Cruciate Ligament Reconstruction
D. Greenberg, M. Robertson, S. Vallurupalli, R. White, W. Allen Journal of Bone & Joint Surgery (JBJS) (2010) 92-A.14: 2402-2408

The purpose of this study was to compare the infection rates between the use of allograft and autograft in ACL reconstruction.

This study found no increased risk of infection with allograft use compared to autograft use for ACL reconstruction.

A Systematic Review of Anterior Cruciate Ligament Reconstruction with Autograft Compared with Allograft
J. Carey, D. Warren, D. Dahm, S. Zeger, K. Spindler Journal of Bone & Joint Surgery (JBJS) (2009) 91-A.9: 2242-2250

The purpose of this study was to review ACL reconstruction cases to determine if the short-term clinical outcomes of autograft cases compared to the outcome of allograft cases.

The authors concluded that the findings of this systematic review and meta-analysis show that the short-term clinical outcomes of ACL reconstruction with allografts are not significantly different from those with autografts.

Allograft Update: The Current Status of Tissue Regulation, Procurement, Processing, and Sterilization
D. McAllister, M. Joyce, B. Mann, T. Vangsness American Journal of Sports Medicine (AJSM) (2007) 35.12: 2148-2158

The purpose of this article is to discuss current issues of allograft transplantation in the knee, including tissue processing and sterilization, concerns of allograft safety, and current allograft regulations.

The FDA does not require that tissue be sterilized, but any successful sterilization method must not damage the biomechanical properties or the incorporation characteristics of the graft.

Nonirradiated Versus Irradiated Achilles Autograft: In Vivo Failure Comparison
M. Rappe, M. Horodyski, K. Meister, P. Indelicato American Journal of Sports Medicine (AJSM) (2007) 35.10: 1653-1658

The purpose of the study was to determine if irradiation decreases allograft strength and results in higher early clinical failures in ACL reconstruction.

Results showed at six months follow-up that one in 42 (2.4%) of nonirradiated tendons failed and 11 in 33 (33%) of irradiated tendons failed. “The probability of successful ACL reconstruction using nonirradiated Achilles tendon allograft was 97.6%, whereas the probability of success using irradiated tendon allograft was only 66.7%.” The significantly higher failure rate led the authors to discontinue the use of irradiated allografts.

Anterior Cruciate Ligament Reconstruction with BPTB Autograft, Irradiated Versus Non-Irradiated Allograft: A Prospective Randomized Clinical Study
K. Sun, S. Tian, J. Zhang, C. Xia, C. Zhang, T. Yu Knee Surgery, Sports Traumatology, Arthroscopy (2009) 17: 464-474

The purpose of the study was to compare the clinical outcomes of ACL reconstruction using irradiated BTB allograft, nonirradiated BTB allograft and BTB autograft.

Results showed similar clinical outcomes in postoperative symptoms, active level, functional outcomes and physical examination measures between nonirradiated allograft and autograft. The authors conclude that nonirradiated allografts are a sufficient alternative to autografts for ACL reconstruction. When comparing nonirradiated BTB allografts to irradiated BTB allografts, results showed a statistically significant increase in laxity, graft ruptures and instability in the irradiated BTB allografts. Patients in the irradiated allograft group reported more discomfort than the other two groups. The results produced by this study led the authors of this article to discontinue the use of irradiated BTB allografts and to not advocate the use of gamma irradiation as a sterilization method.