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First published on May 18, 2004, doi:10.1177/0363546503260060
This version was published on July 1, 2004
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The American Journal of Sports Medicine 32:1131-1135 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

The Biomechanical Effects of Low-Dose Irradiation on Bone–Patellar Tendon–Bone Allografts

Andrew R. Curran, DO*,{dagger}, Douglas J. Adams, PhD{ddagger}, Julie L. Gill, PA-C{dagger}, Mark E. Steiner, MD{dagger} and Arnold D. Scheller, MD{dagger}

From the {dagger} New England Baptist Hospital Sports Medicine Program, Boston, Massachusetts, and the {ddagger} Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut

* Address correspondence to Andrew R. Curran, DO, Saltzer Medical Group, 215 E Hawaii, Nampa, ID 83686.

Background: Despite evidence that low-dose irradiation of 2 Mrad (20 kGy) is not virucidal for patellar tendon allografts and reduces tissue strength, many tissue bank protocols include low-dose irradiation.

Hypothesis: Maintaining tissue mechanical integrity may be particularly relevant toward accelerated rehabilitation of the injured knee, where the cyclic function of patellar tendon allografts is critical.

Study Design: Controlled laboratory study.

Methods: The cyclic and failure mechanical properties of paired bone-patellar tendon-bone allografts, with and without current low-dose irradiation of 20 kGy, were evaluated. Specimens were loaded from 50 N to 250 N for 1000 cycles at 0.5 Hz and subsequently loaded to failure at a strain rate of 100% per second.

Results: After 1000 cycles, grafts elongated 27% more when irradiated than when not (4.4 ± 1.5 mm vs 3.4 ± 1.0 mm; P = .03). Failure load averaged 1965 ± 512 N for irradiated grafts and 2457 ± 647 N for nonirradiated grafts (P = .007).

Conclusions: The diminished strength of irradiated grafts may contribute to overt anterior cruciate ligament graft failure, and the increase in cyclic elongation may also be detrimental to graft function.

Clinical Relevance: These results suggest that one should consider the use of nonirradiated allografts as an alternative to irradiated grafts in anterior cruciate ligament reconstruction.

Key Words: anterior cruciate ligament (ACL) • allograft • biomechanical • reconstruction • knee




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