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Petit CB, Diekfuss JA, Warren SM, Barber Foss KD, Valencia M, Thomas SM, Petushek EJ, Karas SG, Hammond KE, Pombo MW, Labib SA, Maughon TS, Whitfield BJ, Myer GD, Xerogeanes JW, Lamplot JD. Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years. Arthrosc Sports Med Rehabil 2023; 5:100741. [PMID: 37645392 PMCID: PMC10461143 DOI: 10.1016/j.asmr.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/27/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases. Methods All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years. Relative proportions were calculated, binary regression analysis was performed, and receiver operating characteristic analysis was used to identify the threshold age for maximal sensitivity and specificity to predict high risk of allograft failure, defined as undergoing revision ACLR. Results Of the 939 surveys completed, 398 patients underwent primary allograft ACLR (mean age 39.5 years; range 16.0-66.1 years; 54.3% female). The secondary ACL injury rate was 11.6% (5.8% ipsilateral revision ACLR, 5.8% contralateral ACL injury). Male and female patients had similar revision (5.5% male, 6.0% female, P = .82) and contralateral ACL injury rates (6.6% male, 5.1% female, P = .52). Receiver operating characteristic analysis indicated that age ≤34 years was threshold for differentiating high risk of allograft failure (area under the curve 0.65, 95% confidence interval 0.55-0.76; P = .014). Patients aged ≤34 years had a greater secondary injury rate than patients >34 years (20.4% (10.2% revision ACLR, 10.2% contralateral ACL injury) versus 6.9% (3.5% revision ACLR, 3.5% contralateral ACL injury; P < .001). Binary regression analysis demonstrated that decreasing age was associated with increased risk of graft failure (χ2 = 7.9, P = .02.). Conclusions Allograft ACLR showed similar failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. By age 34 years, the increased revision risk for younger patients diminished. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Camryn B. Petit
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Shayla M. Warren
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
| | - Kim D. Barber Foss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
| | - Melanie Valencia
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
| | - Staci M. Thomas
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Sports Medicine Division, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Erich J. Petushek
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Michigan Technological University, Houghton, Michigan, U.S.A
| | - Spero G. Karas
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Kyle E. Hammond
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Mathew W. Pombo
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Sameh A. Labib
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Timothy S. Maughon
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Bryan J. Whitfield
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Gregory D. Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - John W. Xerogeanes
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Emory Sports Medicine Center, Atlanta, Georgia, U.S.A
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Joseph D. Lamplot
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, U.S.A
- Campbell Clinic, Germantown, Tennessee, U.S.A
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Fan D, Ma J, Zhang L. Patellar tendon versus artificial grafts in anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:478. [PMID: 34348750 PMCID: PMC8336077 DOI: 10.1186/s13018-021-02624-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of osteoarthritis. However, due to the structural limitations of the human body, it is not possible to perform ACLR with conventional sutures. To restore normal functioning of the anterior cruciate ligament (ACL), a new ligament must be reconstructed in the position of the previous ACL. Objective To compare autografts and synthetic grafts in terms of postoperative knee stability and function Search methods The protocol for this study was registered with PROSPERO (CRD42021243451). Two reviewers independently searched the PubMed, Embase, and the Cochrane Library databases from database inception though February 10, 2021. The following search method was used: ((Autograft) OR (Autologous) OR (Autotransplant)) OR Artificial Ligament AND (Anterior Cruciate Ligament Injury [MeSH Terms]) AND (Randomized controlled trial [MeSH Terms]). Methodological quality was assessed by the Cochrane risk of bias tool. Selection criteria We only included randomized controlled trials (level I) that compared autograft and synthetic graft interventions in participants with ACL injury. We included trials that evaluated ACLR using at least one outcome (Lachman test, pivot shift test, IKDC grades, or complications). Results A total of 748 studies were identified in the initial literature search, and seven studies that examined only bone-patellar tendon-bone (BPTB) grafts compared with artificial grafts met the predetermined inclusion criteria. The results showed that BPTB grafts were associated with significantly better pivot shift test and Lachman test results and better IKDC grades and lower complication rates than synthetic grafts. Conclusions This review indicates that for adults, BPTB grafts perform more favorably than synthetic grafts in ACLR in terms of knee stability, function, and complication. More research is needed to compare autologous tendons and allogeneic tendons with artificial ligaments, especially in elderly individuals. Level of evidence Level I, systematic review and meta-analysis
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Affiliation(s)
- DingYuan Fan
- Beijing University of Chinese Medicine, Beijing, China.,Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Jia Ma
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China.
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Sarzaeem MM, Razi M, Omrani FA, Azimi F, Aghaalikhani M. Modified patellar side harvest technique for bone-patella, tendon-bone autograft anterior cruciate ligament reconstruction; a three-year prospective cohort. J Orthop 2020; 18:95-98. [PMID: 32189892 DOI: 10.1016/j.jor.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose To introduce and discuss the outcome of a modified patellar side harvest technique. Methods This prospective cohort was conducted on patients with torn ACL who were eligible candidates for surgical intervention. Demographics and baseline characteristics were gathered for each patient. Results In total, 1024 patients with a mean age of 30.6 ± 3.6 were enrolled in this cohort. Results of modified IKDC scores reported with good and excellent outcome in 75% of patients. Conclusion Most of the patients who underwent BPTB-ACL reconstruction surgery with modified patellar side harvest technique, experienced acceptable clinical outcome.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
| | - Mohammad Razi
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
| | - Farzad Amuzade Omrani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
| | - Farya Azimi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Aghaalikhani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran
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Sun J, Wei XC, Li L, Cao XM, Li K, Guo L, Lu JG, Duan ZQ, Xiang C, Wei L. Autografts vs Synthetics for Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:378-387. [PMID: 32180364 PMCID: PMC7189042 DOI: 10.1111/os.12662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/14/2023] Open
Abstract
To describe the outcomes of autografts and synthetics in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient‐reported outcome scores, complications, and graft failure risk. We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four‐strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta‐analysis indicated that there was a significantly lower rate of side‐to‐side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the synthetics group than in the autografts group. This systematic review comparing long‐term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient‐reported outcome scores, and were also associated with more postoperative complications.
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Affiliation(s)
- Jian Sun
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Chun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Lu Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Ming Cao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Kai Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Li Guo
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Jian-Gong Lu
- The Institute of Stem Cell and Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Zhi-Qing Duan
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Chuan Xiang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Lei Wei
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
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Hulet C, Sonnery-Cottet B, Stevenson C, Samuelsson K, Laver L, Zdanowicz U, Stufkens S, Curado J, Verdonk P, Spalding T. The use of allograft tendons in primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:1754-1770. [PMID: 30830297 DOI: 10.1007/s00167-019-05440-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. METHODS The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. RESULTS Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. CONCLUSION When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Christophe Hulet
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Ciara Stevenson
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Kristian Samuelsson
- Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lior Laver
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Urszula Zdanowicz
- Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA, 15219-3110, USA
| | - Sjoerd Stufkens
- Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jonathan Curado
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Peter Verdonk
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK.
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Rose M, Crawford D. Allograft Maturation After Reconstruction of the Anterior Cruciate Ligament Is Dependent on Graft Parameters in the Sagittal Plane. Orthop J Sports Med 2017; 5:2325967117719695. [PMID: 28840143 PMCID: PMC5549879 DOI: 10.1177/2325967117719695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Allograft healing (ligamentization) after reconstruction of the anterior cruciate ligament (ACL) is dependent on multiple factors, including tissue processing, host biologic environment, and biomechanical stressors. Magnetic resonance imaging (MRI) can be used to assess graft maturation after ACL reconstruction. Hypothesis: A significant difference will exist in the MRI analysis between 2 distinct allograft constructs. Specifically, the MRI signal-to-noise quotient (SNQ) value will be smaller in quadrupled hamstring tendon (HT) allografts compared with doubled tibialis anterior (TA) allografts due to the difference in graft geometry (surface area–to-volume ratio). Study Design: Cohort study; Level of evidence, 2. Methods: Prospectively collected data from a subset of patients who participated in a randomized controlled trial at a single center from July 2010 to April 2012 were reviewed. Patients underwent ACL reconstruction using either HT or TA allografts. Six months postoperatively, 32 patients underwent noncontrast MRI to assess ligamentization. The SNQ was calculated for the allograft using sagittal noncontrast T2-weighted MRI as follows: SNQ = (Sgraft − Sqaudriceps)/Sbackgroud. Graft properties including sagittal and coronal angle as well as tibial and femoral tunnel location were measured. All participants completed validated patient-reported outcome measures preoperatively and at 2 years postoperatively. Results: The mean MRI SNQ for the HT and TA allografts was 2.56 ± 2.41 and 3.15 ± 3.38, respectively (P = .57). For the entire group, there was a significant correlation between MRI SNQ and both sagittal graft angle (P = .02) and sagittal tibial tunnel position (P < .001). We did not find a significant correlation between the tibial tunnel location in the coronal plane, coronal graft angle, or location of the femoral tunnel and the MRI SNQ. Conclusion: Allograft ligamentization 6 months postoperatively, as assessed by MRI, is dependent on position of the tibial tunnel in the sagittal plane as well as sagittal graft orientation. We did not detect a difference in graft maturation at 6 months between the tibialis anterior and hamstring tendon allografts. This is the only study to our knowledge that directly compares quadrupled HT allografts and doubled TA allografts using postoperative MRI.
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Affiliation(s)
- Michael Rose
- Department of Orthopaedic Surgery and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
| | - Dennis Crawford
- Department of Orthopaedic Surgery and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
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Edwards JH, Herbert A, Jones GL, Manfield IW, Fisher J, Ingham E. The effects of irradiation on the biological and biomechanical properties of an acellular porcine superflexor tendon graft for cruciate ligament repair. J Biomed Mater Res B Appl Biomater 2016; 105:2477-2486. [PMID: 27662636 PMCID: PMC5655932 DOI: 10.1002/jbm.b.33786] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/10/2016] [Accepted: 08/28/2016] [Indexed: 12/19/2022]
Abstract
Acellular xenogeneic tissues have the potential to provide ‘off‐the‐shelf’ grafts for anterior cruciate ligament (ACL) repair. To ensure that such grafts are sterile following packaging, it is desirable to use terminal sterilization methods. Here, the effects of gamma and electron beam irradiation on the biological and biomechanical properties of a previously developed acellular porcine superflexor tendon (pSFT) were investigated. Irradiation following treatment with peracetic acid was compared to peracetic acid treatment alone and the stability of grafts following long‐term storage assessed. Irradiation did not affect total collagen content or biocompatibility (determined using a contact cytotoxicity assay) of the grafts, but slightly increased the amount of denatured collagen in and decreased the thermal denaturation temperature of the tissue in a dose dependant fashion. Biomechanical properties of the grafts were altered by irradiation (reduced ultimate tensile strength and Young's modulus, increased failure strain), but remained superior to reported properties of the native human ACL. Long term storage at 4°C had no negative effects on the grafts. Of all the conditions tested, a dose of minimum 25 kGy of gamma irradiation had least effect on the grafts, suggesting that this dose produces a biocompatible pSFT graft with adequate mechanical properties for ACL repair. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2477–2486, 2017.
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Affiliation(s)
- Jennifer H Edwards
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Gemma L Jones
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Iain W Manfield
- School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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Editorial Commentary: Well-Performed Anterior Cruciate Ligament Statistical Analysis Results in Figures Worth a Second Look. Arthroscopy 2016; 32:403. [PMID: 26814402 DOI: 10.1016/j.arthro.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
Statisticians are required to ensure that systematic reviews and meta-analyses are performed using proper methods. Forest plots contain substantial and important information and are visually compelling, but conclusions could be incorrect absent appropriate application of statistical methods.
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