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Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

  • Symposium: New Approaches to Allograft Transplantation
  • Published:
Clinical Orthopaedics and Related Research

Abstract

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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References

  1. Amiel D, Kleiner JB, Roux RD, Harwood FL, Akeson WH. The phenomenon of “ligamentization”: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res. 1986;4:162–172.

    Article  PubMed  CAS  Google Scholar 

  2. Baer GS, Harner CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26:661–681.

    Article  PubMed  Google Scholar 

  3. Butler DL. Kappa Delta Award paper. Anterior cruciate ligament: its normal response and replacement. J Orthop Res. 1989;7:910–921.

    Article  PubMed  CAS  Google Scholar 

  4. Cole DW, Ginn TA, Chen GJ, Smith BP, Curl WW, Martin DF, Poehling GG. Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft. Arthroscopy. 2005;21:786–790.

    PubMed  Google Scholar 

  5. Cooper DE, Arnoczky SP, Warren RF. Contaminated patellar tendon grafts: incidence of positive cultures and efficacy of an antibiotic solution soak–an in vitro study. Arthroscopy. 1991;7:272–274.

    PubMed  CAS  Google Scholar 

  6. Curran AR, Adams DJ, Gill JL, Steiner ME, Scheller AD. The biomechanical effects of low-dose irradiation on bone-patellar tendon-bone allografts. Am J Sports Med. 2004;32:1131–1135.

    Article  PubMed  Google Scholar 

  7. Dustmann M, Schmidt T, Gangey I, Unterhauser FN, Weiler A, Scheffler SU. The extracellular remodeling of free-soft-tissue autografts and allografts for reconstruction of the anterior cruciate ligament: a comparison study in a sheep model. Knee Surg Sports Traumatol Arthrosc. 2008;16:360–369.

    Article  PubMed  CAS  Google Scholar 

  8. Ellis DG. Cross-sectional area measurements for tendon specimens: a comparison of several methods. J Biomech. 1969;2:175–186.

    Article  PubMed  CAS  Google Scholar 

  9. Goradia VK, Rochat MC, Grana WA, Rohrer MD, Prasad HS. Tendon-to-bone healing of a semitendinosus tendon autograft used for ACL reconstruction in a sheep model. Am J Knee Surg. 2000;13:143–151.

    PubMed  CAS  Google Scholar 

  10. Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M. Allograft versus autograft anterior cruciate ligament reconstruction: 3- to 5-year outcome. Clin Orthop Relat Res. 1996;324:134–144.

    Article  PubMed  Google Scholar 

  11. Hepatitis C virus transmission from an antibody-negative organ and tissue donor–United States. MMWR Morb Mortal Wkly Rep. 2003;52:273–274, 276.

    Google Scholar 

  12. Jackson DW, Grood ES, Goldstein JD, Rosen MA, Kurzweil PR, Cummings JF, Simon TM. A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med. 1993;21:176–185.

    Article  PubMed  CAS  Google Scholar 

  13. Molina ME, Nonweiller DE, Evans JA, Delee JC. Contaminated anterior cruciate ligament grafts: the efficacy of 3 sterilization agents. Arthroscopy. 2000;16:373–378.

    PubMed  CAS  Google Scholar 

  14. Murray MM, Spector M. Fibroblast distribution in the anteromedial bundle of the human anterior cruciate ligament: the presence of alpha-smooth muscle actin-positive cells. J Orthop Res. 1999;17:18–27.

    Article  PubMed  CAS  Google Scholar 

  15. Prolo DJ, Pedrotti PW, White DH. Ethylene oxide sterilization of bone, dura mater, and fascia lata for human transplantation. Neurosurgery. 1980;6:529–539.

    PubMed  CAS  Google Scholar 

  16. Pruss A, Baumann B, Seibold M, Kao M, Tintelnot K, von Versen R, Radtke H, Dorner T, Pauli G, Gobel UB. Validation of the sterilization procedure of allogeneic avital bone transplants using peracetic acid-ethanol. Biologicals. 2001;29:59–66.

    Article  PubMed  CAS  Google Scholar 

  17. Pruss A, Gobel UB, Pauli G, Kao M, Seibold M, Monig HJ, Hansen A, von Versen R. Peracetic acid-ethanol treatment of allogeneic avital bone tissue transplants–a reliable sterilization method. Ann Transplant. 2003;8:34–42.

    PubMed  Google Scholar 

  18. Rappe M, Horodyski M, Meister K, Indelicato PA. Nonirradiated versus irradiated Achilles allograft: in vivo failure comparison. Am J Sports Med. 2007;35:1653–1658.

    Article  PubMed  Google Scholar 

  19. Roberts TS, Drez D Jr, McCarthy W, Paine R. Anterior cruciate ligament reconstruction using freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts. Two year results in thirty-six patients. Am J Sports Med. 1991;19:35–41.

    Article  PubMed  CAS  Google Scholar 

  20. Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am. 1993;75:1795–1803.

    PubMed  CAS  Google Scholar 

  21. Scheffler SU, Scherler J, Pruss A, von Versen R, Weiler A. Biomechanical comparison of human bone-patellar tendon-bone grafts after sterilization with peracetic acid ethanol. Cell Tissue Bank. 2005;6:109–115.

    Article  PubMed  CAS  Google Scholar 

  22. Scheffler SU, Schmidt T, Gangey I, Dustmann M, Unterhauser F, Weiler A. Fresh-frozen free-tendon allografts versus autografts in anterior cruciate ligament reconstruction: delayed remodeling and inferior mechanical function during long-term healing in sheep. Arthroscopy. 2008;24:448–458.

    PubMed  Google Scholar 

  23. Scheffler SU, Unterhauser FN, Weiler A. Graft remodeling and ligamentization in ACL reconstruction. In: Prodromos CC, et al. eds. The Anterior Cruciate Ligament: Reconstruction and Basic Science. Philadelphia, PA: Saunders/Elsevier; 2007, pp. 407–416, Part K, Chapter 55.

  24. Schwartz HE, Matava MJ, Proch FS, Butler CA, Ratcliffe A, Levy M, Butler DL. 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. Am J Sports Med. 2006;34:1747–1755.

    Article  PubMed  Google Scholar 

  25. Shelton WR, Papendick L, Dukes AD. Autograft versus allograft anterior cruciate ligament reconstruction. Arthroscopy. 1997;13:446–449.

    PubMed  CAS  Google Scholar 

  26. Siebold R, Buelow JU, Bos L, Ellermann A. Primary ACL reconstruction with fresh-frozen patellar versus Achilles tendon allografts. Arch Orthop Trauma Surg. 2003;123:180–185.

    PubMed  CAS  Google Scholar 

  27. Silvaggio VJ, Fu FH, Georgescu HI, Evans CH. The induction of IL-1 by freeze-dried ethylene oxide-treated bone-patellar tendon-bone allograft wear particles: an in vitro study. Arthroscopy. 1993;9:82–86.

    PubMed  CAS  Google Scholar 

  28. Starke R, Hackensellner HA, von Versen R. Experimental studies of the sterilization of transplantation material with peracetic acid [in German]. Z Exp Chir Transplant Kunstliche Organe. 1984;17:254–258.

    PubMed  CAS  Google Scholar 

  29. Tom JA, Rodeo SA. Soft tissue allografts for knee reconstruction in sports medicine. Clin Orthop Relat Res. 2002;402:135–156.

    Article  PubMed  Google Scholar 

  30. Unterhauser FN, Bail HJ, Hoher J, Haas NP, Weiler A. Endoligamentous revascularization of an anterior cruciate ligament graft. Clin Orthop Relat Res. 2003;414:276–288.

    Article  PubMed  Google Scholar 

  31. Update: allograft-associated bacterial infections–United States. MMWR Morb Mortal Wkly Rep. 2002;51:207–210.

  32. Vangsness CT Jr, Garcia IA, Mills CR, Kainer MA, Roberts MR, Moore TM. Allograft transplantation in the knee: tissue regulation, procurement, processing, and sterilization. Am J Sports Med. 2003;31:474–481.

    PubMed  Google Scholar 

  33. Victor J, Bellemans J, Witvrouw E, Govaers K, Fabry G. Graft selection in anterior cruciate ligament reconstruction–prospective analysis of patellar tendon autografts compared with allografts. Int Orthop. 1997;21:93–97.

    Article  PubMed  CAS  Google Scholar 

  34. Weiler A, Peine R, Pashmineh-Azar A, Abel C, Sudkamp NP, Hoffmann RF. Tendon healing in a bone tunnel. Part I: Biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy. 2002;18:113–123.

    Article  PubMed  Google Scholar 

  35. Weiler A, Peters G, Maurer J, Unterhauser FN, Sudkamp NP. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med. 2001;29:751–761.

    PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Frank Schweiger and Sven Schurig for their skillful technical assistance.

Author information

Authors and Affiliations

  1. Sports Medicine & Arthroscopy Service, Department for Orthopaedic Surgery and Traumatology, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Charité Platz 1, 10117, Berlin, Germany

    Sven U. Scheffler MD, Johannes Gonnermann CMD & Julia Kamp CMD

  2. Institute for Laboratory Medicine and Pathobiochemistry, Charité University Medicine Berlin, Berlin, Germany

    Dorothea Przybilla

  3. Tissue Bank Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany

    Axel Pruss MD

Authors
  1. Sven U. Scheffler MD
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  2. Johannes Gonnermann CMD
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  3. Julia Kamp CMD
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  4. Dorothea Przybilla
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  5. Axel Pruss MD
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Corresponding author

Correspondence to Sven U. Scheffler MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. This study was funded by research grants of the Charité Research Funds and the Musculoskeletal Transplant Foundation.

Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Scheffler, S.U., Gonnermann, J., Kamp, J. et al. Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization. Clin Orthop Relat Res 466, 1810–1818 (2008). https://doi.org/10.1007/s11999-008-0288-2

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  • DOI: https://doi.org/10.1007/s11999-008-0288-2

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