Allograft Failure in Cruciate Ligament Reconstruction

Abstract

Previous authors have reported the efficacy of cruciate ligament allograft reconstruction of the knee suggesting that allograft strength is not significantly different than that of autografts. The purpose of this study was to elicit the cause of a higher-than-expected failure rate in cru ciate ligament allograft reconstructions. After clinical di agnoses, 12 male and 6 female patients with cruciate ligament instability underwent intraarticular allograft re construction followed by an aggressive rehabilitation program. Deep-frozen, freeze-dried, ethylene oxide- sterilized, bone-patellar tendon-bone allografts were re hydrated, prestressed, and implanted by an open or ar throscopically assisted technique. Results revealed 6 of 18 failures. Knee instability, postoperative complica tions, and roentgenographic changes were evident. Evaluation of procurement technique showed that graft failure was significantly correlated with time to implan tation. A significant difference in mean time from pro curement and deep freezing to freeze-drying and ster ilization between failed-versus-successful grafts was 265.5 ± 61.9 versus 66.8 ± 43.8 days, respectively. Total mean time of failed grafts from procurement to implantation was significantly greater (528.3 ± 75.1 ver sus 207.3 ± 53.1 days) than for successful grafts. All graft failures came from the same batch number. These findings indicate that cruciate ligament allograft recon struction can be successful; however, longer shelf life negatively affects graft integrity.