Rappé Matthew, Horodyski MaryBeth, Meister Keith, Indelicato Peter A
Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA.
Am J Sports Med. 2007 Oct;35(10):1653-8. doi: 10.1177/0363546507302926. Epub 2007 May 21.
Many studies suggest that gamma irradiation decreases allograft strength in a dose-dependent manner. No study has demonstrated that this decrease in strength translates into higher clinical failures.
Irradiation of allograft tissue will lead to higher early clinical failure in anterior cruciate ligament (ACL) reconstruction.
Cohort study; Level of evidence, 3.
Medical records were reviewed for 90 consecutive patients who had received Achilles allograft reconstruction for unilateral primary ACL injuries at one institution between July 2001 and June 2002. One half of patients received nonirradiated Achilles allograft and the other half received irradiated Achilles allograft at a dose range of 2.0 to 2.5 Mrad. The ACL allograft reconstructions were performed using the same surgical technique. The rehabilitation program was identical for both groups. All clinical failures were recorded.
At least 6 months' follow-up was available on 42 subjects in the nonirradiated group and 33 subjects in the irradiated group. A significant difference was noted in early failure rates between the groups (P <.01). The nonirradiated group had 1 in 42 (2.4%) catastrophic failure. In the irradiated group, 11 of 33 (33%) Achilles tendon grafts failed.
Less than satisfactory results led the senior authors to discontinue the use of irradiated allografts in ACL surgery. Continued research into alternatives to gamma irradiation is needed.
许多研究表明，γ射线照射会以剂量依赖的方式降低同种异体移植物的强度。尚无研究表明这种强度降低会转化为更高的临床失败率。
同种异体移植物的照射会导致前交叉韧带（ACL）重建术后早期临床失败率更高。
队列研究；证据等级，3级。
回顾了2001年7月至2002年6月期间在一家机构接受单侧原发性ACL损伤的跟腱同种异体移植重建术的90例连续患者的病历。一半患者接受未照射的跟腱同种异体移植物，另一半接受剂量范围为2.0至2.5兆拉德的照射跟腱同种异体移植物。ACL同种异体移植重建采用相同的手术技术。两组的康复方案相同。记录所有临床失败情况。
未照射组42名受试者和照射组33名受试者至少有6个月的随访。两组之间的早期失败率存在显著差异（P <.01）。未照射组42例中有1例（2.4%）发生灾难性失败。在照射组中，33例跟腱移植物中有11例（33%）失败。
不太理想的结果导致资深作者停止在ACL手术中使用照射过的同种异体移植物。需要继续研究γ射线照射的替代方法。
