Transplantation of the rabbit medial collateral ligament. II. Biomechanical evaluation of frozen/thawed allografts.

This study was designed to test the mechanical behavior of a frozen/thawed bone-medial collateral ligament (MCL)-bone allograft in a rabbit model and to compare allograft behavior with contralateral unoperated ligaments as well as a group of normal bone-ligament-bone preparations prior to freezing. Twenty-five mature rabbits received similarly frozen bone-MCL-bone allografts and were subsequently allowed to heal without immobilization in groups of five for 3, 6, 12, 24, or 48 weeks after transplantation. A series of biomechanical tests was performed on each allograft, contralateral, and external normal control ligament. Results demonstrated that allografts were significantly tighter than controls at 3 weeks and they remained tight over time. All allografts, however, had inferior structural and material behaviors as compared with controls. Allograft insertional bone and substance deteriorated to about 60% of contralateral strength at 12 and 48 weeks. Bony insertions became the most common site of graft weakness. Both stress at failure and the elastic modulus of allograft substance similarly reached a plateau at those intervals, but at about 30% of contralateral controls. Cyclic and load relaxation properties of allografts, on the other hand, did not deteriorate and were, in fact, indistinguishable from contralateral and normal values at 48 weeks. Comparison with a series of fresh autografts suggests that, with the exception of this viscoelastic recovery, allografts were mechanically inferior to autografts in their healing at the intervals tested. Collectively, these results suggest that allograft MCL healing in this composite model is dynamic but slow, featuring changes in bone and soft tissue over the first year after transplantation. Although "viable" and vascular, allografts have not normalized mechanically and, in fact, appear to have reached a new equilibrium whereby properties are neither improving nor deteriorating. Despite this apparent equilibrium, the trend for some viscoelastic recovery provides hope that allografts may have further potential for improvement. Longer-term studies of MCL allograft mechanical behaviors are clearly required.