Sterling J C, Meyers M C, Calvo R D
Texas Center for Sports Medicine and Orthopaedic Surgery, Sugar Land, USA.
Am J Sports Med. 1995 Mar-Apr;23(2):173-8. doi: 10.1177/036354659502300209.
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 cruciate ligament allograft reconstructions. After clinical diagnoses, 12 male and 6 female patients with cruciate ligament instability underwent intraarticular allograft reconstruction followed by an aggressive rehabilitation program. Deep-frozen, freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts were rehydrated, prestressed, and implanted by an open or arthroscopically assisted technique. Results revealed 6 of 18 failures. Knee instability, postoperative complications, and roentgenographic changes were evident. Evaluation of procurement technique showed that graft failure was significantly correlated with time to implantation. A significant difference in mean time from procurement and deep freezing to freeze-drying and sterilization 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 versus 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 reconstruction can be successful; however, longer shelf life negatively affects graft integrity.
此前有作者报道了膝关节交叉韧带同种异体移植重建的疗效，表明同种异体移植物的强度与自体移植物相比无显著差异。本研究的目的是找出交叉韧带同种异体移植重建失败率高于预期的原因。临床诊断后，12例男性和6例女性交叉韧带不稳定患者接受了关节内同种异体移植重建，随后进行积极的康复计划。使用深冻、冻干、环氧乙烷灭菌的骨-髌腱-骨同种异体移植物，经复水、预加应力后，通过开放或关节镜辅助技术植入。结果显示18例中有6例失败。膝关节不稳定、术后并发症和影像学改变明显。对获取技术的评估表明，移植物失败与植入时间显著相关。失败移植物与成功移植物从获取和深冻到冻干和灭菌的平均时间存在显著差异，分别为265.5±61.9天和66.8±43.8天。失败移植物从获取到植入的总平均时间显著长于成功移植物（528.3±75.1天对207.3±53.1天）。所有移植物失败均来自同一批次。这些发现表明交叉韧带同种异体移植重建可以成功；然而，较长的保存期限会对移植物完整性产生负面影响。
