2025 ISAKOS Biennial Congress ePoster
Outcomes of ACL Reconstruction Utilizing Supercritical CO2-Sterilized Allografts
Keran Sundaraj, MBBS MCs (Trauma) FRACS FAOA, Wollstonecraft, NSW AUSTRALIA
John Farey, MBBS (Hons) MMed (Clin Epi), Sydney, NSW AUSTRALIA
Justin P. Roe, MB BS BSc(Med) Hons, A/Prof., Lindfield, NSW AUSTRALIA
Lucy J. Salmon, PhD, Sydney, NSW AUSTRALIA
Vivianne Russell, BSC(Biomed), Sydney, NSW AUSTRALIA
Leo A. Pinczewski, MBBS, FRACS, FAOA, Sydney, NSW AUSTRALIA
North Sydney Orthopaedic and Sports Medicine Centre, Sydney, NSW, AUSTRALIA
FDA Status Cleared
Summary
SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.
ePosters will be available shortly before Congress
Abstract
Background
Allograft tendons are perceived to have a high re-rupture rate in primary anterior cruciate ligament (ACL) reconstruction. Historical series may be biased by graft processing methods that degrade the biomechanical properties of donor tendons such as irradiation. Supercritical carbon dioxide (SCCO2) is a validated method of sterilising biomaterials at physiological temperatures without irradiation, but in vivo use of SCCO2 processed tendon allografts for primary ACL-R have not been reported to date.
Objectives: To determine the ACL graft rupture rates, subjective knee scores and clinical outcomes at 2 years after ACL reconstruction with SCCO2 allografts
Methods
Patients underwent primary ACL reconstruction with SCCO2 processed human gracilis, peroneus longus, semitendinosus, tibialis anterior and tibialis posterior tendon allografts. Patient demographics were collected, as well as tendon donor age and sex. At 1 year, subjective International Knee Documentation Committee (IKDC), and ACL RSI scores were collected, as well as clinical evaluation. At 2 years, the IKDC and ACL RSI scores were repeated, and return to sport and further knee injuries were recorded.
Results
A total of 144 patients with a median age of 26 (IQR 14) years formed the study group. Patients were predominately male (58%). The loss to follow-up rate was 8% (n = 12). The mean age of allograft tendon donors was 37 (range 17-58) years, and the majority were male (83%). The mean allograft diameter was 8.9 +/- 1.0 mm. At 2 years, ACL graft failure occurred in 5% (n = 7). All graft failures were in patients aged <25 years (P = .007). Neither donor age (<40 or >40 years) nor donor sex was associated with graft failure (P >.05). The median IKDC subjective score was 95 and ACL-RSI score was 75. There were no revisions for sepsis within the first 2 years postoperatively.
Conclusion
SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.