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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIII | Pages 124 - 124
1 May 2012
Ganeshalingam R Oliver R Musgrove T Yu Y
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The biological properties of morselised bone allograft treated with either a supercritical fluid process or low-dose (15 kGy) gamma irradiation were compared using radiological, histological and immunohistological techniques. The aims were to investigate any differences in the biological properties of supercritical fluid treated allograft and low-dose gamma irradiated allograft in-vivo.

Rabbit allograft were cleaned of all soft tissue, cartilage and processed into ‘corticancellous crunch’ using a Noviomagus Bone Mill. Pooled samples were either gamma irradiated (15 kGy) or treated by NovaSterilis using super critical carbon dioxide. A well-reported tibial defect model in ten rabbits was used to examine the in vivo response of the different treatments at two and four weeks following surgery (n=5 per time point). Radiographic (x-ray, CT and micro CT), histology and immunohistochemistry was used to assess the in vivo response.

Radiographic results revealed an initial response to the gamma-irradiated samples compared to SCF. Histology confirmed this reaction to be inflammatory in nature at two weeks that continued at four weeks for the gamma irradiated samples. In contrast, the SCF treated sample demonstrated new bone formation while the inflammatory reaction was muted compared to the gamma irradiated samples. Four week x-rays and histology confirmed new bone formation in both groups while the lack of significant inflammatory response in the SCF group was noted.

Allograft sterilisation techniques do not result in the same initial response when evaluated in vivo. Removal of lipids and cellular debris following SCF treatment may influence the in vivo response. While both techniques can provide a sterile product, the in vivo response requires further investigation.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 266 - 266
1 Nov 2002
Pinczewski L Musgrove T Burt C Salmon L
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Aim: To determine if a side-to-side difference in laxity occurs with anterior cruciate ligament (ACL) reconstruction utilizing a hamstring tendon and standard RCI (Smith and Nephew) interference screw fixation, and if this can be affected by the use of a reverse thread RCI screw in right-sided knees.

Methods: This was a prospective study of 80 patients undergoing right-sided ACL reconstruction with hamstring tendon autograft. Females were excluded in case of there being a sex difference in postoperative laxity with HT graft. The study group comprised of 36 males utilising standard RCI screws (STD) and 44 males utilising reverse-thread RCI screws (REV). The same technique was used on all patients and all procedures were carried out by the same surgeon. The patients were evaluated at six and 12 months following the surgery with KT1000, IKDC assessment, and Lysholm Knee Score.

Results: At the follow-up after 12 months, the average side-to-side differences using KT1000 testing were 2.0 mm (STD) and 1.0 mm (REV) using manual maximum, and 1.7 (STD) and 1.0 (REV) using KT20. Both results were statistically significant. In addition, 33% of the STD group had a manual maximum of ≥3mm compared with 11% of the REV group (p< 0.01). Accordingly, there was a higher incidence of grade I instability (Lachman) in the STD group (23% of STD group; 8% of REV group, p=0.04).

Conclusion: The use of a reverse-thread interference (RCI) screw for femoral fixation in right-sided hamstring tendon ACL reconstructions in males significantly decreased side-to-side laxity at the 12 month review when compared with standard RCI fixation.