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Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament
Abstract
One hundred nine patients over a 3 year period under went reconstruction for chronic ACL ruptures using a freeze-dried, ethylene oxide-sterilized bone-patella ten don-bone allograft. Seven patients (6.4%) developed a characteristic persistent intraarticular reaction. This re action was characterized by persistent synovial effusion with collagenous particulates and cellular inflammatory response. Synovial biopsies in all cases showed a similar chronic inflammatory process, characterized by fibrin, collagen, and phagocytic cells. The intraarticular white cells were predominantly lymphocytes. Removal of the allograft resulted in resolution of the reaction in all of the patients. Three of the seven patients showed HLA conversion. Gas chromatography demonstrated detectable levels of ethylene chlorohydrin, a toxic re action product of ethylene oxide, within the allograft and synovium 14 months following implantation of one graft. These seven cases presented strongly suggest a nonspecific or immune mediated response that must be further delineated. The use of freeze-dried, ethylene oxide-sterilized allografts using standard techniques cannot be recommended for reconstruction of the ACL.
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Cited by
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Gilbert, T. W., Sellaro, T. L., & Badylak, S. F. (2006) · Biomaterials · doi:10.1016/j.biomaterials.2006.02.014 · Cited by 2,222
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Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction?
Höher, J., Möller, H. D., & Fu, F. H. (1998) · Knee Surgery, Sports Traumatology, Arthroscopy · doi:10.1007/s001670050105 · Cited by 381
Mendibil, U., Ruiz-Hernandez, R., Retegi-Carrion, S., Garcia-Urquia, N., Olalde-Graells, B., & Abarrategi, A. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21155447 · Cited by 299
Metadata
- Authors
- Jackson, D. W., Windler, G. E., & Simon, T. M.
- Venue
- The American Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 1990-01
- Volume
- 18
- Issue
- 1
- Pages
- 1-11
- ISSN
- 0363-5465 (ISSN-L)
- 1552-3365
- OpenAlex
- W2002194777
- Cited by
- 387
- References
- 0
- FWCI
- 14.75
- Type
- journal article
- Language
- en
- Open access
- closed
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- CoChat. (2026). Citation check: Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. https://app.cochat.ai/papers/10.1177/036354659001800101
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- Jackson, D. W., Windler, G. E., & Simon, T. M. (1990). Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. The American Journal of Sports Medicine. https://doi.org/10.1177/036354659001800101
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