Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction: A systematic review

Table 1 In vivo studies of non-irradiated and irradiated allograft tissue for anterior cruciate ligament reconstruction

Ref.	Year	Type of study	Graft type	Irradiation dose	No. of patients (at final follow-up/enrolled)	Male	Female	Average age (yr)	Follow-up length	Findings	Weaknesses
Rihn et al[26]	2006	Retrospective	BPTB - allograft	2.5 Mrad	39	27	12	44 ± 8.4	4.2 yr	Significant difference between irradiated allograft and allograft with laxity, Lachman, and pivot shift clunk	Age difference in populations
			BPTB - autograft	None	63	43	20	25.3 ± 9.3	4.6 yr	No significant difference on range of motion, effusion, IKDC, KT-1000 when adjusted for age, IKDC physical exam rating, and return to sport	No mention of temperature when irradiation performed
Rappé et al[18]	2007	Cohort	Achilles - allograft	2.0-2.5 Mrad	33/45	N/A	N/A	26 (ranage 14-59)	6 mo	Significantly more clincal failures in irradiated allograft vs non-irradiated allograft groups with failures occuring about 9 mo earlier in irradiated group (failure of graft = 5 mm or greater on KT-1000 compared to contralateral side, positive Lachman, or magnetic resonance imaging)	Large loss of follow-up in irradiated group
			Achilles - allograft	None	42/45			27 (range 14-57)			No mention of temperature when irradiation performed
Sun et al[22]	2009	Prospective, randomized	BPTB - allograft	2.5 Mrad	32/33	24	8	30.1 ± 6.1	31 mo (2% lost to follow-up)	Significant difference between irradiated allograft and autograft with greater laxity on KT-2000, side to side difference on KT-2000, pivot shift grade II or III, anterior drawer test grade II or III, and Lachman test grade II or III	No mention of temperature when irradiation performed
			BPTB - autograft	None	33/33	24	9	29.7 ± 7.2		No significant difference on overall IKDC, range of motion, Harner's vertical jump test, Daniel's one-leg hip test, subjective IKDC, Cincinnati knee score, Lysholm score, and Tegner score
Sun et al[23]	2009	Prospective, randomized	BPTB - allograft	2.5 Mrad	32	24	8	30.1 ± 6.1	31 mo (1% lost to follow-up - treatment group not mentioned)	Significant difference between irradiated allograft, non-irradiated allograft, and autograft with greater laxity on KT-2000, side to side difference on KT-2000, pivot shift grade II or III, anterior drawer test grade II or III, and Lachman test grade II or III	No mention of temperature when irradiation performed
			BPTB - allograft	None	34	22	12	31.8 ± 6.9
			BPTB - autograft	None	33	24	9	29.7 ± 7.2		No significant difference on overall IKDC, range of motion, Harner's vertical jump test, Daniel’s one-leg hip test, subjective IKDC, Cincinnati knee score, Lysholm score, and Tegner score
Sun et al[24]	2011	Prospective, randomized	Hamstring - allograft	2.5 Mrad	31/37	24	7	30.3 ± 7.9	42.2 mo (11% lost to follow-up)	Significant difference between irradiated allograft and autograft with greater laxity on KT-2000, side to side difference on KT-2000, pivot shift grade II or III, anterior drawer test grade II or III, and Lachman test grade II or III	No mention of temperature when irradiation performed
			Hamstring - autograft	None	36/38	28	8	30.9 ± 8.7		No significant difference on overall IKDC, range of motion, Harner's vertical jump test, Daniel's one-leg hip test, subjective IKDC, Cincinnati knee score, Lysholm score, and Tegner score
Sun et al[25]	2012	Prospective, randomized	Hamstring - allograft	2.5 Mrad	31/38	24	7	30.3 ± 7.9	42.5 mo (9.1% lost to follow-up)	Significant difference between irradiated allograft and non-irradiated allograft with greater laxity on KT-2000, side to side difference on KT-2000, pivot shift grade II or III, anterior drawer test grade II or III, and Lachman test grade II or III	No mention of temperature when irradiation performed
			Hamstring - allograft	None	38/39	31	7	31.7 ± 7.8		No significant difference on overall IKDC, range of motion, Harner's vertical jump test, Daniel's one-leg hip test, subjective IKDC, Cincinnati knee score, Lysholm score, and Tegner score

IKDC: International Knee Documentation Committee; BPTB: Bone patella tendon bone.