The influence of freezing on the tensile strength of tendon grafts : a biomechanical study.

We investigated the influence of freezing on the tensile strength of fresh frozen tendon grafts. The biomechanical characteristics of tendons that are less commonly used in knee surgery (tibialis anterior, tibialis posterior, peroneus longus and medial and lateral half of Achilles tendons) were compared to those of a semitendinosus and gracilis graft harvested from the same 10 multi-organ donors. All right side tendons constituted the study group and were frozen at -80 degrees C and thawed at room temperature 5 times. All left side tendons were frozen at -80 degrees C and thawed at room temperature once. There were 59 tendons in the control group and 56 in the study group. The looped grafts were clamped at one side using a custom-made freeze clamp and loaded until failure on an Instron 4505 testing machine. The average ultimate failure load was not significantly different between the control and the study group (p > 0.05). The failure load of the medial tendon Achilles was the lowest in both study and control group (p < 0.001). There was no significant difference in maximum stress, maximum displacement, maximum strain and stiffness between the control and study group (p > 0.05). From our study, we conclude that freezing tendons at -80 degrees C and thawing several times does not influence the maximum load, maximum stress, maximum displacement, maximum strain and stiffness. The medial half of the Achilles tendon is clearly the weakest tendon (p < 0.001). These findings show that tendon grafts can be frozen at -80 degrees C and thawed at room temperature several times without altering their biomechanical properties.

The effect of bone morphogenetic protein-7 (OP-1) and demineralized bone matrix (DBM) in the rabbit tibial distraction model.

OP-1 (800 microg) or DBM (1900 mg) were implanted in a rabbit tibial distraction model, and healing was compared to a non treated control group. The limbs were harvested after ten weeks and examined using radiography, computerized axial tomography and histological analysis. Neither of the treatments showed a changed healing pattern. Densities as measured by CT scan were not increased and the only significant finding was an increased area of bone formation in the DBM treated group (65% increase as compared to the OP-1 group). These experimental results do not show an effect of these substances in this model of bone lengthening. They indicate that further studies are warranted to understand the process of bone formation and the working mechanisms of substances that potentially trigger bone healing.

Short- and long-term bacterial inhibiting effect of high concentrations of glycerol used in the preservation of skin allografts.

Human skin allografts are important in the treatment of severe burns. Transplantation of skin allografts can cause bacterial transmission. Glycerol in higher concentrations is an appropriate storage medium for allograft cadaver skin and has been attributed an antimicrobial effect. We investigated this effect in more detail. First, the minimal inhibitory concentration of glycerol was determined for 13 bacteria and 1 yeast. This gives an indication about an immediate (20h of incubation) antibacterial effect of glycerol. Second, effect of glycerol in the long-term was studied. Therefore, the survival time was determined for 11 different bacteria suspended in different concentrations of glycerol (50% and 85%) and incubated at three temperatures (4, 24, and 36 degrees C). The minimal inhibitory concentration exceeded 256microg/mL, thus glycerol had no direct inhibitory effect. In contrast, a long-term antimicrobial effect was present and more pronounced at higher concentrations of glycerol and higher temperatures of incubation. The mean survival time of Pseudomonas aeruginosa strains in glycerol 85% at 24 degrees C was 2.6 days, 14.7 days for the tested staphylococci and 29.6 days for three vegetative Bacillus species. In conclusion, microbial safety of glycerol-preserved skin can be increased by preserving skin allografts for some weeks at room temperature.

Comparison of microbiological culture methods in screening allograft tissue. Swab versus nutrient broth.

In order to reduce the risk of transmission of infectious diseases through transplantation of tissue allografts, one should examine tissues for the presence of microorganisms. However, there are no detailed tissue banking guidelines describing the culture method or incubation time to be used. Therefore, we compared two culture methods--blood agar plate versus Wilkins Chalgren broth--and three incubation times--2, 7 or 14 days for their performance. The ultimate aim is to use the optimal setting as standard operating procedure (SOP) for tissue allograft cultures. From 70 consecutive donors, 919 tissue samples were taken. All 919 tissue samples were incubated on blood agar as well as in Wilkins Chalgren broth for 7 days. 567 of these 919 tissue samples were left to incubate up to 14 days. Wilkins Chalgren broth yielded 24.5% (139/567) positive cultures after 14 days of incubation. This was slightly more than the growth on blood agar after 14 days (22.9%--130/567) (p=n.s.) and significantly more than the growth in Wilkins Chalgren broth after 7 days of incubation (21.9%--124/567) (p<0.05). Based on these results, Wilkins Chalgren broth has been implemented as the SOP. Since the yield of positive cultures increased from 2 to 7 days of incubation in broth (1.8 times) and the variability of species cultured from 7 to 14 days of incubation shifted towards mostly microorganisms known to be common contaminants, we established the cut-off at 7 days of incubation in Wilkins Chalgren broth.

Flow cytometric viability assessment and transmission electron microscopic morphological study of bacteria in glycerol.

Human cadaveric skin allografts are used in the treatment of burns and can be preserved in glycerol at high concentrations. Previously, glycerol has been attributed some antimicrobial effect. In an experimental set-up, we aimed at investigating this effect of prolonged incubation of bacteria in 85% glycerol. Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Bacillus subtilis were incubated in 85% glycerol. The influence of duration of incubation and temperature on ultrastructure and viability were investigated. Unstressed cultures served as controls. Survival was studied after 24-36 h and 10 days incubation in 85% glycerol at 4 degrees C and 36 degrees C with transmission electron microscopy (TEM) and flow cytometry using viability stains indicating membrane damage (SYTO9, propidium iodide) or esterase activity (carboxyfluorescein diacetate). TEM clearly demonstrated variability in morphological changes of bacteria suggesting different mechanisms of damage. Viability stains supported these findings with faster declining viable cell populations in 85% glycerol at 36 degrees C compared with 4 degrees C. Both methods demonstrated that Gram-negative species were more susceptible than Gram-positive species. In conclusion, 85% glycerol may have some additional antimicrobial effect. Temperature is an important factor herein and Gram-negatives are most susceptible. The latter finding probably reflects the difference in cell wall composition between Gram-positive and Gram-negative bacteria.

Antimicrobial susceptibility of coagulase-negative staphylococci on tissue allografts and isolates from orthopedic patients.

Allograft infection occurs at a rate not different from that of similar procedures with large allografts or sterilized prosthetic devices and is usually caused by coagulase-negative staphylococci (CNS). CNS are feared for their limited antimicrobial susceptibility. We aimed at investigating this risk. CNS were isolated from 260 of 1461 allograft tissue grafts and compared with 384 consecutive clinical isolates from a general orthopedic population (258 patients). The CNS were identified and examined for their susceptibility to nine antibiotics used in routine practice. Staphylococcus epidermidis was the most commonly identified (35%) and the most resistant species of the allograft isolates. Comparing the overall antibiotic susceptibility patterns, clinical pathogens were significantly more resistant to six of the nine antibiotics (p < 0.01), namely penicillin, oxacillin, erythromycin, clindamycin, ofloxacin, and gentamicin. In conclusion, massive allograft infection is a well-known life-threatening surgical risk. However, we did demonstrate that allograft-related in contrast to orthopedic clinics-related CNS, are susceptible to commonly used first and second line antibiotics.