Biomechanical strength of deep-frozen versus lyophilized large cortical allografts

OBJECTIVE: To compare biomechanical strength of deep-frozen versus lyophilized large cortical allografts. DESIGN: In vivo transplantation studies performed in tibia of adult cats using 4 cm deep-frozen and lyophilized, gamma-irradiated allografts to bridge large cortical defect model. BACKGROUND: Bridging large cortical bone defect is a challenging problem. Options include autografts, allografts, bioceramics and prostheses. Allografts provide a suitable option. METHODS: Forty mature cats were used. A large defect (4 cm) was created in mid-diaphysis of right tibia. In 16 cats, cortical defect was reconstructed using deep-frozen allografts (-80 degrees C) with intra-medullary rodding. In another 16 cats, lyophilized, gamma-irradiated allografts were used. Observation periods include 8, 12, 16 and 24 weeks. The specimens were procured together with unoperated legs as controls. Mechanical testing was performed using a materials testing machine with torsion test device of up to 500 Nm at speed of 0.18 rpm. Parameters studied included maximum torque, torsional stiffness and energy of absorption. RESULTS: Deep-frozen allografts did not reach 100% strength, achieving only 64% at 6 months. In marked contrast, lyophilized allografts were significantly weaker with only 12% maximum torque strength at 6 months. Lyophilized allografts were significantly weaker than deep-frozen allografts in all observation periods (p < 0.05). CONCLUSION: Deep-frozen allografts did not reach 100% normal strength and were significantly weaker than non-vascularised autografts. Lyophilized allografts were significantly weaker than deep-frozen allografts. RELEVANCE: For the reconstruction of massive cortical bone defects, only deep-frozen cortical allografts should be used. Lyophilized allografts are not suitable.