Sterilization of allografts for anterior cruciate ligament (ACL) reconstruction has become an important prerequisite to prevent
disease transmission. However, current sterilization techniques impair the biological or mechanical properties of such treated
grafts. Peracetic acid (PAA) has been successfully used to sterilize bone allografts without these disadvantages and does
not impair the mechanical properties of soft tissue grafts in vitro. We asked whether PAA sterilization would influence recellularization,
restoration of crimp length and pattern, and revascularization of ACL grafts during early healing. We used an in vivo sheep
model for open ACL reconstruction. We also correlated the histologic findings with the restoration of anteroposterior stability
and structural properties during load-to-failure testing. PAA slowed remodeling activity at 6 and 12 weeks compared to nonsterilized
allografts and autografts. The mechanical properties of PAA grafts were also reduced compared to these control groups at both
time points. We conclude PAA sterilization currently should not be used to sterilize soft tissue grafts typically used in
ACL reconstruction.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. This
study was funded by research grants of the Charité Research Funds and the Musculoskeletal Transplant Foundation.
Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations
were conducted in conformity with ethical principles of research.