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Demineralized Bone Matrix Shows Promise for Reducing ACL Tunnel Widening
1. Demineralized Bone Matrix
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder surgery
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA
3. Demineralized Bone Matrix
• Allograft bone with inorganic mineral removed, leaving only organic
collagen matrix
• Increased osteoinductivity
– Exposed growth factors (BMP’s)
• Requires a carrier
• Many clinical studies showing efficacy but each product has different
characteristics
4. DBM
Osteoinduction
Carrier Terminal
Product Distributor Assay – Test
% DBM (by wt) Sterility?
Every Lot?
RPM Yes In Vivo
StimuBlast Arthrex
(36) E-Beam Yes
Wright CaSO4 Yes In Vitro
AlloMatrix
Medical (40) E-Beam Yes
Na Hyaluronate In Vivo / In Vitro
DBX Synthes No
(32) Yes
Glycerol In Vivo
Grafton Medtronic No
(17) No
5. Reverse Phase Medium (RPM)
• Mod Pluronic F127 (Poloxamer PPO PEO)
5 min
• More viscous at body temp
• Resists irrigation, can use arthroscopically
• Permeable to blood, resorbed
• Metabolized readily
RPM Glycerol
8. Etiology of ACL Tunnel Widening
Biological Mechanical
• Synovial fluid propagation • Graft position
• Increased cytokine levels • Fixation method
• Sterilization methods
• Implant material
• Graft type
• Graft donor
Maak et al. JAAOS. 2010; 18: 695-706.
Fauno et al. Arthoscopy. 2005; 21(11): 1337-41.
Wilson et al. AJSM. 2004; 32(2): 543-9.
Darabos et al. Knee Surg Sports Traum Arthrsc; 2011; 19: S36-46.
Rodeo et al. AJSM. 2006; 34(11): 1790-800.
9. Potential Consequences
• Delaying incorporation of the soft tissue graft
into bone
• Decreasing graft stability
• Causing difficulty with future revision surgery