Biology of Allograft Incorporation

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Bone allograft

Although not unique to orthopedic sports medicine, a discussion of bone allograft is warranted, given the frequency of its use in all areas of orthopedic surgery. Bone is the second most commonly transplanted tissue after blood transfusion.9 It is estimated that there are approximately 500,000 bone grafting procedures performed annually in the United States, with approximately 200,000 of these involving allografts.9

The process of bone graft incorporation (Table 1) has been described in terms of

Tendon allograft

Tendon allograft is one of the most commonly used tissues in sports medicine procedures. Grafts are available from several sources, including Achilles tendon, hamstring, and patellar tendon. Although tendon grafts have been applied to a variety of surgical procedures, this discussion focuses on anterior cruciate ligament (ACL) reconstruction.

There has been a great deal of study evaluating the incorporation and remodeling of implanted tendon allograft.37, 38 These studies have involved animal

Meniscal allograft

Unlike bone and tendon grafts, no acceptable autograft option exists to replace meniscal tissue. This problem underscores the importance of allograft tissue as the only acceptable option for meniscal replacement.

Owing to the unique function of the meniscus, correct size and shape matching between patient and donor is important in achieving good outcomes. Once a correct match has been made, meniscal tissue is implanted into the host via both soft tissue attachment and, in some cases, bone

Osteochondral allografts

Osteochondral allografts are primarily used to repair large defects in the articular surface of the knee related to trauma or osteochondritis dissecans (OCD). It is typically considered a salvage procedure for lesions that are too large to be amenable to other modes of treatment63, 64 or in cases where other treatments have failed. Lesions treated by osteochondral allografting are usually large (>4 cm2), unifocal, and traumatic in nature, rather than degenerative.63 The typical patient is young

Summary

The use of allograft tissues in orthopedic sports medicine has increased dramatically in recent years. With tissue banks and safety guidelines, allograft tissue implantation has emerged as a safe and effective alternative to autograft procedures. In many instances, no acceptable autograft alternatives exist, and allograft tissue implantation is the only option available.

The successful incorporation of any allograft depends on several factors that must be identified and understood by the

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