Biology of Allograft Incorporation
Section snippets
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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Cited by (43)
A review on biomaterials-based scaffold: An emerging tool for bone tissue engineering
2023, Materials Today CommunicationsCitation Excerpt :Traditional surgical treatment may result in infection, inflammation, and pain [3]. An autograft that comprises various components including calcified bone matrix, bone cells, macrophages and fibroblasts represents a transplant, which supports and heals the defective site through bone regeneration [4]. Healthy bone tissue harvested from different areas of the body for autograft transplantation results in a second defective site in the area where harvesting was done.
FDA-approved bone grafts and bone graft substitute devices in bone regeneration
2021, Materials Science and Engineering CCitation Excerpt :Another downside, is the body's host inflammatory response encapsulates the graft in fibrous tissue, making it more difficult for the graft to integrate [22,94]. A cortical allogenic graft is stronger than the cancellous autograft and can be used in structural or load-bearing areas of the body [115]. They also can be used to fill large defects.
Anterior Cruciate Ligament Reconstruction Graft Preference Most Dependent on Patient Age: A Survey of United States Surgeons
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Geographically, our multivariable results are similar to those found in the MOON study, with a higher preference for hamstring autograft in the West, Pacific, and Mid-Atlantic regions and a stronger BTB preference in the Northeast, Southeast, Midwest, and Southwest.13 Approximately 20% of ACLRs involve allografts.39 The most common options include Achilles, tibialis anterior or posterior, hamstring, and BTB.
Supercritical Carbon Dioxide–Sterilized Bone Allograft in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic Evaluation
2018, Arthroscopy - Journal of Arthroscopic and Related SurgeryFresh osteochondral allotransplants: Outcomes, failures and future developments
2017, InjuryCitation Excerpt :Allograft viability decreases with storing time, particularly after 14 days, and transplantation should usually occur within 28 days [3,4]. After blood transfusion, bone is the most common transplanted tissue and in recent years, there has been a significant increase, up to 500%, in FOCA transplantation procedures in the United States [5,6]. Indications for FOCA of the knee include full thickness articular cartilage defects of 1 cm2 or larger.