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Allograft for knee ligament surgery: an American perspective

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Allografts are frequently use for ligamentous reconstruction at the knee. In the United States, tissue donation and distribution are highly regulated processes with thorough oversight from private and government entities. Allograft is widely available in the United States and allograft procurement is a large industry with varying procurement, sterilization, processing, and distribution procedures. It is important to understand allograft regulation and processing which may affect graft mechanical properties and biological graft integration.

Methods

English-language literature, United States government and regulatory agency statues pertaining to allograft procurement, distribution, and usage were reviewed and the findings summarized.

Results

During the processing of allograft, multiple factors including sterilization procedures, irradiation, storage conditions, and graft type all affect the biomechanical properties of the allograft tissue. Biological incorporation and ligamentization of allograft does occur, but at a slower rate compared with autograft. For ligamentous reconstruction around the knee, allograft offers shorter operative time, no donor-site morbidity, but has shown an increased risk for graft failure compared to autograft.

Conclusion

This article reviews the regulations on graft tissue within the United States, factors affecting the biomechanics of allograft tissue, differences in allograft tissue choices, and the use of allograft for anterior cruciate ligament reconstruction and multiligamentous knee injury reconstruction.

Level of evidence

V

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA

    Robert Tisherman, Kevin Wilson, Kevin Byrne, Joseph De Groot & Volker Musahl

  2. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

    Alexandra Horvath

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  1. Robert Tisherman
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  2. Kevin Wilson
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  3. Alexandra Horvath
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  4. Kevin Byrne
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  5. Joseph De Groot
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VM conceived of the study, participated in the review process, and helped to draft the manuscript. RT, JDG, KW, KB, and AH carried out the literature review and drafted the manuscript. All authors read and approved the final manuscript.

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Correspondence to Robert Tisherman.

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Tisherman, R., Wilson, K., Horvath, A. et al. Allograft for knee ligament surgery: an American perspective. Knee Surg Sports Traumatol Arthrosc 27, 1882–1890 (2019). https://doi.org/10.1007/s00167-019-05425-2

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