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What tissue bankers should know about the use of allograft tendons and cartilage in orthopaedics

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Abstract

Tendon and osteochondral allograft are key requirements for reconstructive orthopaedic surgery. Their successful use has been published repeatedly, however, they are associated with potential significant problems, which both patients and surgeons should be aware of. This review highlights the advantages and disadvantages associated with the clinical use of both tendon and osteochondral allograft. Particular emphasis is paid to graft immunogenicity, viability, incorporation and disease transmission, with specific examples from the literature illustrating each point.

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References

  • Arnoczky SP, Warren RF, Ashlock MA (1986) Replacement of the anterior cruciate ligament using a patellar tendon allograft. An experimental study. J Bone Joint Surg Am 68(3):376–385

    CAS  PubMed  Google Scholar 

  • Aubin PP, Cheah HK, Davis AM, Gross AE (2001) Long-term followup of fresh femoral osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res no. 391 Suppl, p S318–S327

  • Baer GS, Harner CD (2007) Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med 26(4):661–681

    Article  PubMed  Google Scholar 

  • Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM, Skinner JA, Pringle J (2003) A prospective randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85(2):223–230

    Article  CAS  PubMed  Google Scholar 

  • Bugbee WD, Khadivi B (2004) Fresh osteochondral allografting in the treatment of osteonecrosis of the knee. Read at the annual meeting of the American academy of orthopaedic surgeons; Mar 10–14; San Francisco, CA

  • Busam ML, Rue JP, Bach BR Jr (2007) Fresh-frozen allograft anterior cruciate ligament reconstruction. Clin Sports Med 26(4):607–623

    Article  PubMed  Google Scholar 

  • Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB (2003) Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy 19(5):453–462

    PubMed  Google Scholar 

  • Chu CR, Convery FR, Akeson WH, Meyers M, Amiel D (1999) Articular cartilage transplantation. Clinical results in the knee. Clin Orthop Relat Res no. 360, pp 159–168

  • DiStefano V (1993) Anterior cruciate ligament reconstruction. Autograft or allograft? Clin Sports Med 12(1):1–11

    CAS  PubMed  Google Scholar 

  • Eastlund T (2006) Bacterial infection transmitted by human tissue allograft transplantation. Cell Tissue Bank 7(3):147–166

    Article  PubMed  Google Scholar 

  • Emmerson BC, Gortz S, Jamali AA, Chung C, Amiel D, Bugbee WD (2007) Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med 35(6):907–914

    Article  PubMed  Google Scholar 

  • Friedlaender GE (1983) Immune responses to osteochondral allografts. Current knowledge and future directions. Clin Orthop Relat Res no. 174, pp 58–68

  • Gianotti SM, Marshall SW, Hume PA, Bunt L (2008) Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 2008 Oct 1 [Epub ahead of print]

  • Gibbons MJ, Butler DL, Grood ES, Bylski-Austrow DI, Levy MS, Noyes FR (1991) Effects of gamma irradiation on the initial mechanical and material properties of goat bone-patellar tendon-bone allografts. J Orthop Res 9(2):209–218

    Article  CAS  PubMed  Google Scholar 

  • Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13(3):213–221

    Article  PubMed  Google Scholar 

  • Gortz S, Bugbee WD (2006) Allografts in articular cartilage repair. J Bone Joint Surg Am 88(6):1374–1384

    PubMed  Google Scholar 

  • Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M (1996) Allograft versus autograft anterior cruciate ligament reconstruction: 3- to 5-year outcome. Clin Orthop Relat Res 324:134–144

    Google Scholar 

  • Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2000) Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med Sci Sports Exerc 32(8):1472–1479

    Article  CAS  PubMed  Google Scholar 

  • Jackson DW, Grood ES, Arnoczky SP, Butler DL, Simon TM (1987) Freeze dried anterior cruciate ligament allografts. Preliminary studies in a goat model. Am J Sports Med 15(4):295–303

    Article  PubMed  Google Scholar 

  • Jackson DW, Windler GE, Simon TM (1990) Intraarticular reaction associated with the use of freeze-dried ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med 18(1):1–10

    Article  CAS  PubMed  Google Scholar 

  • Jackson DW, Grood ES, Goldstein JD, Rosen MA, Kurzweil PR, Cummings JF, Simon TM (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21(2):176–185

    Article  CAS  PubMed  Google Scholar 

  • Jamali AA, Hatcher SL, You Z (2007) Donor cell survival in a fresh osteochondral allograft at twenty-nine years. A case report. J Bone Joint Surg Am 89(1):166–169

    Article  PubMed  Google Scholar 

  • Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89(10):2105–2112

    Article  PubMed  Google Scholar 

  • Krych AJ, Jackson JD, Hoskin TL, Dahm DL (2008) A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. Arthroscopy 24(3):292–298

    PubMed  Google Scholar 

  • Lexer E (1908) Substitition of whole or half joints from freshly amputated extremeties by free plastic operations. Surg Gynecol Obstet 6:601–607

    Google Scholar 

  • Lynn AK, Yannas IV, Bonfield W (2004) Antigenicity and immunogenicity of collagen. J Biomed Mater Res B Appl Biomater 71(2):343–354

    Article  CAS  PubMed  Google Scholar 

  • Mankin HJ, Fogelson FS, Thrasher AZ, Jaffer F (1976) Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med 294(23):1247–1255

    CAS  PubMed  Google Scholar 

  • Marrale J, Morrissey MC, Haddad FS (2007) A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15(6):690–704

    Article  PubMed  Google Scholar 

  • McCulloch PC, Kang RW, Sobhy MH, Hayden JK, Cole BJ (2007) Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up. Am J Sports Med 35(3):411–420

    Article  PubMed  Google Scholar 

  • McDermott I, Thomas NP (2005) Tendon allografts in the knee. Knee 12(6):401–404

    PubMed  Google Scholar 

  • McDermott ID, Thomas NP, Poniatowski S, Warwick RM (2006) Soft tissue allografts in the knee: a survey of UK usage and a report of a combined user/provider collaborative group. Knee 13(1):72–75

    Article  PubMed  Google Scholar 

  • Moore DR, Cain EL, Schwartz ML, Clancy WG Jr (2006) Allograft reconstruction for massive irreparable rotator cuff tears. Am J Sports Med 34(3):392–396

    Article  PubMed  Google Scholar 

  • Murphy JM, Fink DJ, Hunziker EB, Barry FP (2003) Stem cell therapy in a caprine model of osteoarthritis. Arthritis Rheum 48(12):3464–3474

    Article  PubMed  Google Scholar 

  • Park DY, Chung CB, Bugbee WD (2006) Fresh osteochondral allografts for younger, active individuals with osteoarthrosis of the knee. Read at the symposium of the international cartilage repair society; Jan 8–11; San Diego, CA

  • Poehling GG, Curl WW, Lee CA, Ginn TA, Rushing JT, Naughton MJ, Holden MB, Martin DF, Smith BP (2005) Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy 21(7):774–785

    Article  PubMed  Google Scholar 

  • Prodromos C, Joyce B, Shi K (2007) A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15(7):851–856

    Article  PubMed  Google Scholar 

  • Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bauwhede BJ, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 36(2):235–246

    Article  PubMed  Google Scholar 

  • Shino K, Kawasaki T, Hirose H, Gotoh I, Inoue M, Ono K (1984) Replacement of the anterior cruciate ligament by an allogeneic tendon graft. An experimental study in the dog. J Bone Joint Surg Br 66(5):672–681

    CAS  PubMed  Google Scholar 

  • Shino K, Inoue M, Horibe S, Nagano J, Ono K (1988) Maturation of allograft tendons transplanted into the knee. An arthroscopic and histological study. J Bone Joint Surg Br 70(4):556–560

    CAS  PubMed  Google Scholar 

  • Strickland SM, MacGillivray JD, Warren RF (2003) Anterior cruciate ligament reconstruction with allograft tendons. Orthop Clin North Am 34(1):41–47

    Article  PubMed  Google Scholar 

  • Stringham DR, Pelmas CJ, Burks RT, Newman AP, Marcus RL (1996) Comparison of anterior cruciate ligament reconstructions using patellar tendon autograft or allograft. Arthroscopy 12(4):414–421

    Article  CAS  PubMed  Google Scholar 

  • Tom JA, Rodeo SA (2002) Soft tissue allografts for knee reconstruction in sports medicine. Clin Orthop Relat Res no. 402, pp 135–156

  • Vangsness CT Jr, Garcia IA, Mills CR, Kainer MA, Roberts MR, Moore TM (2003) Allograft transplantation in the knee: tissue regulation procurement, processing, and sterilization. Am J Sports Med 31(3):474–481

    PubMed  Google Scholar 

  • Wang S, Zinderman C, Wise R, Braun M (2007) Infections and human tissue transplants: review of FDA MedWatch reports 2001–2004. Cell Tissue Bank 8(3):211–219

    Article  PubMed  Google Scholar 

  • Williams SK, Amiel D, Ball ST, Allen RT, Wong VW, Chen AC, Sah RL, Bugbee WD (2003) Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. J Bone Joint Surg Am 85-A(11):2111–2120

    PubMed  Google Scholar 

  • Zelle BA, Brucker PU, Feng MT, Fu FH (2006) Anatomical double-bundle anterior cruciate ligament reconstruction. Sports Med 36(2):99–108

    Article  PubMed  Google Scholar 

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Correspondence to Alan Getgood.

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Getgood, A., Bollen, S. What tissue bankers should know about the use of allograft tendons and cartilage in orthopaedics. Cell Tissue Bank 11, 87–97 (2010). https://doi.org/10.1007/s10561-009-9129-0

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  • DOI: https://doi.org/10.1007/s10561-009-9129-0

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