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Consideration of religious sentiments while selecting a biological product for knee arthroscopy

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



There is an increasing use of various synthetic and biological products in orthopaedics. The use of a biological product can be a major area of concern for patients of various cultures/religions. The purpose of this work is to study various restrictions in different faiths and their compatibility with available products focused on cartilage repair.


A systematic search in several databases, CINAHL, EMBASE, Global health, PubMed, MEDLINE and the Cochrane collaboration, was performed to find out various religious beliefs of some major religions regarding the use of animal products. Hindu, Muslim, Christian, Jewish and Buddhist faiths were studied to find out whether animal-derived surgical implants are permitted. Major religious scholars were asked about their opinions, and guidelines related to human/religious ethics were evaluated. A market survey was carried out to find out biological contents of various products and their compatibility.


Jews and Muslims have religious restrictions for porcine products, while Hindus reject bovine products. Vegetarian Hindus reject usage of any animal product. Most Christians do not have any restrictions except those who follow vegetarian dietary regulations. Though there is no prohibition for the use of animal products in Buddhism, a code of non-violence to animals is being followed. However, difference of opinion exists about interpretation of these dietary guidelines for surgical usage amongst various scholars.


Products of biological origin have a definite restriction for various religions, with few exceptions. Surgeons should know the source of the product and should be aware of the basic requirements of the patient’s faith. Patient should be informed about the source of the product and alternative if available, and an informed consent may be considered.

Level of evidence

Type of study, Level V.

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  1. Food in accord with halakha (Jewish law) is termed kosher in English.


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We are thankful to Mr. A I Saiyad, Chairman, Wakf Board, Government of Gujarat, India for providing us the religious viewpoints of Muslim community. We are also thankful to Shashtri Jnanprakash Swami, MA (Indian Philosophy & World Religion), Vedantacharya (Sanskrut University—Varanasi), Trustee, Satsang Shiksha Parishad, Swaminarayan Gurukul, Gandhinagar, India for providing us analysis of Hindu beliefs.

Conflict of interest

Authors declare that there is no conflict of interests. No financial support or grant was obtained in preparation of this manuscript. Third author is a consultant for Sanofi Genzyme and Piramal Healthcare.


(1) The chapter is written with a purpose of informing clinicians and industry about various religious sentiments and possible restrictions. (2) This information may help clinicians and industry to avoid any complication arising after use of a particular product in a strict religious patient. (3) Basic religious guidelines have been drawn from various sources, as complete guidelines for each religion are out of scope of this study. (4) Utmost care has been taken to ascertain the correct source of each product. But still product tables are for reference purpose only. There may be a case where modification of the source has been done by a particular company. (5) In no way, the list is complete for all the products. There might be instances when some of the products have been missed. (6) Even though authors tried to study all products available in market, there were instances when details of some of the products could not be found. (7) In no way, it is intended to harm or disrespect any product or religion. (8) Clinicians and Industry are advised to study each case individually and use best practice.

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Correspondence to Deepak Goyal.

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Goyal, D., Goyal, A. & Brittberg, M. Consideration of religious sentiments while selecting a biological product for knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 21, 1577–1586 (2013).

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