Allografts for Ligament Reconstruction: Where Are We Now?

The American Journal of Orthopedics. 2016 November;45(7):446-452

November 10, 2016 | The American Journal of Orthopedics

Frank B. Wydra ; MD; Philip J. York ; MD; Christopher R. Johnson; Lorenzo Silvestri ; MD

The use of musculoskeletal allografts by orthopedic surgeons continues to rise. The process of procuring and sterilizing allografts is evolving with much consideration to limiting the spread of infectious diseases and preserving tissue integrity. Research involving the application of allografts, particularly for ligament repair, is quite active, necessitating an update for the practicing orthopedist. Avoiding donor site morbidities is one of the most commonly cited advantages of allografts over autografts. There is controversy amongst studies for allografts in terms of their biological incorporation and clinical outcomes compared to autografts. This article focuses on reviewing the most current literature and usage of allograft tissue for ligamentous reconstruction amongst orthopedic surgeons today. It includes an in-depth analysis of the current processing, handling, and safety standards employed today, in addition to the advantages and disadvantages of allograft use.

Discussion

Musculoskeletal allografts are gaining popularity for ligamentous reconstruction as their safety and efficacy continue to improve. With the great majority of tissue banks being accredited by the AATB and specific regulations such as NAT screening becoming common practice, infection rates and transmission of diseases have become incredibly rare. However, a thorough consideration needs to be taken into account when choosing between autograft and allograft on a case-by-case basis (Table).

Although the incidence of donor site complications is low with autografts, there are inherent risks, such as harvest site hyperesthesia, persistent numbness, cosmetic dissatisfaction, pain, weakness, functional implications, and unsuitability of the harvested graft. While it may appear that allografts may obviate donor site morbidity, one must consider the reduced potential for the donor tissue to incorporate into the host. Several studies have suggested that incorporation into the host tissue is inferior and slower for allografts. With this knowledge, factors such as clinical outcomes, future expectations, rehabilitation protocol, and individual patient characteristics all need to be considered when selecting the source of the tissue to be transplanted. Given that there is a growing need for availability of allografts, a well-rounded understanding of the biologic and physiologic aspects of the transplanted tissues is imperative. Future research will need to focus on improving the rate and quality of the biological incorporation of the transplanted graft into the host while eliminating the risk of disease transmission and infection.

References

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