Instructional course 105
The use of musculoskeletal allograft tissue in knee surgery

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Considerations in allograft safety

In most cases of reconstructive knee surgery, the orthopaedic surgeon has a choice between allograft and autograft tissue. Thus, the advantages and disadvantages of both graft options must be carefully weighed before surgery. Allograft tissue is associated with the risk of disease transmission, the potential for immune reaction, increased cost, and delayed graft incorporation. Advantages include decreased operating time, no donor-site morbidity, and increased availability of tissue in complex

Use of allograft tissue in primary ACL reconstruction

A significant amount of research has been devoted to the ACL. Injury of this ligament is common and can be debilitating. It is often associated with instability, particularly in patients who participate in activities that involve twisting and cutting movements. If left untreated, this instability can lead to articular cartilage degeneration and meniscal injury. With over 75,000 performed annually, reconstruction of the ACL is currently the seventh most commonly performed orthopaedic procedure.19

The use of allograft tissue in revision ACL surgery

A small percentage of patients who undergo ACL reconstruction experience failure of the ACL graft and recurrent instability. Reasons for failure include technical error, inadequate graft incorporation, and trauma. Identifying the cause of primary ACL graft failure so that measures can be taken to prevent failure of revision surgery is important. Failed ACL reconstruction can be diagnosed when (1) the patient complains of functional instability with activities of daily living and sports activity

Meniscal allograft transplantation

The meniscus has been shown to contribute to the stability, load transmission, nutrition, and overall function of the knee joint.35, 36, 37 Thus, preservation of the injured meniscus has become the focus of meniscal surgery. Meniscal repair is a successful alternative to meniscectomy in certain patterns of meniscal injury.38, 39 Partial, subtotal, or complete meniscectomy are necessary in certain cases of irreparable tears or significant intrasubstance meniscal degeneration. Without a

Allograft tissue in multiligament injury in the dislocated knee

Knee dislocations are uncommon orthopaedic injuries. Although reports of knee dislocation involving an isolated ACL or PCL injury exist, both of the cruciate ligaments are usually disrupted.63 Associated injuries to the collateral ligaments, menisci, articular cartilage, and neurovascular structures often complicate the management of knee dislocation. Because nonsurgical treatment has been associated with poor outcome,64 the majority of knee dislocations are treated surgically. Relative

Osteochondral allograft

Articular cartilage is remarkably resilient to repetitive mechanical stresses. Once damaged, however, it has a limited capacity to heal. Osteochondral injury can be debilitating, often leading to degenerative joint disease with associated pain, swelling, and mechanical symptoms (locking or catching). Treatment of articular cartilage defects remains a challenging problem. Nonoperative treatment, including protected weight-bearing, activity modification, and nonsteroidal medications, is often

Conclusions

Musculoskeletal tissue grafts are commonly used to treat pathologic conditions of the knee. Histologic and biologic studies have shown that tendon, meniscal, and osteochondral allograft tissues can heal and remodel after implantation. Immune reaction to this tissue does not appear to be clinically significant. Clinical studies suggest that allograft tissue can effectively be used to treat ligamentous injuries, meniscal deficiency, and chondral defects. Most clinical studies to date, however,

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