What are the issues with allograft?
Since allografts are purchased, and not harvested from the patient (causing further damage), it seems an easy decision to use them to reconstruct torn cruciate ligaments. But there are issues...
Firstly they have a cost. Secondly the tissue bank from which they are purchased needs to be extremely vigilant about making the tissue safe to transplant while not destroying its important properties.
Peer-reviewed papersQuote from peer-reviewed paper:
"....The advantages of allografts are no donor site morbidity, a shorter operation and less painful initial recovery. The disadvantages are slower graft incorporation and concern about higher rupture rates in some young highly active groups, concern about disease transmission and increased cost....The concern about a higher re-rupture rate may not be warranted...."
Citation: Mistry H, Metcalfe A, Colquitt J, Loveman E, Smith NA, Royle P, Waugh N. Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective. Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1782-1790. doi: 10.1007/s00167-019-05436-z. Epub 2019 Mar 14. PMID: 30874836; PMCID: PMC6541574.
Allograft or autograft?
The decision to choose allograft is not an easy one, and the use of allograft for the first reconstruction procedure is a bit controversial.
Most surgeons nowadays would tend to use an autograft in the first instance, as the chances of a successful procedure are higher, although an allograft might be the first choice for a second or third procedure if there are no more tendons available in that patient to harvest.
Peer-reviewed papersQuote from peer-reviewed paper:
"....There may be situations where a satisfactory autograft is not available, for example in multi-ligament injury where available autografts will be used for other reconstructions. Also, in the setting of revision ACL reconstruction, there are various considerations regarding graft choice, due to tunnel size or position, previous usage of other grafts, and reconstructions in the other leg, that may mean that allografts would be preferred to autografts...."
Citation: Mistry H, Metcalfe A, Colquitt J, Loveman E, Smith NA, Royle P, Waugh N. Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective. Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1782-1790. doi: 10.1007/s00167-019-05436-z. Epub 2019 Mar 14. PMID: 30874836; PMCID: PMC6541574.
Tissue banks
Although transmission of infection is a risk with any allograft, most are purchased from accredited tissue banks which adhere to stringent regulation, although standards might vary from country to country.
Very occasionally an allograft might be taken from a family member, such as a parent for a child, and in this case there is no tissue bank involved as the material does not have to be stored.
Forum discussions
- please give advice an graft selection, im freaking out.
A long discussion about graft choice.