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The use of allograft tissue in posterior cruciate, collateral and multi-ligament knee reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Currently both autograft and allograft tissues are available for reconstruction of posterior cruciate, collateral and multi-ligament knee injuries. Decision-making is based on a complex interplay between anatomical structures, functional bundles and varying biomechanical requirements. Despite theoretically better biological healing and reduced risk of disease transmission autografts are associated with donor site morbidity as well as being limited by size and quantity. The use of allografts eliminates donor-site morbidity but raises cost and issues of clinical effectiveness. The purpose of this paper is to review current concepts and evidence for the use of allografts in primary posterior cruciate, collateral and multi-ligament reconstructions.

Methods

A narrative review of the relevant literature was conducted for PCL, collateral ligament and multi-ligament knee reconstruction. Studies were identified using a targeted and systematic search with focus on recent comparative studies and all clinical systematic reviews and meta-analyses. The rationale and principles of management underpinning the role of allograft tissue were identified and the clinical and functional outcomes were analysed. Finally, the position of postoperative physiotherapy and rehabilitation was identified.

Results

The review demonstrated paucity in high quality and up-to-date results addressing the issue especially on collaterals and multi-ligament reconstructions. There was no significant evidence of superiority of a graft type over another for PCL reconstruction. Contemporary principles in the management of posterolateral corner, MCL and multi-ligament injuries support the use of allograft tissue.

Conclusion

The present review demonstrates equivalent clinical results with the use of autografts or allografts. It remains, however, difficult to generate a conclusive evidence-based approach due to the paucity of high-level research. When confronted by the need for combined reconstructions with multiple grafts, preservation of synergistic muscles, and adapted postoperative rehabilitation; the current evidence does offer support for the use of allograft tissue.

Level of evidence

IV.

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Authors and Affiliations

  1. Steadman Philippon Research Institute, Vail, CO, USA

    Marc Jacob Strauss

  2. Orthopaedic Division, Oslo University Hospital and University of Oslo, Oslo, Norway

    Marc Jacob Strauss

  3. OSTRC, Norwegian School of Sports Sciences, Oslo, Norway

    Marc Jacob Strauss

  4. Hospital Cuf Descobertas, Rua Mário Botas, Lisbon, Portugal

    Ricardo Varatojo

  5. University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK

    Tarek Boutefnouchet, Lior Laver & Tim Spalding

  6. Department of Orthopaedics, Clinica Humanitas Castelli, Via Mazzini, 11, Bergamo, Italy

    Vincenzo Condello

  7. Sahlgrenska University Hospital, Mölndal, Sweden

    Kristian Samuelsson

  8. Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Kristian Samuelsson

  9. Hospital de la Santa Creu I Sant Pau, Universitat Autònoma Barcelona, Barcelona, Spain

    Pablo E. Gelber

  10. ICATME-Hospital Universitari Dexeus, Universitat Autònoma Barcelona, Barcelona, Spain

    Pablo E. Gelber

  11. Orthopaedic Department, Città di Parma Clinic, Piazzale Athos Maestri 5, Parma, Italy

    Paolo Adravanti

  12. Lovisenberg Diaconal Hospital, Oslo, Norway

    Sigbjorn Dimmen

  13. Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden

    Karl Eriksson

  14. Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium

    Peter Verdonk

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Institution: work performed as a part of the ESSKA Arthroscopy Committee.

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Strauss, M.J., Varatojo, R., Boutefnouchet, T. et al. The use of allograft tissue in posterior cruciate, collateral and multi-ligament knee reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 1791–1809 (2019). https://doi.org/10.1007/s00167-019-05426-1

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