The Use of Allografts in Sports Medicine

In the last decade musculoskeletal allograft usage has more than doubled. In sports medicine, allografts for meniscal and ligament reconstruction have been used as an integral component in the surgeon's armamentarium to treat knee, hip, elbow and shoulder disorders. Cartilage replacement remains problematic because cryopreservation only preserves surface cells. Fresh osteochondral allografts for cartilage problems have been used to overcome the preservation issues but are of concern for safety reasons and this chapter describes how minimally processed grafts may pose risks. Other issues relate to the need for size matching between allograft and recipient, and the essential aspects relating to measuring surgical outcomes both from the point of view of the type of graft and of the surgical technique to use. For instance, meniscus deficiency accelerates the onset of osteoarthritis and meniscus transplantation is indicated for knees with associated minimal articular cartilage degeneration, but may be contraindicated in knees with uncorrected malalignment. Osteochondral allograft tissue is used to repair a substantial injury or diseased segment of a joint, whereas chondrocyte implantation has been used for treatment of articular cartilage defects in specific small areas of the knee articular cartilage surface. Tendon allografts are commonly used for ligament reconstruction in the knee but surgical repair techniques vary and can be dependent on the type of allograft or autograft tendon or ligament selected. Improvements in allograft processing treatments, human-derived products evolving from stem cell technology, tissue engineering, and biomaterials have tremendous potential to lead to new methods to treat orthopaedic soft tissue injuries.