Cells, soluble factors and matrix harmonically play the concert of allograft integration

  • Laura de Girolamo
  • Enrico RagniEmail author
  • Magali Cucchiarini
  • Christian J. A. van Bergen
  • Ernst B. Hunziker
  • Susanna Chubinskaya


Implantation of allograft tissues has massively grown over the last years, especially in the fields related to sports medicine. Beside the fact that often no autograft option exists, autograft related disadvantages as donor-site morbidity and prolonged operative time are drastically reduced with allograft tissues. Despite the well documented clinical success for bone allograft procedures, advances in tissue engineering raised the interest in meniscus, osteochondral and ligament/tendon allografts. Notably, their overall success rates are constantly higher than 80%, making them a valuable treatment option in orthopaedics, especially in knee surgery. Complications reported for allografting procedures are a small risk of disease transmission, immunologic rejection, and decreased biologic incorporation together with nonunion at the graft-host juncture and, rarely, massive allograft resorption. Although allografting is a successful procedure, improved techniques and biological knowledge to limit these pitfalls and maximize graft incorporation are needed. A basic understanding of the biologic processes that affect the donor-host interactions and eventual incorporation and remodelling of various allograft tissues is a fundamental prerequisite for their successful clinical use. Further, the importance of the interaction of immunologic factors with the biologic processes involved in allograft incorporation has yet to be fully dissected. Finally, new tissue engineering techniques and use of adjunctive growth factors, cell based and focused gene therapies may improve the quality and uniformity of clinical outcomes. The aim of this review is to shed light on the biology of meniscus, osteochondral and ligament/tendon allograft incorporation and how collection and storage techniques may affect graft stability and embodiment.

Level of evidence V.


Allograft Meniscus Tendon Cartilage Integration Cytokines Inflammation Irradiation Deep-freezing Scaffold 


Author contributions

LdG, ER, MC, CJAvB, EBH and SC have been involved in drafting the manuscript and revising it critically. All authors read and approved the final manuscript.


No funding has been received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie applicate all’OrtopediaMilanoItaly
  2. 2.Center of Experimental OrthopaedicsSaarland University Medical CenterHomburg/SaarGermany
  3. 3.Department of Orthopedic SurgeryAmphia HospitalBredaThe Netherlands
  4. 4.Departments of Osteoporosis and Orthopaedic SurgeryInselspital (University Hospital)BernSwitzerland
  5. 5.Department of PediatricsRush University Medical CenterChicagoUSA

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