Cells, soluble factors and matrix harmonically play the concert of allograft integration
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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.
KeywordsAllograft Meniscus Tendon Cartilage Integration Cytokines Inflammation Irradiation Deep-freezing Scaffold
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.
This article does not contain any studies with human participants performed by any of the authors.
- 9.Bhatia S, Bell R, Frank RM, Rodeo SA, Bach BR Jr, Cole BJ, Chubinskaya S, Wang VM, Verma NN (2012) Bony incorporation of soft tissue anterior cruciate ligament grafts in an animal model: autograft versus allograft with low-dose gamma irradiation. Am J Sports Med 40(8):1789–1798CrossRefGoogle Scholar
- 40.Hoburg A, Keshlaf S, Schmidt T, Smith M, Gohs U, Perka C, Pruss A, Scheffler S (2011) Fractionation of high-dose electron beam irradiation of BPTB grafts provides significantly improved viscoelastic and structural properties compared to standard gamma irradiation. Knee Surg Sports Traumatol Arthrosc 19(11):1955–1961CrossRefGoogle Scholar
- 55.Knauper V, Will H, Lopez-Otin C, Smith B, Atkinson SJ, Stanton H, Hembry RM, Murphy G (1996) Cellular mechanisms for human procollagenase-3 (MMP-13) activation: evidence that MT1-MMP (MMP-14) and gelatinase a (MMP-2) are able to generate active enzyme. J Biol Chem 271:17124–17131CrossRefGoogle Scholar
- 63.McCormick F, Harris JD, Frank RM, Hussey KE, Wilson H, Gupta AK, Abrams GD, Bach BR, Cole BJ (2014) Meniscal allograft transplantation reoperation rates, operative findings, and survival analysis: a review of 200 consecutive transplants at minimum two-year follow-up. Orthop J Sports Med 2(1 Suppl):2325967114S00003PubMedCentralGoogle Scholar
- 70.Pallante AL, Görtz S, Chen AC, Healey RM, Chase DC, Ball ST, Amiel D, Sah RL, Bugbee WD (2012) Treatment of articular cartilage defects in the goat with frozen versus fresh osteochondral allografts: effects on cartilage stiffness, zonal composition, and structure at six months. J Bone Jt Surg Am 94(21):1984–1995CrossRefGoogle Scholar
- 72.Peretti GM, Campo-Ruiz V, Gonzalez S, Randolph MA, Wei Xu J, Morse KR, Roses RE, Yaremchuk MJ (2006) Tissue engineered cartilage integration to live and devitalized cartilage: a study by reflectance mode confocal microscopy and standard histology. Connect Tissue Res 47(4):190–199CrossRefGoogle Scholar
- 86.Tachiiri H, Morihara T, Iwata Y, Yoshida A, Kajikawa Y, Kida Y, Matsuda K, Fujiwara H, Kurokawa M, Kawata M, Kubo T (2010) Characteristics of donor and host cells in the early remodeling process after transplant of Achilles tendon with and without live cells for the treatment of rotator cuff defect–what is the ideal graft for the treatment of massive rotator cuff defects? J Shoulder Elbow Surg 19(6):891–898CrossRefGoogle Scholar
- 95.Wada Y (1993) Meniscal transplantation using fresh and cryopreserved allografts. An experimental study in the genetically defined rat. J Jpn Orthop Assoc 67:677–683Google Scholar