Clinical applications of allografts in foot and ankle surgery

  • Pedro DinizEmail author
  • Jácome Pacheco
  • Miguel Flora
  • Diego Quintero
  • Sjoerd Stufkens
  • Gino Kerkhoffs
  • Jorge Batista
  • Jon Karlsson
  • Hélder Pereira



The purpose of this review is to systematically analyse current literature on the use of allografts in the surgical treatment of foot and ankle disorders in adult patients. Based on this study, we propose evidence-based recommendations.


The database for PubMed was searched for all published articles. No timeframe restrictions were applied. Clinical studies eligible for inclusion met the following criteria: performed on patients over 18 years old; subject to surgical treatment of foot and ankle disorders; with report on the outcome of the use of allografts; with a report and assessment of pain and function, or equivalent; minimum follow-up of 1 year was required. Two reviewers independently screened and selected studies for full-text analysis from title and abstract. 107 studies were included from 1113 records. Studies were grouped according to surgical indications into ten categories: musculoskeletal tumours (n = 16), chronic ankle instability (n = 15), ankle arthritis (n = 14), osteochondral lesions of the talus (n = 12), Achilles tendon defects (n = 11), other tendon defects (n = 9), fusions (n = 9), fractures (n = 8), hallux rigidus (n = 3) and other indications (n = 10).


Most studies displayed evidence level of IV (n = 57) and V (n = 39). There was one level I, one level II and nine level III studies. Most studies reported allografting as a good option (n = 99; 92.5%). Overall complication rate was 17% (n = 202).


Fair evidence (Grade B) was found in favour of the use of allografts in lateral ankle ligament reconstruction or treatment of intra-articular calcaneal fracture. Fair evidence (Grade B) was found against the use of allogeneic MSCs in tibiotalar fusions.

Level of evidence



Allografts Foot and ankle surgery Chronic ankle instability Calcaneal fractures Ankle arthritis Ankle fusion Osteochondral lesions of the talus Tendons 



Chronic ankle instability


Bipolar fresh osteochondral allograft


Range of motion


Platelet-rich plasma


Mesenchymal stem cells


Osteochondral lesions of the talus


Author contributions

PD designed the systematic review protocol, screened and selected studies, extracted and analyzed data, drafted the manuscript. JP screened and selected studies, extracted and analyzed data. MF, SS, GK and JB revised the manuscript. DQ contributed the anatomic dissection pictures and insights on allografts technology. HP and JK designed the systematic review protocol, supervised the selection of studies and revised the manuscript. All authors read and approved the final manuscript.


No external fundings were received by any of the authors for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the Research and Ethical Committees of our Institution. This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryHospital de Sant’AnaParedePortugal
  2. 2.Institute for Bioengineering and Biosciences, Instituto Superior TécnicoUniversidade de LisboaLisbonPortugal
  3. 3.FisiogasparLisbonPortugal
  4. 4.Department of Applied Anatomy in Physiatry Orthopedics and Traumatology of the Chair of Normal Anatomy, Faculty of Medical SciencesNational University of RosarioRosarioArgentina
  5. 5.Department of Orthopaedic SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  6. 6.Clinical Department Club Atletico Boca JunioresCAJB-Centro ArtroscopicoBuenos AiresArgentina
  7. 7.Department of OrthopaedicsUniversity of GothenburgGothenburgSweden
  8. 8.Orthopaedic DepartmentCentro Hospitalar Póvoa de VarzimVila do CondePortugal
  9. 9.Ripoll y De Prado Sports Clinic: FIFA Medical Centre of ExcellenceMurcia-MadridSpain
  10. 10.University of Minho, ICVS/3B’s-PT Government Associate LaboratoryBraga/GuimarãesPortugal

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