Expanding Use of Donor Tissue in Knee Surgery

Improved quality and safety of allograft (donor) tissue has made it possible to use this tissue for more knee surgeries. Ligament repair and reconstruction tops the list of common uses for allograft tissue. Repair of the meniscus (knee cartilage) and osteochondral (cartilage to bone interface) are also on the rise.

The use of allografts in knee surgery is the focus of this article. The authors review how the tissue is obtained, sterilized, and stored. Risk factors and incidence of infection are discussed. Nucleic acid testing is used to detect HIV and hepatitis C. Proper sterilization is a must to avoid bacterial infection.

Various groups have been set up to help control the quality and safety of allograft tissues. Regulation of the supply is not completely standardized. Some groups such as the American Association of Tissue Banks (AATB) has standards that are voluntary and not mandatory.

Other groups such as the Musculoskeletal Transplant Foundation (MTF) have high standards for screening and selection of donors. They have a perfect record when it comes to infection. There have been no reported cases of infection in more than two million cases of tissue transplantation.

Autografts (patient's own tissue) are still best for competitive athletes who want to get back into action. Patients who can benefit the most from allograft tissue for knee surgery include:

  • Autograft was used in a first surgery; now a
    second operation is needed with graft tissue
  • A large amount of soft tissue is needed for the graft
  • The graft is for an older (less active) adult
  • The patient requires multiple ligament repair at one time

    Surgeons are advised to use only tissue from the American Association of Tissue Banks (AATB). Patient selection is a key factor in the success of tissue transplantation. Specific recommendations for each of the three procedures (ligament, meniscus, osteochondral repair) are offered.



    References: Barton R. Branam, MD, and Darren L. Johnson, MD. Allografts in Knee Surgery. In Orthopedics. November 2007. Vol. 30. No. 11. Pp. 925-929.

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