Allografts in Soft Tissue Reconstructive Procedures

Allograft and autograft tissues have proven to be invaluable treatment modalities for patients with a variety of injuries, from athletes with musculoskeletal sports injuries to victims of severe burns to those requiring solid organ transplantation. Skin grafting is a viable treatment in the care of large burns, and the use of allografts in organ transplantation is great in breadth—allograft cardiac, hepatic, and renal components are but a few examples of allograft utility. Allografts have seen considerable clinical success in many soft tissue reconstructive procedures, including anterior cruciate ligament (ACL) reconstruction, one of the most common orthopaedic procedures performed today; estimates indicate that 300,000 ACL reconstructions are performed annually, with approximately 240,000 (80%) performed utilizing autograft tissue and 60,000 (20%) with allograft tissue. The American Academy of Orthopaedic Surgeons asserts that over 5 million musculoskeletal allografts have been allocated to surgeons in the past decade, while the American Association of Tissue Banks reports that the demand for musculoskeletal grafts has grown from approximately 700,000 grafts in 2001 to 1.5 million grafts in 2007. Reasons for increased use of allograft tissue include effective sterilization procedures, organized collection and distribution of tissue, and increased confidence in the overall stability of allografts. The increasing utilization of allograft tissue necessitates a critical review of its regulation, management, and sterilization.