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This paper will provide information concerning the specifics of allograft use in ACL reconstruction. A detailed discussion of the science of allografts, both technical and theoretical, along with experimental studies will be followed by information concerning graft preparation and the advantages and disadvantages of allografts, as well as a review of the clinical literature surrounding allograft use...
An unusual case of Clostridium perfringens infection after an allograft reconstruction of an extensor mechanism in a multiply revised total knee arthroplasty is reported. The case occurred in an elderly patient with an underlying bleeding dyscrasia who had previously undergone two revision total knee arthroplasties. The patient was treated by open irrigation, debridement, removal of allograft and...
Treatment of osteochondral defects in weight-bearing areas of the knee, especially when they are sizeable and involve considerable subchondral bone loss, is a challenging problem. We report our experience on the use of osteochondral allografts with the MEGA-OATS technique in the management of large osteochondral defects of the knee in young patients.Five patients (3 male and 2 female) were included...
Fractures of the distal femur in the elderly are usually due to low energy ground level fall onto a flexed knee. Pre-existing osteoarthritis and juxta-articular osteopenia in this age group result in high levels of comminution and articular damage at the time of injury, which challenges the management and treatment outcome. Preservation of knee function and early weight bearing should be the objectives...
Supplementary or back-up tibial tunnel fixation of a quadruple semitendinosus–gracilis (STG) graft is often performed when the knee surgeon questions the integrity of intra-tunnel fixation. Back-up fixation devices such as staples however may contribute to increased knee pain and dysfunction. Both primary extra-tunnel and intra-tunnel fixation devices may provide sufficient quadruple STG graft fixation...
Patellar tendon rupture following use of its central third for anterior cruciate ligament (ACL) reconstruction is a rare disabling injury that is technically difficult to repair. We report one case of patellar tendon rupture after harvesting the mid-third for ACL reconstruction. A number of different surgical methods exist for reconstructing patellar tendon ruptures. Here we report a case using a...
Our aim was to evaluate whether a fibrin glue and octyl-cyanoacrylate can promote fixation of meniscal allograft in rabbits. The medial menisci of 18 rabbits were frozen and stored at −73 °C (30 days) and then was allotransplantation and fixed by: GSu (n=6) soft tissue; GFi (n=6) fibrin glue; GCy (n=6) cyanoacrylate. They were evaluated by daily surgery recovery score (4 weeks), gross inspection and...
Large tibial bone defects may cause problems at the time of revision total knee replacement. We report on 15 patients (15 knees) followed at a mean of 5.4 years (33–115 months) who underwent revision total knee replacement for severe tibial bone loss using shaped femoral head allograft and Freeman–Samuelson revision components (Zimmer, Winterthur, Switzerland). The mean American Knee Society Score...
We present a case of chronic disruption of the patellar tendon in a patient with Osteogenesis Imperfecta. This patient was treated with a customized extensor mechanism allograft. Results were excellent at 5years follow up. To our knowledge this treatment has not previously been published in this situation. We present this as a reliable treatment option.
Surgeon recommendation is the primary influence for patients choosing a graft for their ACL reconstruction. However, it is unknown if demographic factors also play a role. We hypothesize that education, age, and living in an urban setting may influence a patient's graft choice. Patients who had an ACL reconstruction from 2005 to 2009 were identified retrospectively, and received a written survey on...
Platelet rich plasma has been promoted as a biologic agent to enhance tissue healing. As a concentration of autologous growth factors, it has gained increased use in musculoskeletal applications.The purpose of this study was to evaluate the effect of intra-operative PRP on patient-reported outcomes 2years after ACL reconstruction with tibialis anterior allograft. Fifty patients who underwent allograft...
Proper treatment of bone loss is essential for the long term durability of revision TKA. However, the method of choice in managing large bone defects is still under debate. We therefore assessed the mid to long term clinical and radiographic results of revision TKA using a fresh frozen femoral head allograft and a standard condylar implant or varus–valgus constrained prosthesis with a diaphyseal-engaging...
Management of patella infera remains a difficult therapeutic endeavor. We report a case of a 21-year-old man, who had development of patella infera and knee flexion contracture after a patella fracture. Patella infera was treated by patellar tendon lengthening and augmentation with a tibialis anterior tendon allograft fixed with bioabsorbable cross-pins. The patient regained an anatomic patellar position...
Post-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring...
This study compared lower extremity EMG activation and sagittal plane kinematics of subjects at a minimum of 2years post-successful ACL reconstruction and rehabilitation during instrumented single leg hop testing.Comparisons were made based on subject responses to the following question, “compared to prior to your knee injury how capable are you now in performing sports activities”? Group 1=very capable,...
To compare autograft with non-irradiated allograft for reconstruction of anterior cruciate ligament.MEDLINE, EMBASE, and Cochrane Library databases, as well as unpublished and ongoing studies were searched through up to 20 July 2013 to identify studies meeting the pre-stated inclusion criteria.A total of 12 studies (n=1167, including 597 patients in the autograft group and 570 patients in the allograft...
The objective of this study was to systematically evaluate the existing literature to compare the biomechanical effects of low dose and high dose gamma irradiation on commonly used ACL allografts.A systematic search was performed in PubMed, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Cochrane Reviews, SCOPUS, and SportDiscus. Nine studies were identified that met the following...
Conduct a prospective randomized study to compare clinical outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendon (HT) allograft or doubled tibialis anterior (TA) allograft. Limited level 1 data exist comparing outcomes of different soft tissue allograft constructs for ACL reconstruction. We hypothesized no difference would exist in the patient reported outcomes...
The aim of this study was to report the short-term clinical and imaging outcomes of lateral meniscus allograft transplantations (LMAT) combined with intra-articular platelet-rich plasma (PRP) injection.Thirty-three patients who had undergone LMAT combined with intra-articular PRP injection were evaluated. The Lysholm, International Knee Documentation Committee (IKDC), Western Ontario and McMaster...
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