History of Soft-Tissue Allografts in Orthopedics

Abstract

Experimentation with soft-tissue allografts has been reported for over 100 years. Gluck described the successful transplantation of an Achilles tendon in a chicken in 1881. Subsequent animal work with tendon and fascia transplantation continued in the early 1900s. The first attempt at preservation prior to implantation was reported in 1918. A case of human tendon allografting was reported in 1923 involving the use of an entire patella with its attached tendons. Successful fascial allograft use in humans was noted in 1927. A large amount of experimental and clinical work in flexor tendon replacement of the hand was performed in the 1960s and 1970s. However, such application was curtailed in the 1980s. Allograft tissue for anterior cruciate ligament reconstruction has seen an enormous amount of use in the last 10 years. Numerous reports of ACL allograft selection, processing and preservation, mechanical properties, rejection phenomenon, and clinical results are in the literature. Early use has been encouraging, although a possible trend toward late failure is noted. Meniscal allografts have also been used and have shown limited clinical success. The use of allograft tissue in other joints has also been reported. The concomitant rise in allograft bone and cartilage transplantation is noted, along with the development of tissue banks. Although many questions remain unanswered with respect to soft-tissue allografts, there is clearly a role for their continued use in orthopedic surgery.