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Review Use of Allografts in Orthopaedic Surgery Safety, Procurement, Storage, and Outcomes Adam J. Beer,* BS, Tracy M. Tauro,* BS, Michael L. Redondo, † MD, David R. Christian, ‡ MD, Brian J. Cole,* MD, MBA, and Rachel M. Frank, § k MD Investigation performed at Rush University Medical Center, Chicago, Illinois, USA The use of allografts has become a vital option for orthopaedic surgeons in the treatment of a variety of musculoskeletal lesions, ranging from osteochondral defects in the glenohumeral joint to meniscal deficiency in the young athlete. Nevertheless, barriers to treating a patient with an allograft-based procedure may arise from concerns over disease transmission, the navigation of tissue banks that supply allografts, the process of obtaining insurance approval, or optimal storage methods. This review serves to support orthopaedic surgeons in the incorporation of allografts into their practice by quelling these potential concerns. Fresh osteochondral allografts, fresh-frozen meniscal allografts, soft tissue allografts, and off-the-shelf cartilage products are the focus of this review amid broad overviews of allograft safety and tissue bank practices in the United States. Keywords: allografts; shoulder; general; knee; articular cartilage; tissue banks Orthopaedic surgeons have incorporated allografts into their surgical practice for more than a century. Specifically, the first fresh osteochondral allograft (OCA) transplantation, referred to as “joint allotransplantation” at the time, was first documented to be performed by Lexer in 1908. 48 The procedure became increasingly popular for the treatment of tumors and osteoarthritic lesions during the latter half of the 20th century, as larger case series on OCA transplantation began to appear in the literature in the 1960s and 1970s. 38 The increasing use of allografts in orthopaedic surgery, how- ever, pertains not strictly to those intended to treat osteo- chondral lesions; the United States saw a jump from 7525 tendon allografts distributed by tissue banks in 1993 to 750,000 tendon allografts distributed in 1999. 44 As these trends of allograft utilization continue, the modern-day orthopaedic surgeon’s ability to obtain, store, and apply allo- grafts from tissue banks has seen a proportional uptick of importance. From the surgeon’s perspective, the benefits of having allografts at one’s disposal are clear. Among countless other examples, 1 common instance of their utility is the use of bone–patellar tendon–bone (BTB) allograft as well as soft tissue allograft (eg, semitendinosus) in revision anterior cruciate ligament (ACL) reconstruction, particularly in cases in which an autograft was used to treat the initial ACL rupture. Another example is the application of OCA transplantation to address a focal articular cartilage defect in the knee. This is in contrast to the osteochondral auto- graft equivalent, which may raise concerns over donor site morbidity. 12,19 The use of an allograft requires extensive thought and planning. Surgeons and their patients must feel confident that the possibility of an infection or an immunogenic reac- tion poses only a minimal risk. The clinical practice itself, moreover, benefits greatly from familiarity with tissue k Address correspondence to Rachel M. Frank, MD, Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Mail Stop B202, Aurora, CO 80045, USA (email: rmfrank3 @gmail.com). *Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA. † Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA. ‡ Department of Orthopaedic Surgery, McGaw Northwestern Univer- sity Medical Center, Chicago, Illinois, USA. § Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA. One or more of the authors has declared the following potential con- flict of interest or source of funding: B.J.C. has received research support from Aesculap/B. Braun, Arthrex, National Institutes of Health (NIAMS & NICHD), and Regentis; consulting fees from Anica Therapeutics, Arthrex, Bioventus, Geistlich Pharma, Genzyme, Pacira, Regentis, Smith & Nephew, Vericel, and Zimmer; royalties from Arthrex, DJO, Elsevier, and Operative Techniques in Sports Medicine ; educational support from Arthrex and Pacira; financial/material support from Athletico and JRF Ortho; nonconsulting fees from Carticept Medical and LifeNet Health; stock/stock options in Ossio and Regentis; and hospitality payments from Aesculap/B.Braun, DePuy, and GE Healthcare. R.M.F. has received institutional support from Arthrex and Smith & Nephew; research support from Arthrex; and royalties from Elsevier; and is a consultant for Arthrex, JRF, and AlloSource. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. The Orthopaedic Journal of Sports Medicine, 7(12), 2325967119891435 DOI: 10.1177/2325967119891435 ª The Author(s) 2019 1 This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/ licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions. OCTOBER 2020 | The Surgical Technologist | 449