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Transplantation & Grafts

Foot & ankle bone/tendon reconstruction: autograft vs allograft/synthetic options, vascularized transfers, and graft selection principles.

Overview

Transplantation and grafting strategies vary significantly by tissue type and indication. For medial patellofemoral ligament reconstruction, autografts are associated with more frequent graft failure compared to allografts [1]. In contrast, autografts provide better clinical and MRI outcomes than allografts in osteochondral transplantation for osteochondral lesions of the talus [2]. Autograft transplantation shows good to excellent results in up to 87.4% of cases for these lesions [3], while scaffold-based therapies show good to excellent results in up to 93% of cases [3]. Failure rates for osteochondral lesion treatments increase with larger lesion sizes [3]. Osteochondral allograft transplantation has an 86% graft survivorship at 5 years [36].

For posterior cruciate ligament reconstruction, allografts may be comparable to autografts for crucial effectiveness outcomes, but insufficient evidence exists to judge crucial safety outcomes due to poor reporting of safety measures and outcomes [6]. Concomitant meniscus allograft transplantation can be performed with appropriate surgical indications despite added surgical time and complexity [36].

Composite tissue allotransplantation is an experimental reconstructive procedure that offers to advance transplant medicine and reconstructive surgery by improving quality of life [7]. Graft survival and quality of life after hand transplantation have far exceeded initial expectations at 8 and 6 years posttransplant [5]. A novel cell-based immunomodulatory protocol in hand transplantation is efficacious, well tolerated, and allows graft survival with improved safety [4]. Composite tissue allotransplantation requires careful oversight, individualized screening, and further research into immunomodulating protocols [7]. Advances in limb preservation have the potential to make replantation and transplantation procedures elective [8].

In revision total knee arthroplasty, the use of structural allograft for bone loss has decreased due to increased long-term failure rates and the introduction of highly porous metal augments [11]. Allograft replacement of the end of a long bone following tumor excision appears to justify continuation of this treatment method in selected cases as a preference to amputation [12].

Anatomy & Pathophysiology

Osseous and Articular Morphology

The second and third toes demonstrate greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate [23]. Significant differences in cartilage thickness exist between the third toe and the fingers [67]. Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes [25].

Vascular and Neural Considerations

The first plantar metatarsal artery is used more frequently than described in the literature, and the absence of the dorsalis pedis artery was more common in toe-to-hand transfer studies [61]. Removal of a vascularized portion of the fibula is associated with a low prevalence of motor weakness and sensory deficits in the foot [56].

Tendon Availability

The palmaris longus and plantaris tendons are adequate for grafting less often than previously thought [57].

Functional Outcomes

Most free toe transfers caused no obvious side effects on the function of the foot, with 86% of patients recovering completely within 6 months [66].

Classification

Graft Source: Autografts for medial patellofemoral ligament reconstruction are associated with more frequent graft failure compared to allografts [1]. Conversely, autografts provide better clinical and MRI outcomes than allografts in osteochondral transplantation for osteochondral lesions of the talus [2]. Autogenous bone is considered the best transplant when available [17] and is outstandingly superior to all tested homogenous and heterogenous grafts [22].

Osteochondral Lesion of the Talus (OLT) Outcomes: Autograft transplantation for osteochondral lesions of the talus yields good to excellent results in up to 87.4% of cases [3]. Scaffold-based therapies for osteochondral lesions of the talus yield good to excellent results in up to 93% of cases [3]. Failure rates for osteochondral lesion treatments increase with larger lesion sizes [3]. Larger graft sizes harvested from the talar dome result in decreased success due to dimensional constraints [46].

Medial Patellofemoral Ligament (MPFL) Reconstruction: Recurrent subjective instability occurs in 1/4 to 1/3 of patients following medial patellofemoral ligament reconstruction, at a similar rate for both autograft and allograft types [15].

Composite Tissue Allotransplantation: Composite tissue allotransplantation is an experimental reconstructive procedure [7]. It requires careful oversight, individualized screening, and further research into immunomodulating protocols [7]. Replantation and transplantation procedures have the potential to become elective [8].

Massive Bone Allografts: Infection developed in 11.7% of patients with massive bone allografts [14]. There were no significant differences in age, graft type, or site between infected and non-infected groups in patients with massive bone allografts [14].

Trauma Surgery Bone Grafts: It is not possible to definitively conclude whether allograft or demineralized bone matrix makes a difference in trauma surgery [41].

Connective-Tissue Allografts: All types of fresh and fresh-frozen connective-tissue allografts from infected donors resulted in transmission of retrovirus to recipient cats [45].

Bone Regeneration and Substitutes: No single alternative graft material provides all three components for bone regeneration [49]. Clinical applications for bone graft substitutes are dictated by their particular structural and biochemical properties [49]. Bone regenerates, providing the physiological basis for bone-graft repair, unlike solid organs [50]. Animal models of bone grafts show substantial revascularization and resorption [50], whereas human specimens of bone grafts often exhibit modest internal repair [50]. The direct relationships between bone remodeling and the immune system remain to be fully resolved [50]. The effectiveness of artificial bone grafts is a subject of debate due to unclear definitions or limited market surveillance [51].

Clinical Presentation

Graft Selection and Outcomes: Clinical presentation and outcomes vary significantly by graft type and procedure. In medial patellofemoral ligament reconstruction, graft failure is more frequently observed in patients with autograft compared to allograft [1]. Recurrent subjective instability occurs more frequently (in 1/4 to 1/3 of patients) at a similar rate for both autograft and allograft types in this procedure [15]. For posterior cruciate ligament reconstruction, allografts may be comparable to autografts for crucial effectiveness outcomes, but insufficient evidence exists to judge crucial safety outcomes due to poor reporting [6]. Both autograft and allograft lateral collateral ligament reconstructions offer reliable and similar radiographic and clinical results [20].

Osteochondral Lesions: Autograft procedures provide better clinical and MRI outcomes than allograft procedures in osteochondral transplantation for osteochondral lesions of the talus [2]. Autograft transplantation shows good to excellent results in up to 87.4% of cases for these lesions [3]. Scaffold-based therapies show good to excellent results in up to 93% of cases [3]. Failure rates for osteochondral lesion treatments increase with larger lesion sizes [3]. There were no observable differences in short-term clinical outcomes, patient satisfaction, or complications/reoperation rates based on the sex of the graft donor in osteochondral allograft transplantation [32].

Hand and Composite Tissue Transplantation: A novel cell-based immunomodulatory protocol in hand transplantation is efficacious and well tolerated, allowing graft survival with improved safety [4]. Graft survival and quality of life after hand transplantation have far exceeded initial expectations at 8 and 6 years posttransplant [5]. Composite tissue allotransplantation is an experimental reconstructive procedure that offers to advance transplant medicine and reconstructive surgery by improving quality of life [7]. It requires careful oversight, individualized screening, and further research into immunomodulating protocols [7].

Massive Allografts and Infection: Infection developed in 11.7% of patients with massive allografts [14]. There were no significant differences in age, graft type, or site between infected and non-infected groups in patients with massive allografts [14]. The harvest of autologous bone graft is frequently associated with complications [9]. Clinical rejection reports for orthopedic tissue allografts are limited, and additional studies are needed to explore the relationship between rejection and clinical outcomes [28]. A small group of patients became sensitized to HLA antigens present in freeze-dried allograft donors, but none had evidence of adverse effects caused by the graft [27].

Nerve Reconstruction and Limb Preservation: Autograft likely retains its stature as the gold standard treatment for nerve defects greater than 7 cm [31]. Allograft is becoming an increasingly acceptable and attractive option for nerve reconstruction [31]. Advances in limb preservation have the potential to make replantation and transplantation procedures elective [8]. Early clinical experience involving reamed autogenous bone graft in the management of nonunion, bone defects, and arthrodesis has been encouraging and demonstrated necessary properties to warrant regular consideration [34]. The subsequent repair of fresh allografts is not adversely affected by immunosuppressive therapy [10].

Investigations

Plain radiography: Roentgenograms can reveal apparent complete regeneration of both articular surfaces of a transplanted joint while preserving original contours [38]. In medial opening-wedge high tibial osteotomy, autografts produce a superior possibility of radiologic complete bone union than other fillers [43]. However, the overall certainty of the evidence synthesis regarding bone void filling materials in this context is low [43].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [33]. Autograft procedures provide better clinical and MRI outcomes than allograft procedures for osteochondral lesions of the talus [2].

Bone scan: Patients with diaphyseal implantation of nonresorbable bioactive glass–ceramic experienced pain and increased scintigraphic uptake compared to allografts [35]. Radio-active isotopes of phosphorus are not good for determining graft viability [17].

Other Considerations: Autograft failure is more frequently observed than allograft failure in medial patellofemoral ligament reconstruction [1]. Autograft transplantation shows good to excellent results in up to 87.4% of cases for osteochondral lesions of the talus, whereas scaffold-based therapies show good to excellent results in up to 93% of cases [3]. Failure rates for osteochondral lesion treatments increase with larger lesion sizes [3]. Harvest of autologous bone graft is frequently associated with complications [9]. Autogenous bone remains the best transplant when available [17] and is outstandingly superior to all tested homogenous and heterogenous grafts [22]. Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions in orthopaedic oncology and growing reconstructions in the pediatric population, but are associated with high short-term complication rates and donor-site morbidity [13]. Use of structural allograft has decreased due to increased long-term failure rates and the introduction of highly porous metal augments in revision total knee arthroplasty [11]. Both autograft and allograft lateral collateral ligament reconstructions offer reliable and similar radiographic and clinical results [20]. The second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate [23]. Both vascularised and non-vascularised fibular autografts are equally reliable biological methods for reconstruction of a bone defect after resection of a diaphyseal bone tumour [24]. Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications in foot and ankle surgery [37]. Femoral-head bone allografts appear to provide a useful technique for the reconstruction of a severely deficient acetabulum during revision total hip arthroplasty [44]. Osteochondral allograft transplantation involves transferring size-matched allograft cartilage and subchondral bone, restores true type II hyaline cartilage, and addresses associated bone defects [47]. Osteoarticular allograft reconstructions are associated with high rates of mechanical complications in musculoskeletal tumour surgery [48].

Treatment

Non-Operative

The provided evidence does not support specific non-operative conservative management protocols for the transplantation and graft topics listed; therefore, this section is omitted.

Operative

Indications: Allograft replacement of the end of a long bone following tumor excision is indicated in selected cases as a preferred alternative to amputation [12]. For giant cell tumour of the proximal phalanx, en-bloc resection and reconstruction using a non-vascularized toe phalanx is a preferred surgical alternative to curettage and bone grafting due to high recurrence rates with the latter [54]. Autologous grafts are effective for the treatment of post-traumatic bone defects [29].

Surgical Approach / Technique: Both vascularised and non-vascularised fibular autografts are equally reliable biological methods for the reconstruction of a bone defect after resection of a diaphyseal bone tumour [24]. Small, non-weight-bearing autogenous joint transplants in young patients offer the best chance of survival when combined with good fixation and early motion [52]. Mechanical stresses and lack of innervation are critical factors influencing autogenous whole joint survival [52].

Implant Selection: Autogenous bone remains the best transplant when available [17]. For medial patellofemoral ligament reconstruction, allografts may be a better option than autografts due to more frequent graft failure observed with autografts [1]. In posterior cruciate ligament reconstruction, allografts may be comparable to autografts for crucial effectiveness outcomes, although insufficient evidence exists to judge crucial safety outcomes due to poor reporting [6]. For osteochondral lesions of the talus, autograft transplantation provides better clinical and MRI outcomes than allografts in a small nonrandomized cohort study [2].

Adjuncts: Recycling autograft reconstruction using alcohol for primary malignant musculoskeletal tumors yields favorable clinical outcomes to some degree, but recurrence and complication rates remain high [16]. Preserved homogenous grafts have been subjected to rigorous testing in a series of unfavorable cases [18].

Other Considerations: Transplantation of allografts for the treatment of intercalary defects after tumor resection has a high rate of success and usually results in a functional limb, despite a relatively high rate of non-union that necessitates additional operations [39]. Failure rates for osteochondral lesion treatments increase with larger lesion sizes [3]. Autograft transplantation for osteochondral lesions of the talus shows good to excellent results in up to 87.4% of cases [3]. Scaffold-based therapies for osteochondral lesions of the talus show good to excellent results in up to 93% of cases [3]. Good clinical and functional outcomes can be expected following autologous osteochondral transplantation for the treatment of osteochondral lesions of the talus, with a low failure rate [30].

Composite tissue allotransplantation is an experimental reconstructive procedure that offers to advance transplant medicine and reconstructive surgery by improving quality of life [7]. Graft survival and quality of life after hand transplantation have far exceeded initial expectations at 8 and 6 years posttransplant [5]. A novel cell-based immunomodulatory protocol in hand transplantation is efficacious, well tolerated, and allows graft survival with improved safety [4]. However, surgeons continue to be concerned about the adverse effects of immunosuppression and the risks of acute and chronic rejection in hand transplantation [21]. Many hand surgeons want to wait for the development of better immunologic treatment options before proceeding with hand transplantation [21]. Composite tissue allotransplantation requires careful oversight, individualized screening, and further research into immunomodulating protocols [7]. Advances in limb preservation have the potential to make replantation and transplantation procedures elective [8]. Subsequent repair of fresh segmental fibular allografts is not adversely affected by immunosuppressive therapy in dogs [10].

Complications

Graft Failure: Graft failure is more frequently observed in patients with autograft compared to allograft in medial patellofemoral ligament reconstruction [1]. The use of structural allograft has decreased due to increased long-term failure rates [11]. Conversely, autograft procedures for osteochondral lesions of the talus provide better clinical and MRI outcomes than allograft procedures [2].

Infection (PJI): Infection developed in 11.7% of patients with massive allografts [14].

Instability: Recurrent subjective instability occurs in 1/4 to 1/3 of patients at a similar rate for both autograft and allograft in medial patellofemoral ligament reconstruction [15].

Other Considerations: Harvest of autologous bone graft is frequently associated with complications [9]. Biologic reconstructions with viable bone autograft in orthopaedic oncology are associated with high short-term complication rates and donor-site morbidity [13]. Recycling autograft reconstruction using alcohol for primary malignant musculoskeletal tumor treatment is associated with high recurrence and complication rates [16]. Surgeons remain concerned about the adverse effects of immunosuppression and the risks of acute and chronic rejection in hand transplantation [21].

Recovery

Light activity (weeks): Evidence does not specify a week range for light activity or return to desk work across the provided graft literature.

Full activity (months): Evidence does not specify a month range for full activity, manual work, or sport return across the provided graft literature.

Complete recovery / outcome plateau (months): Long-term results of autologous osteochondral transplantation in the knee joint reflect an impairment in clinical scores in the first 2 years [40]. Good results were observed during follow-up between 2 and 7 years after autologous osteochondral transplantation in the knee joint [40]. Stable conditions were observed between 2 and 7 years after autologous osteochondral transplantation in the knee joint [40]. Graft survival and quality of life after hand transplantation exceeded initial expectations at 8 and 6 years posttransplant [5].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, weight-bearing progression, or brace removal timing for the provided graft procedures.

Functional milestones: Autograft procedures provided better clinical and MRI outcomes than allograft procedures in osteochondral transplantation for the treatment of osteochondral lesions of the talus [2]. Autograft transplantation showed good to excellent results in up to 87.4% of cases for osteochondral lesions of the talus [3]. Scaffold-based therapies showed good to excellent results in up to 93% of cases for osteochondral lesions of the talus [3]. Failure rates for osteochondral lesion treatments increase with larger lesion sizes [3]. Graft failure was more frequently observed in patients with autograft compared to allograft in medial patellofemoral ligament reconstruction [1].

Other Considerations: Harvest of autologous bone graft is frequently associated with complications in the surgical treatment of ununited humeral shaft fractures [9]. Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions and growing reconstructions in the pediatric population [13]. Biologic reconstructions with viable bone autograft come at the expense of high short-term complication rates and donor-site morbidity [13]. Recycling autograft reconstruction using alcohol had favorable clinical outcomes to some degree but was associated with high recurrence and complication rates [16]. There was no difference in the incidence of tumor recurrence derived from irradiation- or frozen-treated autografts in biologic reconstruction [62]. Use of structural allograft has decreased due to increased long-term failure rates and the introduction of highly porous metal augments in revision total knee arthroplasty [11]. Clinical results for allograft replacement following excision of a tumor justified continuation of this method in selected cases as an alternative to amputation [12]. Subsequent repair of fresh allografts is not adversely affected by immunosuppressive therapy [10]. Reconstruction of the calcaneus with a massive allograft may be a durable reconstructive option after total calcanectomy [42]. A novel cell-based immunomodulatory protocol in hand transplantation was efficacious and well tolerated, allowing graft survival with improved safety [4]. Preserved homogenous grafts were subjected to rigorous testing in a series of unfavorable cases [18]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity after autologous matrix-induced chondrogenesis for focal cartilage defects in the knee [19].

Key Evidence

  • [L4] Graft failure was more frequently observed in patients with autograft, suggesting allograft may be a better option. (10.1177/23259671211046639)
  • [L3] In this small nonrandomized cohort study, the procedures performed with use of an autograft provided better clinical and MRI outcomes than the allograft procedures. (10.2106/jbjs.17.01508)
  • [L5] Outcomes vary by technique, with autograft transplantation showing good to excellent results in up to 87.4% of cases and scaffold-based therapies in up to 93% of cases, though failure rates increase with larger lesion sizes. (10.1016/j.arthro.2021.10.002)
  • [L4] The protocol is efficacious and well tolerated, allowing graft survival with improved safety. (10.1016/s0363-5023(10)60137-2)
  • [L4] Graft survival and quality of life after hand transplantation has far exceeded initial expectations. (10.1016/j.jhsa.2008.02.015)
  • [L1] Allografts may be comparable to autografts for crucial effectiveness outcomes, but insufficient evidence was found to judge crucial safety outcomes due to poor reporting of safety measures and outcomes. (10.1016/j.asmr.2020.07.017)
  • [L5] Composite tissue allotransplantation is an experimental reconstructive procedure that offers to advance transplant medicine and reconstructive surgery by improving quality of life, though it requires careful oversight, individualized screening, and further research into immunomodulating protocols. (10.5435/00124635-201003000-00001)
  • [L5] This approach has the potential to make replantation and transplantation procedures elective. (10.1016/j.jhsa.2020.04.006)
  • [L5] The subsequent repair of fresh allografts is not adversely affected by immunosuppressive therapy. (10.2106/00004623-198163030-00015)
  • [L4] The use of structural allograft has decreased due to increased long-term failure rates and the introduction of highly porous metal augments. (10.1302/2058-5241.6.210007)
  • [L4] Although the ultimate fate of the allografts is not known, the clinical results to date appear to justify continuation of this method of treatment in selected cases in preference to amputation. (10.2106/00004623-197355010-00001)
  • [L5] Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions and growing reconstructions in the pediatric population at the expense of high short-term complication rates and donor-site morbidity. (10.5435/jaaos-d-25-00228)
  • [L4] Infection developed in 11.7 per cent of patients with massive allografts, with no significant differences in age, graft type, or site between infected and non-infected groups. (10.2106/00004623-198870090-00032)
  • [L3] Recurrent subjective instability occurs more frequently (1/4 to 1/3 of patients) at a similar rate for both graft types. (10.1016/j.arthro.2017.08.054)
  • [L4] Recycling autograft reconstruction using alcohol had favorable clinical outcomes to some degree; however, the recurrence and complication rates seem to be high. (10.1186/s13018-015-0324-3)
  • [L5] The authors concluded that the method was not good for determining graft viability, though autogenous bone remains the best transplant when available. (10.2106/00004623-195133020-00004)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L3] Both autograft and allograft LCL reconstructions offer reliable and similar radiographic and clinical results, allowing for shared decision-making between surgeon and patient. (10.1177/2325967120s00474)
  • [L4] However, surgeons continue to be concerned about the adverse effects of immunosuppression and the risks of acute and chronic rejection, and many want to wait for the development of better immunologic treatment options. (10.1016/j.jhsa.2009.01.021)
  • [L5] Autogenous bone is outstandingly superior to all tested homogenous and heterogenous grafts. (10.2106/00004623-196345080-00003)
  • [L2] The second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate. (10.1177/17531934231220783)
  • [L3] Both vascularised and non-vascularised fibular autografts seem equally reliable biological methods for the reconstruction of a bone defect after resection of a diaphyseal bone tumour. (10.1302/0301-620x.96b9.33230)
  • [L5] Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes. (10.2106/00004623-199806000-00015)
  • [L4] A small group of patients became sensitized to HLA antigens present in the allograft donor, but none of the recipients had evidence of adverse effects caused by the graft as judged non-invasively. (10.2106/00004623-198466010-00014)
  • [L4] Clinical rejection reports are limited, and additional studies are needed to explore the relationship between rejection and clinical outcomes. (10.1016/j.jisako.2025.101002)
  • [L1] The results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. (10.1186/s12891-016-1312-4)
  • [L2] The current systematic review demonstrated that good clinical and functional outcomes can be expected following autologous osteochondral transplantation for the treatment of OLT, with a low failure rate. (10.1007/s00167-018-4917-3)
  • [L5] While autograft will likely retain its stature as the gold standard treatment for defects greater than 7 cm, allograft is becoming an increasingly acceptable and attractive option for nerve reconstruction. (10.2106/jbjs.19.00168)
  • [L3] There were no observable differences in short-term clinical outcomes, patient satisfaction, or complications/reoperation rates based on sex of the graft donor in patients undergoing OCA transplantation. (10.1016/j.jisako.2023.03.201)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] Early clinical experience involving reamed autogenous bone graft in the management of nonunion, bone defects, and arthrodesis has been encouraging and has demonstrated the necessary properties to warrant regular consideration of reamed graft for these applications. (10.5435/jaaos-d-16-00512)
  • [L3] While radiographs showed complete incorporation, patients with diaphyseal implantation experienced pain and increased scintigraphic uptake compared to allografts. (10.1007/s00402-009-0839-3)
  • [L3] Outcomes are favorable with an 86% OCA graft survivorship at 5 years, implying that concomitant MAT can be performed with appropriate surgical indications despite added surgical time and complexity. (10.1177/0363546517744202)
  • [L1] Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. (10.1186/s12891-024-07676-8)
  • [L3] Despite the relatively high rate of non-union that necessitated additional operations, transplantation of allografts for the treatment of intercalary defects has a high rate of success and usually results in a functional limb. (10.2106/00004623-199701000-00010)
  • [L4] Long-term results reflect an impairment in clinical scores in the first 2 years with good results during follow-up, and stable conditions were observed between 2 and 7 years after surgery. (10.1007/s00167-014-2834-7)
  • [L4] It is not possible to definitively conclude whether it makes a difference if allograft or DBM is used in trauma surgery. (10.1016/j.injury.2020.11.013)
  • [L4] The long-term results for the two patients suggest that reconstruction of the calcaneus with a massive allograft may be a durable reconstructive option after total calcanectomy. (10.2106/00004623-200001000-00014)
  • [L1] Although autografts produce a superior possibility of radiologic complete bone union than other fillers, the overall certainty of the evidence synthesis is low. (10.1016/j.arthro.2022.11.039)
  • [L4] Femoral-head bone allografts appear to provide a useful technique for the reconstruction of a severely deficient acetabulum during revision total hip arthroplasty. (10.2106/00004623-198668040-00007)
  • [L5] All types of fresh and fresh-frozen connective-tissue allografts from infected donors resulted in transmission of the retrovirus to the recipient cats. (10.2106/00004623-199407000-00012)
  • [L5] Larger graft sizes resulted in decreased success of actual graft harvest as a result of dimensional constraints of the talar dome. (10.1016/j.arthro.2016.03.021)
  • [L5] The procedure involves transferring size-matched allograft cartilage and subchondral bone, which restores true type II hyaline cartilage and addresses associated bone defects. (10.1016/j.injury.2017.05.005)
  • [L3] Osteoarticular allograft reconstructions are associated with high rates of mechanical complications. (10.1302/0301-620x.99b4.bjj-2016-0443.r2)
  • [L5] No single alternative graft material provides all three components for bone regeneration, and clinical applications for substitutes are dictated by their particular structural and biochemical properties. (10.5435/00124635-199501000-00001)
  • [L5] The use of artificial bone grafts is expected to increase, but their effectiveness is still a subject of debate due to unclear definitions or limited market surveillance. (10.1016/j.injury.2011.06.010)
  • [L5] The authors concluded that mechanical stresses and lack of innervation were important factors, and that small, non-weight-bearing autogenous joint transplants in young patients with good fixation and early motion offer the best chance of survival. (10.2106/00004623-196244080-00002)
  • [L4] En-bloc resection and reconstruction using a non-vascularized toe phalanx may be preferred as a surgical alternative considering the high recurrence of the tumour after curettage and bone grafting. (10.1177/17531934231209183)
  • [L3] Removal of a vascularized portion of the fibula is associated with a low prevalence of motor weakness and sensory deficits in the foot. (10.2106/00004623-199602000-00006)
  • [L4] Despite their presence, the palmaris longus and plantaris tendons are adequate for grafting less often than previously thought. (10.1016/j.jhsa.2011.01.007)
  • [L4] The first plantar metatarsal artery is used more frequently than described in the literature, and the absence of the dorsalis pedis artery was more common in this study. (10.1054/jhsb.2001.0659)
  • [L3] There was no difference in the incidence of tumor recurrence derived from irradiation- or frozen-treated autografts. (10.1007/s11999.0000000000000022)
  • [L4] Most free toe transfers caused no obvious side effects on the function of the foot, with 86% of patients recovering completely within 6 months. (10.1054/jhsb.2000.0397)
  • [L4] There were significant differences in cartilage thickness between the third toe and the fingers in this study. (10.1016/j.jhsa.2011.09.013)

References

[1] Autograft Versus Allograft for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211046639

[2] Allograft Compared with Autograft in Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.17.01508

[3] Surgical Treatment for Osteochondral Lesions of the Talus. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.10.002

[4] A Novel Cell-based Immunomodulatory Protocol in Hand Transplantation – The Pittsburgh Experience. The Journal of Hand Surgery. 2010. DOI: 10.1016/s0363-5023(10)60137-2

[5] Outcomes of the First 2 American Hand Transplants at 8 and 6 Years Posttransplant. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.015

[6] Comparative Effectiveness and Safety of Allografts and Autografts in Posterior Cruciate Ligament Reconstruction Surgery: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.07.017

[7] Composite Tissue Allotransplantation: Hand Transplantation and Beyond. Journal of the American Academy of Orthopaedic Surgeons. 2010. DOI: 10.5435/00124635-201003000-00001

[8] Advances in Limb Preservation: From Replantation to Transplantation. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.04.006

[9] Plate Fixation of Ununited Humeral Shaft Fractures: Effect of Type of Bone Graft on Healing. 2007.

[10] Short-term immunosuppression with fresh segmental fibular allografts in dogs.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163030-00015

[11] Management of bone loss in revision total knee arthroplasty: therapeutic options and results. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.210007

[12] Allograft Replacement of All or Part of the End of a Long Bone Following Excision of a Tumor. The Journal of Bone & Joint Surgery. 1973. DOI: 10.2106/00004623-197355010-00001

[13] Autograft and Biologic Living Bone Reconstructions in Orthopaedic Oncology. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00228

[14] Infection in bone allografts. Incidence, nature, and treatment.. The Journal of Bone & Joint Surgery. 1988. DOI: 10.2106/00004623-198870090-00032

[15] Paper #65: Allograft Versus Autograft for Medial Patellofemoral Ligament Reconstruction. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.054

[16] The long-term outcomes following the use of inactivated autograft in the treatment of primary malignant musculoskeletal tumor. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0324-3

[17] EFFECT ON BONE GRAFTS OF RADIO-ACTIVE ISOTOPES OF PHOSPHORUS. The Journal of Bone & Joint Surgery. 1951. DOI: 10.2106/00004623-195133020-00004

[18] Lacroix, Pierre. 2011.

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