Abstract
Tendon allograft has been an important alternative graft option aside from autograft. The outcome of reconstruction surgery is determined by donor and recipient related factors. The purpose of this article was to identified all studies reporting donor and recipient characteristics, including the age and gender of donors, along with the age, gender, activity level and smoking status of recipients, that affect the biomechanical properties and post-transplantation outcomes of allograft tendons. The systematic study search was based on MEDLINE via PubMed, Embase and the Cochrane Library databases. The reference lists of the included studies were used for hand searching (snowballing). The searching process was performed by two independent investigators, using search MESH term: “tendon”, “allograft”, and “person”. Studies evaluating the influence of donor and recipient biological characteristics on the mechanical property and transplantation outcome of allograft were included. A total of 12 studies were selected for qualitative synthesis, including 6 studies evaluated the influence of donor characteristics, including age and gender, on the mechanical strength of tendon allograft. 6 studies assessed the influence of recipient characteristics, including age, gender, smoking status, and activity level, on the clinical outcome. As a conclusion, tendon allografts from donor younger than 40 years old were expected to have a higher mechanical property. Young patients or patients with a high level of activity were not recommended to receive allograft tendon when autograft is optional. There is no strong evidence supporting that neither donor or recipient gender affects the tendon allograft transplantation outcomes. Smoking history could increase the risk of complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Balsly CR, Cotter AT, Williams LA, Gaskins BD, Moore MA, Wolfinbarger L (2008) Effect of low dose and moderate dose gamma irradiation on the mechanical properties of bone and soft tissue allografts. Cell Tissue Bank 9:289–298. https://doi.org/10.1007/s10561-008-9069-0
Barber FA, Aziz-Jacobo J, Oro FB (2010) Anterior cruciate ligament reconstruction using patellar tendon allograft: an age-dependent outcome evaluation. Arthroscopy 26:488–493. https://doi.org/10.1016/j.arthro.2009.08.022
Barrett GR, Luber K, Replogle WH, Manley JL (2010) Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy 26:1593–1601. https://doi.org/10.1016/j.arthro.2010.05.014
Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR (2011) Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med 39:2194–2198. https://doi.org/10.1177/0363546511415655
Blevins FT, Hecker AT, Bigler GT, Boland AL, Hayes WC (1994) The effects of donor age and strain rate on the biomechanical properties of bone-patellar tendon-bone allografts. Am J Sports Med 22:328–333. https://doi.org/10.1177/036354659402200306
Brophy RH et al (2015) Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Joint Surg Am 97:450–454. https://doi.org/10.2106/JBJS.N.00694
Cole DW, Ginn TA, Chen GJ, Smith BP, Curl WW, Martin DF, Poehling GG (2005) Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft. Arthroscopy 21:786–790. https://doi.org/10.1016/j.arthro.2005.04.102
Diaz-de-Rada P, Barriga A, Barroso JL, Garcia-Barrecheguren E, Alfonso M, Valenti JR (2003) Positive culture in allograft ACL-reconstruction: what to do? Knee Surg Sports Traumatol Arthrosc 11:219–222. https://doi.org/10.1007/s00167-003-0385-4
Ding DY et al (2017) Subsequent surgery after revision anterior cruciate ligament reconstruction: rates and risk factors from a multicenter cohort. Am J Sports Med 45:2068–2076. https://doi.org/10.1177/0363546517707207
Farkas B, Kvell K, Czoempoely T, Illes T, Bardos T (2010) Increased chondrocyte death after steroid and local anesthetic combination. Clin Orthop Relat Res 468:3112–3120. https://doi.org/10.1007/s11999-010-1443-0
Ficklscherer A, Sievers B, Redeker J, Guelecyuez MF, Paulus A, Pietschmann ME, Mueller PE (2013) Comparison of ropivacaine and fentanyl toxicity in human fibroblasts. Arch Med Sci 9:576–580. https://doi.org/10.5114/aoms.2013.35339
Flahiff CM, Brooks AT, Hollis JM, Vander Schilden JL, Nicholas RW (1995) Biomechanical analysis of patellar tendon allografts as a function of donor age. Am J Sports Med 23:354–358. https://doi.org/10.1177/036354659502300319
Greaves LL, Hecker AT, Brown CH Jr (2008) The effect of donor age and low-dose gamma irradiation on the initial biomechanical properties of human tibialis tendon allografts. Am J Sports Med 36:1358–1366. https://doi.org/10.1177/0363546508314394
Hashemi J, Chandrashekar N, Slauterbeck J (2005) The mechanical properties of the human patellar tendon are correlated to its mass density and are independent of sex. Clin Biomech (Bristol, Avon) 20:645–652. https://doi.org/10.1016/j.clinbiomech.2005.02.008
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13
Indelli PF, Dillingham MF, Fanton GS, Schurman DJ (2004) Anterior cruciate ligament reconstruction using cryopreserved allografts. Clin Orthop Relat Res 420:268–275. https://doi.org/10.1097/00003086-200403000-00038
Jones DB, Huddleston PM, Zobitz ME, Stuart MJ (2007) Mechanical properties of patellar tendon allografts subjected to chemical sterilization. Arthroscopy 23:400–404. https://doi.org/10.1016/j.arthro.2006.11.031
Kadic AJ, Vucic K, Dosenovic S, Sapunar D, Puljak L (2016) Extracting data from figures with software was faster, with higher interrater reliability than manual extraction. J Clin Epidemiol 74:119–123. https://doi.org/10.1016/j.jclinepi.2016.01.002
Kaeding CC et al (2011) Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 3:73–81. https://doi.org/10.1177/1941738110386185
Kaeding CC, Pedroza AD, Reinke EK, Huston LJ (2015) Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med 43:1583–1590. https://doi.org/10.1177/0363546515578836
Kane PW, Wascher J, Dodson CC, Hammoud S, Cohen SB, Ciccotti MG (2016) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in skeletally mature patients aged 25 years or younger. Knee Surg Sports Traumatol Arthrosc 24:3627–3633. https://doi.org/10.1007/s00167-016-4213-z
Kiapour AM, Fleming BC, Proffen BL, Murray MM (2015) Sex influences the biomechanical outcomes of anterior cruciate ligament reconstruction in a preclinical large animal model. Am J Sports Med 43:1623–1631. https://doi.org/10.1177/0363546515582024
Kim SJ, Lee SK, Choi CH, Kim SH, Kim SH, Jung M (2014) Graft selection in anterior cruciate ligament reconstruction for smoking patients. Am J Sports Med 42:166–172. https://doi.org/10.1177/0363546513505191
Knobloch K (2016) Drug-induced tendon disorders. Adv Exp Med Biol 920:229–238. https://doi.org/10.1007/978-3-319-33943-6_22
Lee DO, Eom JS, Jung HG (2018) The effect of smoking on the outcomes of lateral ankle ligament reconstruction. J Orthop Sci 23:88–91. https://doi.org/10.1016/j.jos.2017.09.001
Lewis G, Shaw KM (1997) Tensile properties of human tendo Achillis: effect of donor age and strain rate. J Foot Ankle Surg 36:435–445. https://doi.org/10.1016/s1067-2516(97)80096-8
Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, Wright RW, Kaeding CC, MARS Group, SFA Revision ACL Group (2015) Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 23:2339–2348. https://doi.org/10.1007/s00167-014-3060-z
Maletis GB, Inacio MC, Funahashi TT (2015) Risk factors associated with revision and contralateral anterior cruciate ligament reconstructions in the Kaiser Permanente ACLR registry. Am J Sports Med 43:641–647. https://doi.org/10.1177/0363546514561745
Maletis GB, Chen J, Inacio MC, Funahashi TT (2016) Age-related risk factors for revision anterior cruciate ligament reconstruction: a cohort study of 21,304 patients from the Kaiser Permanente anterior cruciate ligament registry. Am J Sports Med 44:331–336. https://doi.org/10.1177/0363546515614813
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535
O'Brien DF, Kraeutler MJ, Koyonos L, Flato RR, Ciccotti MG, Cohen SB (2014) Allograft anterior cruciate ligament reconstruction in patients younger than 30 years: a matched-pair comparison of bone-patellar tendon-bone and tibialis anterior. Am J Orthop 43:132–136
Ollivier M, Sbihi J, Sbihi A, Pithioux M, Parratte S, Argenson JN (2017) Ropivacaine alters the mechanical properties of hamstring tendons: in vitro controlled mechanical testing of tendons from living donors. Orthop Traumatol Surg Res 103:1027–1030. https://doi.org/10.1016/j.otsr.2017.05.024
Reid J, Sikka R, Tsoi W, Narvy SJ, Hedman T, Lee TQ, Vangsness CT Jr (2010) Sterilization effects on the mechanical properties of human bone-patellar tendon-bone allografts. Orthopedics. https://doi.org/10.3928/01477447-20100225-06
Robertson A, Nutton RW, Keating JF (2006) Current trends in the use of tendon allografts in orthopaedic surgery. J Bone Joint Surg Br 88:988–992. https://doi.org/10.1302/0301-620X.88B8.17555
Singhal MC, Gardiner JR, Johnson DL (2007) Failure of primary anterior cruciate ligament surgery using anterior tibialis allograft. Arthroscopy 23:469–475. https://doi.org/10.1016/j.arthro.2006.12.010
Suhodolcan L, Brojan M, Kosel F, Drobnic M, Alibegovic A, Brecelj J (2013) Cryopreservation with glycerol improves the in vitro biomechanical characteristics of human patellar tendon allografts. Knee Surg Sports Traumatol Arthrosc 21:1218–1225. https://doi.org/10.1007/s00167-012-1954-1
Swank KR, Behn AW, Dragoo JL (2015) The effect of donor age on structural and mechanical properties of allograft tendons. Am J Sports Med 43:453–459. https://doi.org/10.1177/0363546514557246
U.S. Department of Health and Human Services (2015) 2012 and 2015 National Tissue Recovery through Utilization Survey Report. https://www.hhs.gov/sites/default/files/ntrus-report-2015.pdf. Accessed 7 Aug 2019
Weber AE, Mayer EN, Nathani A, Chen DX, Kelly AM, Rodeo SA, Bedi A (2018) How variable are Achilles allografts used for anterior cruciate ligament reconstruction? A biomechanical study. Am J Sports Med 46:1870–1876. https://doi.org/10.1177/0363546518768780
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2014) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf. Accessed 28 July 2019
Woo SL, Hollis JM, Adams DJ, Lyon R, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 19:217–225. https://doi.org/10.1177/036354659101900303
Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Roberti Di Sarsina T, Macchiarola L, Mosca M, Neri MP, Marcacci M (2018a) Anterior cruciate ligament revision with Achilles tendon allograft in young athletes. Orthop Traumatol Surg Res 104:209–215. https://doi.org/10.1016/j.otsr.2017.09.015
Zaffagnini S, Roberti di Sarsina T, Bonanzinga T, Nitri M, Macchiarola L, Stefanelli F, Lucidi G, Grassi A (2018b) Does donor age of nonirradiated Achilles tendon allograft influence mid-term results of revision ACL reconstruction? Joints 6:10–15. https://doi.org/10.1055/s-0038-1626739
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Xu, M., Zhang, H., Yang, X. et al. The influence of donor and recipient characteristics on allograft tendons: a systematic review. Cell Tissue Bank 21, 17–29 (2020). https://doi.org/10.1007/s10561-019-09803-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10561-019-09803-5