What is an Allograft?

In my previous posts, I have mentioned something called an Allograft. It's a piece of donated human skin tissue. It's treated, dried and packaged and is rehydrated at the time of surgery. Think instant freeze-dried skin - no, really.

Who cares? Well, you might do if you've torn your achilles tendon, suffered major skin trauma (like burns) or you have a chronic or massive rotator cuff tear in your shoulder that is difficult to repair. Surgeons have been trialling different tissue grafts for many years. Skin grafts are nothing new, but their applications in tendon repair are newer. Injuries like achilles rupture and rotator-cuff tear - that are always dificult to recover from due to poor healing - are now more readily treatable with the augmentation of the tendon using a tissue graft. Note the word 'augmentation'.

If you're a shoulder patient and you are reading this, then you may be one of the many people with a massive or irrepairable rotator-cuff tear. For you, an 'augmentation' is impossible, because, if your tendon cannot be repaired, the repair cannot be augmented. Fortunately, in recent years, surgeons have been begun to treat these kinds of tears by using an allograft as an 'interposition' graft. This means using the graft to replace the missing tendon tissue, effectively bridging the defect between what is left of the tendon and it's attatchment site on the bone.

There is a big difference between augmentation and interposition grafting, in particular, the surgical complexity and patient eligability. There are many fewer surgeons doing interpositions than there are doing augmentations. In the UK, after a 12 month search to find someone who could do this procedure - including at least six consultations with different surgeons - I discovered the number of surgeons doing interposition allograft surgery in the UK was roughly distributed as follows:

   - London - 0
   - Cambridge - 1
   - Leicester - 4

That's right, no one in London. No one I saw in London knew of anyone doing this kind of operation in London! There maybe others in places like Birmingham, Manchester or Edinburgh, but as I live in the south-east of of the UK, my search did not cover these areas.

Anyway, if you've read this far, you may be interested in this article published by the team from Leicester. It describes the interposition procedure, outcomes and recovery protocol.

Note: if you are from outside the UK, interposition grafts are being performed in the US, Europe and other continents. I would recommend a thorough Google search including the words "Shoulder Allograft Interposition".