Allografts in knee surgery

Nick Smith was involved in a programme of work looking at the clinical and cost effectiveness of allografts (donor tissue) in knee surgery. This was subdivided into four main projects: ACL reconstruction, PCL reconstruction, meniscal allograft transplantation and osteochondral allograft transplantation.

Osteochondral allograft transplantation

Osteochondral allograft transplantation (OCA) is a procedure where donor cartilage with attached bone is implanted in a knee, for patients with a bone/cartilage defect. This project found that osteochondral allograft transplantation was clinically very effective, and also highly cost effective. The knee team at UHCW NHS Trust have one of the highest volume clinical practices in OCA and Nick Smith is in the process of publishing further clinical experience data.

ACL reconstruction

The work found that allografts in ACL reconstruction were clinically useful for the right population, but not cost effective, if autografts (the patient’s own tissue) were an option. There are small risks with autograft, such as post operative pain and weakness, but overall, these were well tolerated by patients.

PCL reconstruction

As with ACL reconstruction, it was found to be more cost effective to use autografts, but in some situations, allografts could be justified.

Meniscal transplant

There are lots of clinical studies showing that meniscal allograft transplantation results in improved clinical outcomes in the medium and longer term. However, there are not many comparative studies and therefore it is difficult to draw conclusions on how cost effective it is. The upcoming multicentre trial in which Nick Smith is a co-applicant on, will attempt to answer this question.