At HC Marbella we are accredited by the Andalusian Health Service (SAS) to carry out osteotendinous tissue allograft procedures.
Having a bone or osteotendinous tissue bank for transplantation provides improved effectiveness in surgical procedures which require re-establishment of the anatomy, having been damaged by either a tumour or an infection, or which are the result of a ligament injury.
Currently, the many reconstructive surgical procedures in the musculoskeletal system, as well as rescue treatment in widely used joint prosthesis implants, make it necessary to have tissue capable of:
The homotransplantation of bone tissue in humans dates back to the 16th century when the famous French surgeon, Ambroise Paré, transplanted a tooth from a maid into a princess who had a decayed tooth. Subsequently, the first more specific reference to tissue transplant from a cadaver to a living human dates back to 1913, when Kuettner transplanted the proximal third of the femur from a cadaver into a patient suffering from a tumour in that region.
But it would not be until 1942 in the US when the first dedicated “bone bank” was created, growing rapidly afterwards, particularly throughout the 1960s.
The most common surgery in which an allograft is used is reconstructive surgery of the anterior cruciate ligament. It is also used to correct deformity after a bone fracture. This type of graft can also be used in spinal surgery when it is required to achieve greater fusion or greater rigidity in the spine. Likewise, it may be used in prosthesis rescue surgery when it is required to provide a bone structure to replace bone deficiency in that joint. Finally, it can be used in tumour surgery when tumours destroy or cause severe damage to bones.
Bone allograft
The main current indications for allograft occur in prosthetic revision surgery of the hip, knee and spinal column, and tumour surgery.
- Spinal surgery There are two initial indications, the absence of an autograft and the need for immediate structural support.
- Hip surgery It is indicated in prosthetic revision surgery using two types of graft, either structural grafts for large defects or bone loss, or sponge chips to fill cavity defects or for impaction grafting.
- Knee surgery It is indicated in prosthetic revision surgery, in the same way as for hip surgery, using structural grafts for large defects or bone loss, and sponge chips to fill cavity defects.
- Tumour surgery. Massive bone allografts are used to cover large defects after extensive resection. The allograft can be used as an intercalary graft, osteoarticular graft, for joint removal (arthrodesis) or for reconstruction with megaprosthesis.
Osteotendinous allograft
- In primary reconstruction of the anterior cruciate ligament.
The use of allograft is recommended in the following cases: older people or those who are going to perform low-intensity physical activities, patients with degenerative changes in the knee and patients who are interested in facilitating the rehabilitation process.
- In anterior cruciate ligament revision surgery.
Allograft is highly recommended in those who have previously undergone extraction of autologous tissue and who present widening of the bony tunnels.
- In isolated reconstruction of the posterior cruciate ligament.
It is recommended according to the reconstruction technique used.
- In the knees with multiple ligament injuries.
The use of osteotendinous allografts is recommended to rebuild all damaged ligaments.
- In reconstruction of the extension apparatus.
In total knee arthroplasty.
Specialists in Trauma and Orthopaedic Surgery, during prior outpatient assessment, will determine which patients are candidates for bone and osteotendinous implants. They take the patient’s history, perform an examination and undertake a detailed study of their clinical case and investigation results.
The need to ensure agreed national regulations in this area has given rise to Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on setting standards on quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells, and Commission Directive 2006/17/EC of 8 February 2006 implementing Directive 2004/23/EC of the European Parliament and of the Council as regards certain technical requirements for donation, procurement and testing of human cells and tissues.
ROYAL ,”CREE-LAW 9/2014, of 4 July, establishes standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human cells and tissues and approves coordination and operational standards for their use in humans” and in particular, referring to in Annex 1 thereof, the “Minimum requirements and conditions for the authorisation of tissue establishments and centres or units for obtaining and applying cells and tissues”.
Pioneers in orthopaedic surgery in Andalusia.
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Specialist Physiotherapy Unit.
Dr. Boerger, Thomas
Specialist in Orthopedic Surgery and Traumatology
Knee and Hip Specialist
Dr. Negru, Marius
Consultant Orthopaedic Surgeon
Shoulder and Elbow Specialist
Dr. Baczynski, Kamil
Specialist in Orthopedic Surgery and Traumatology
Special interest in Sports Injuries, Hip and Knee surgery
Dr. Ayllón García, Antonio
Specialist in Minimally Invasive and Endoscopic Spinal Surgery
Dr. Estades Rubio, Francisco Javier
Specialist in Orthopedic Surgery and Traumatology
Dr. López Alcázar, Juan Luis
Spinal Surgery Specialist
Dr. Rodríguez García, Miguel Ángel
Specialist in Minimally Invasive and Endoscopic Spinal Surgery
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