Allograft Use in Hand Surgery - 'Off the Shelf' Tendon Reconstruction: A Scoping Review

Introduction: Tendon grafting is standard for treating tendon defects. Allografts are popular in cruciate ligament reconstruction but not yet in upper limb tendon reconstruction. A scoping review was conducted to map the existing practice of allograft use in hand surgery for tendon reconstruction and identify gaps in knowledge for future research. Methods: Two independent reviewers searched MEDLINE and SCOPUS databases for studies on upper limb tendon reconstruction using tendon allografts until June 2022. Eligible studies included controlled randomised clinical trials, cohort, case-control, cross-sectional, or case report and series studies conducted in English and enrolling patients who underwent tendon allograft reconstruction in the upper limb. Screening for eligibility was done by both reviewers, who reached a consensus through discussion, with no exclusion based on poor methodological quality. Data charting included study title, patients' demographics and outcomes, complications, and follow-up period. Results: The database search found 6 eligible articles with a total of 116 patients and 148 allografts used for reconstruction. Of the studies that looked at functional outcomes, 72.9% of patients had 'good' or 'fair' results, while 25.8% were classed as 'poor'. All of the patients assessed for subjective outcomes were at least partially/fairly satisfied with the allograft. Conclusion: This scoping review has indicated that the utilisation of tendon allografts in the upper limb can potentially be a promising approach for tendon reconstruction, especially in cases of severe trauma or salvage. However, further research is needed to comprehensively assess efficacy, long-term outcomes, complications, postoperative rehabilitation protocols, and comparative effectiveness against autograft tendon reconstruction.