Achilles Allograft in the Upper Extremity: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Reconstruction
• Biomaterials in Surgery

Background:

• Achilles tendon allografts (ATAs) are versatile grafts used in various upper-extremity reconstructive procedures.
• Understanding the associated complications, reoperation rates, and functional outcomes is crucial for optimizing patient care.

Purpose of the Study:

• To systematically review the existing literature on complications, reoperation rates, and outcomes of ATAs in upper-extremity reconstructions.
• To provide insights into the overall performance of ATA reconstruction in the shoulder, elbow, and wrist.

Main Methods:

• A systematic review was conducted following PRISMA guidelines, including studies from January 1990 to August 2024.
• Eligible studies involved adult patients undergoing shoulder, elbow, or wrist tendon reconstruction with ATAs, excluding cadaveric or biomechanical studies.
• Studies reporting complications and/or functional outcomes were included.

Main Results:

• Twenty-three studies comprising 408 cases met the inclusion criteria.
• Common indications included distal biceps reconstruction (26%), rotator cuff tears (24%), and distal ulna resection (20%).
• The overall complication rate was 19% (graft failure 43%, infection 20%), with a 10% reoperation rate (graft failure 42%, infection 29%).
• Despite complications, patient-reported outcomes were favorable (VAS 2, MEPS 88).

Conclusions:

• ATAs in upper-extremity reconstruction yield favorable functional outcomes and pain relief.
• However, the overall complication rate (19%) and reoperation rate (10%) necessitate careful consideration by surgeons.
• The benefits of decreased donor-site morbidity must be weighed against the risks of graft-related complications.