Description
Background: In 2011 the Danish National Board of Health (DNBH) centralized treatment of multi-ligament injury and revision ligament surgery of the knee, meniscus transplantation, and advanced cartilage procedures to few departments with the purpose to increase experience and quality of these challenging procedures. This increased the need for allogeneic connective tissue (grafts). It is possible to obtain grafts from tissue banks in other countries, but from an ethical point of view Denmark should be self-providing, and there are differences in how grafts are obtained and preserved, which might affect tissue quality. Therefore, a local tissue bank was established in 2014.
Aim: To report establishment of and experience from this tissue bank.
Materials and Methods: Various logistic models were explored. It was decided to connect allograft donation to the organ donor program. The age limit for donors is 50 years for tendons, 40 for menisci, and 30 for hyaline cartilage. After permission from relatives is obtained the transplantation coordinator contacts the orthopedic team (two surgeons and two nurses), and after organ donation the musculoskeletal tissue is removed. The tissue is handled and stored by dept. of clinical immunology. The donor is tested for contagious disease and the grafts are cultured for contamination. The grafts are fresh frozen to -80°Celsius, and decontamination procedures are not used. After negative results from cultures, the grafts are released for use. Grafts with a positive culture are discarded. When a graft is used during an operation, a swap from the graft is cultured.
Results: Since June 2014 there has been 31 donations, resulting in 1160 grafts. 40 grafts (3.4 %) had a positive bacteria culture before freezing and were discarded. Until April 2023, 552 recipients have been treated by use of these allografts: 175 knee multi-ligament reconstructions (Rs), 226 revision ligament Rs, 44 meniscal transplantations (Ts), 18 fresh cartilage Ts, 3 tibial plateau+meniscal Ts, 2 ulnar Rs, 5 AC joint-, 9 SC joint- and 1 PTF joint-stabilizations, 4 quadriceps Rs, 9 labral Rs (hip) 2 pectoralis major tendon Rs, 1 revision ankle stabilization, 45 one ligament Rs (knee). There are no recorded transplantation related complications. Two grafts had a positive culture (one with Staphylococcus capitis and one with Staphylococcus Aureus) of the swaps taken right before insertion in the recipient. During the period it was necessary in addition to buy 245 grafts from tissue banks in Belgium.
Interpretation / Conclusion: Through the established donation program it has been possible to offer optimal treatment for several highly specialized musculoskeletal conditions. Very few grafts (2 ‰) were contaminated, and decontamination procedures were not necessary.
