Preface of the editor of this special issue of the "Clinics in sports medicine": This issue is dedicated to the use of allograft tissue in knee surgery. During the last 20 to 30 years, the use of allograft tissue has increased exponentially, particularly as it relates to the field of sports medicine and knee surgery in the athletically active. Many high school and collegiate athletes have recovered from serious knee injuries and returned to the playing field because of our ability to use allograft tissue for replacement substitutes in complex knee problems. Along with this tremendous increase in the use of allograft tissue, a number of concerning issues have been brought to the forefront for discussion as well as to stimulate future research endeavors. I have asked national leaders within the knee surgery community to assist with this issue and its discussion. The table of contents is an outstanding one. I hope you will find it as enjoyable to read and learn from as I have in serving as the guest editor with these fine contributors. I have asked Dr. Thomas Vangsness from the University of Southern California to update us on the safety and preparation of allograft tissue. Over the last 10 years, drastic improvements have been made to ensure the safety of allograft tissue with respect to not only the prevention of bacterial infection but also the transmission of viruses that could even be fatal in extreme, unlikely circumstances. Dr. Fred Azar from the Campbell Clinic has provided an outstanding review of the proprietary techniques used for tissue processing and the role of secondary sterilization techniques for allograft tissue. Many of these techniques are proprietary in nature, with specific details of that process lacking from many tissue banks. We still have much to learn about the role they play with respect to the biological incorporation process of the allograft and the eventual outcome of the surgical procedure. Future studies to define these proprietary techniques in an animal model are required and desperately needed. I have asked Dr. David McAllister from the University of California, Los Angeles, to discuss the exact biology of allograft incorporation. Many of our studies have shown us that it appears to be "different" and somewhat delayed compared with the incorporation of autogenous tissue. It is important to many of us who use allograft tissue to understand fully what those differences are and, more importantly, how we might rehabilitate a patient differently who undergoes allograft versus autograft anterior cruciate ligament (ACL) surgery. If the biological incorporation is different between the 2, we may have to rehabilitate them differently for optimal outcome. Dr. Ned Amendola from the University of Iowa has updated us in 2009 about what we really know when comparing allograft tissue to autograft tissue in cruciate ligament surgery. Although very few high-quality level 1 studies have been completed comparing the 2, Dr. Amendola has done an admirable job in presenting the facts as they stand in 2009. Dr. Peter Indelicato from the University of Florida has discussed his rationale for the use of Achilles tendon allograft tissue in primary ACL reconstruction in the athletically active. He has had outstanding success with his patients over the last 10 years. Dr. Gene Barrett from Jackson, Mississippi, has discussed his use of allograft tissue in reconstruction of posterior cruciate ligament. Dr. Scott Rodeo from the Hospital for Special Surgery has provided us with an outstanding review and update of the current concepts of meniscal allografts in 2009. Dr. Christian Lattermann from the University of Kentucky has discussed the use of osteochondral allografts and the state of the art in 2009. I have asked Dr. Walt Shelton from Jackson, Mississippi, to share with us his rationale for the use of allograft tissue in collateral ligament augmentation and reconstruction in the multiple-ligament-injured knee. I have written of my own experience in using Achilles tendon allograft tissue in revision anatomic double-bundle ACL surgery in the Bluegrass experience from the University of Kentucky. Finally, Dr. Chris Harner from the University of Pittsburgh, who has an outstanding wealth of knowledge and experience with the use of autograft tissue, has given us his views on what he sees as the future role of allografts in sports medicine as it relates to knee surgery. I want to personally thank the contributors for devoting their time and energy to this valuable educational effort. It is an honor to have worked with them in making this issue a tremendous success. I hope you find this issue of Clinics in Sports Medicine informative, interesting, and, most importantly, an asset to the care of the patients whom we are privileged to care for. It has been an honor and pleasure to serve as the guest editor for this informative issue. We should always remember that ultimately it is we as surgeons who are the "tissue bankers" for the patient. When considering and using allograft tissue, safety of use is the number 1 priority. We as surgeons must not take that responsibility lightly.
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