Allograft use in foot and ankle reconstruction: A narrative review of indications, outcomes, and limitations

Allografts have emerged as an effective option in foot and ankle reconstruction, offering advantages such as reduced donor site morbidity and shorter operative time compared to autografts. This narrative review examines the clinical efficacy, safety, and applications of biologic allografts, excluding synthetic grafts, in a variety of foot and ankle procedures. A structured literature search was performed using PubMed, Embase, and the Cochrane Library to identify English language studies published from January 2000 to April 2024. The search strategy combined medical subject headings terms and keywords including “allograft,” “tissue transplantation,” “foot and ankle reconstruction,” “osteochondral defects,” “Achilles tendon,” “lateral ligament,” and “ankle arthroplasty.” Eligible studies reported on patient-reported outcomes, functional assessments, or complication rates. While autografts remain the standard in many settings, allografts have demonstrated comparable outcomes in selected procedures, particularly when autograft harvest is contraindicated or undesirable. The success of allografts depends on appropriate graft selection, surgical technique, and the specific anatomical site. Future advances in tissue processing and biologic integration may enhance their role in complex reconstructions.