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Table 1 Studies comparing structural autologous bone grafts with substitutes in hindfoot arthrodeses and osteotomies

From: Substitutes of structural and non-structural autologous bone grafts in hindfoot arthrodeses and osteotomies: a systematic review

Ref.

Methodology

Results

Quality

Structural allografts versus cortical autologous grafts in hindfoot OTs

Dolan et al. [51]

Randomized controlled trial

Rate of union at 8 weeks

No concealed allocation No blinded outcome assessment 100% FU Underpowered study

18 freeze-dried structural allografts vs. 15 cortical autologus grafts in 31 adults undergoing Evan’s OTs. FU: 8 and 12 weeks

Allografts: 17/18 (94%)

Autologous grafts: 9/15 (60%), P = 0.03

Rate of union at 12 weeks

100% for allografts and autologous grafts

No graft collapse in both groups

Templin et al. [52]

Retrospective comparative chart review (1994–2003)

Rate of union

Selection: ***

Allografts: 27/30 (90%)

Comparability:

30 freeze-dried structural allografts vs 5 structural autologous grafts in 35 children undergoing Evan’s OTs. Mean FU 3.6 years (range 6–12 years)

Autologous grafts: 4/5 (80%)

Outcome: *

P = n. s.

Kwak et al. [53]

Retrospective comparative chart review (2000–2005)

Talo-1 st metatarsal, talo-calcaneal and calcaneal pitch angle at final FU

Selection: ***

Comparability:

118 acellular allografts (Tutoplast ®) vs. 10 structural autologous grafts in 79 children undergoing Evan’s OTs. Mean FU 15 months (range 13-21months)

No significant difference between the two graft types

Outcome: *

Structural allografts versus cortical autologous grafts in hindfoot ADs

Easley et al. [4]

Subgroup comparison in a retrospective chart review (1988–1995)

Rate of union

Selection: ***

Allografts: 2/5 (40%)

Comparability:

5 structural allografts vs. 29 structural autologous grafts in isolated subtalar ADs. Mean FU 51 months (range 24–130 months)

Autologous grafts: 24/29 (83%)

Outcome: *

P = n.s.

Time to union

Autologous grafts: 16 weeks (10-30 weeks)

P = n. s.

Structural allografts versus cortical autologous grafts in miscellaneous procedures (hindfoot ADs/OTs)

Grier et al.[54]

Retrospective comparative chart review (1996–2006)

Rate of union

Selection: **

Allografts + PRP: 29/31 (94%)

Comparability:

31 structural freeze-dried allografts + PRP vs. 20 structural autologous grafts in 18 adult Evan’s OTs and 33 adult CC ADs. Mean FU: 20 months (range 3-72 months)

Autologous grafts: 14/20 (70%)

Outcome: *

P = 0.045

 

Improvement of the talo-1 st metatarsal and calcaneal pitch angle

No significant difference between the two graft types

Danko et al. [17]

Retrospective comparative chart review (1990–1992)

Graft collapse

Selection: ***

Evan’s OT:

Comparability:

7 structural allografts vs 33 structural autologous grafts in 69 pediatric Evan’s OTs and 61 pediatric CC ADs. Mean FU 2.5 years (range 0.6-7.8 years)

Allografts: 0/39

Outcome: ***

Autologous grafts 0/30

P = ?

CC ADs:

Allografts: 17/58 (29%)

Autologous grafts: 0/3 (0%)

P = ?

Mahan et al.[55]

Retrospective comparative chart review (1977–1990)

Rate of union

Selection: **

Allografts: 198/215

Comparability:

215 freeze dried allografts vs 85 autologous grafts in 153 OTs, 55 ADs, 82 other procedures. Minimum FU 6 weeks

(92%)

Outcome: *

Autologous grafts: 78 /85 (92%),

P = n. s.

Rate of delayed union

Allografts: 8/215 (4%)

Autologous grafts 2/85 (2%)

P = n. s.

  1. Abbreviations: CC=calcaneocuboideal, OTs= osteotomies, ADs= arthrodeses, FU = follow-up, n.s.= not significant.