Table 2.
Studies comparing non-structural autologous bone grafts with substitutes in hindfoot arthrodeses and osteotomies
| Ref. | Methodology | Results | Quality |
|---|---|---|---|
|
Cancellous allografts versus cancellous autologous grafts in hindfoot ADs | |||
|
McGarvey et al.[58] |
Retrospective comparative chart review (1990–1992) |
Rate of union |
Selection: *** |
| Allografts: 21/24 (88%) |
Comparability: |
||
| 24 acellular allograft chips vs 17 cancellous autologous grafts in 37 subtalar, double and triple ADs. FU: Minimum 18 months |
Autologous grafts: 16/17 (94%) |
Outcome:* |
|
| P=? | |||
|
Time-to- union | |||
|
Triple/Double/Subtalar AD | |||
| Allografts: 4.0/4.0/4.1 months | |||
| Autologous grafts 3.0/3.2/3.6 months | |||
| P= n. s | |||
|
Easley et al.[4] |
Subgroup comparison in a retrospective chart review (1988–1995) |
Rate of union |
Selection: ** |
| Allografts: 14/17 (82%) |
Comparability: |
||
| 17 cancellous allograft vs. 94 cancellous autologous grafts in subtalar ADs. Mean FU 51 months(range: 24–130 months) |
Autologous grafts: 80/94 (85%) |
Outcome:* |
|
| P= n. s. | |||
|
Time –to- union | |||
| Allografts: 13 weeks | |||
| (10–24 weeks) | |||
| Autologous grafts: 11weeks (8–20 weeks) | |||
| P= n. s | |||
|
DBM versus cancellous autologous grafts in hindfoot ADs | |||
|
Michelson et al.[57] |
Prospective comparative study (1990–1993) |
Rate of union |
Selection: *** |
| 37 DBM vs.18 cancellous autologous grafts in 11 subtalar AD’s, and 44 triple AD’s FU: Until complete healing |
DBM: 36/37 (97%) |
Comparability: |
|
| Autologous grafts: 16/18 (89%) |
Outcome:*** |
||
| P= n. s. | |||
| Time –to-union | |||
| DBM: 3.0 – 3.4 months | |||
| Autologous grafts 2.7-3.7 months | |||
| P=n. s. | |||
|
No graft versus cancellous autologous grafts in hindfoot ADs | |||
|
Easley et al. [4] |
Subgroup comparison in a retrospective chart review (1988–1995) |
Rate of union |
Selection: ** |
| No graft: 34/39 (87%) |
Comparability: |
||
| 39 “no graft” vs 94 cancellous autologous grafts in isolated subtalar ADs. Mean FU 54 months (range: 24–130 months) |
Autologous grafts: 80/94 (85%) |
Outcome:* |
|
| P= n. s. | |||
|
Time-to-union | |||
| No graft: 11w (8–24) | |||
| Autologous grafts: 11weeks (8–20 weeks) | |||
| P= n. s | |||
|
Synthetic bone grafts versus cancellous autologous grafts in hindfoot ADs | |||
| DiGiovanni et al. [56] |
Randomized controlled trial (2006/7) |
Rate of X ray based union at 6-12-36 weeks: |
No concealed allocation Blinded outcome assessment 80-93% follow-up Underpowered study |
| 14 PDGF augmented ß-TCP (Augment ®) vs 6 cancellous autologous grafts in 20 adult subtalar, triple, ankle ADs. FU:6, 12 and 36 weeks | |||
| PDGF/ß-TCP: | |||
| 0/11(0%)-5/12(42%)-10/13 | |||
| Autologous grafts: | |||
| 0/4 (0%)-1/3 (33%)-3/5 (60%) | |||
| P= ? | |||
|
Rate of CT based union at 6–12 weeks | |||
| PDGF/ß-TCP: | |||
| 5/13 (38%)-9/13% (69%) | |||
| Autologous grafts: | |||
| 2/5 (40%)- 3/5 (60%) | |||
| P= ? | |||
Abbreviations: OTs= osteotomies, ADs= arthrodeses, FU= follow-up, n.s.= not significant.