Autograft and Allograft Unite Similarly in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

J.Y. Vosseller, MD
Columbia University, Mew York, NY


Scott J. Ellis, MD

Assistant Attending, Orthopaedic Surgery, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College

Martin J. O'Malley, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopedic Surgery, Weill Cornell Medical College

Andrew J. Elliott, MD

Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College

David S. Levine, MD

Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College

Jonathan T. Deland, MD

Co-Chief of the Foot and Ankle Service, Hospital for Special Surgery
Attending Orthopaedic Surgeon, Hospital for Special Surgery

Matthew M. Roberts, MD

Co-Chief of the Foot and Ankle Service, Hospital for Special Surgery
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Abstract

Background

Lateral column lengthening (LCL) is used to address the forefoot abduction associated with the adult acquired flatfoot. This opening wedge osteotomy can be filled with either allograft or autograft bone.

Questions/Purposes

The investigators sought to determine union rates and any loss of correction in patients undergoing LCL with autograft versus allograft.

Methods

Over a 3-year period, 126 LCLs performed by five surgeons in 120 patients were reviewed. Autograft was used in 51 patients, allograft in 75 patients. Times to clinical and radiographic union were established for these patients. Any loss of correction of forefoot abduction as manifested by talonavicular uncoverage was recorded for those grafts that healed. Failure was defined as nonunion or loss of 50% or greater correction. The size of the implanted graft was assessed as a risk factor for failure.

Results

There were 20 total failures: seven in patients with autograft and 13 in patients with allograft (p = 0.63). The size of the implanted graft was larger in those patients that did fail (p = 0.04).

Conclusions

The rate of nonunion and loss of correction for LCL was not significantly different between allograft and autograft. The overall rate of nonunion may be higher than has previously been reported.

This article appears in HSS Journal: Volume 9, Number 1.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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