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Allograft to correct adult flatfoot deformity healed at 12 weeks
Union of lateral-column lengthening osteotomy with allograft comparable to tricortical iliac crest autograft.
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Osteotomy union with iliac crest allograft bone was comparable to that of iliac crest autograft, according to early results of a randomized, controlled prospective trial of patients undergoing surgical lateral-column lengthening for correction of adult-acquired flatfoot deformity.
Lateral-column lengthening surgery is indicated for stage 2 posterior tibial tendon insufficiency. The procedure, which involves a calcaneal osteotomy, had been mostly performed in adults using autograft bone from the ipsilateral iliac crest.
“Evans described the procedure using allograft in children and had good success … but it had not really been substantiated with data in the adult population. This study provides some data to confirm that,” Marc J. Kornmesser, MD, of Grand Rapids, Mich., said in a telephone interview with Orthopedics Today.
Kornmesser presented his results during the American Orthopaedic Foot and Ankle Society 19th Annual Summer Meeting in Hilton Head, S.C.
Allograft efficacy data
Investigators used graft incorporation and healing as assessed by radiographs as study endpoints. “Early results demonstrated that, with respect to union rates, iliac crest allograft appears to be equal in efficacy to the gold standard: iliac crest autograft,” he said.
Twenty-seven adults with stage 2 painful, acquired flatfoot deformity who did not respond to conservative therapy were enrolled in the study and randomized to undergo 29 lateral-column lengthening procedures (21 women, six men; mean age 57 years). For 18 procedures, tricortical iliac crest allograft was used from the same tissue bank accredited by the American Association of Tissue Banks. Ipsilateral iliac crest autograft was used for 11 surgeries.
Two surgeons using similar techniques did the surgeries, making an incision over the anterior calcaneus parallel to the plantar surface of the foot and perpendicular to the joint. They retracted the tendons and suralis nerve and made an osteotomy 15 mm proximal to the joint. A laminar spreader was introduced in tension to place the bone graft, which was custom-cut, at the osteotomy site. Grafts were fixed with one fully threaded cortical screw.
Patients were placed in bulky plaster splints for two weeks postoperatively; for six additional weeks they wore short leg casts and were nonweight-bearing. Patients wore fracture braces for four weeks and began progressive weight-bearing. Unrestricted weight-bearing commenced at 12 weeks with radiographic and clinical signs of healing.
“We found that the rate of union in the allograft arm is 100%,” Kornmesser said. There were no delayed or nonunions or hardware failures in either group.
For more information:
- Anderson JG, Bohay DR, Endres T, Kornmesser MJ. Randomized prospective study comparing union rates of tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for surgical correction of the adult acquired flatfoot deformity: early report. Presented at the American Orthopaedic Foot and Ankle Society 19th Annual Summer Meeting. June 27-29, 2003. Hilton Head, SC.