Autograft, allograft use for nerve gap repair may have comparable recovery rates
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Published results showed autograft and allograft repair in peripheral nerve reconstruction had comparable rates of meaningful recovery regardless of gap length or nerve type, while conduit repairs had lower meaningful recovery rates.
“We conducted the most extensive systematic review and meta-analysis of peripheral nerve reconstructions to date in order to evaluate the ability of autograft, allograft and conduits to achieve meaningful sensory and motor recovery in patients with peripheral nerve injuries in which a primary repair is not an option,” Joe Styron, MD, PhD, of the Cleveland Clinic, told Healio. “We found there not to be any significant difference between autograft and allograft in achieving meaningful recovery regardless of gap size or type of nerve.”
Searching Medline from January 1980 to March 2020, Styron and colleagues identified 35 studies with 1,559 nerve repairs that included nerve injury type, repair type, gap length and outcomes for meaningful recovery rates. Researchers considered meaningful recovery rates, defined as Medical Research Council Classification sensory scales and muscle strength grading of S3 or greater and M3 or greater. Researchers included complications, consisting of revision surgery, symptomatic neuroma, pain, infection or altered sensibility, as outcomes, and evaluated donor site complications in studies assessing autograft nerve repairs.
Results showed autograft and allograft repair did not have significantly different meaningful recovery rates for sensory and motor function across both short and long gaps. However, researchers found significantly higher meaningful recovery rates in sensory short gap repairs among autograft and allograft repairs at 81.6% and 87.1%, respectively, compared with conduit repairs at 62.2%. With regard to pain, autograft and allograft repair had comparable complication rates, while conduit repair had higher complication rates, according to results.
Cost analysis showed allograft repair had lower inpatient costs vs. autograft repair ($25,751 vs. $29,560), but similar outpatient costs ($13,143 vs. $12,635). Researchers noted that the higher inpatient costs for autograft repair may be attributable to OR costs. Although OR costs are also higher for autograft repair in the outpatient setting, researchers found the cost was offset by the higher implant cost for allograft repair.
“[These results are] liberating for surgeons because it allows surgeons to have an open and better informed conversation with patients regarding their preferences and what is best for that individual patient knowing that both autograft and allograft nerve reconstructions achieve comparable outcomes,” Styron said.
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