The Use of Tricortical Autograft Versus Allograft in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity: An Analysis of Union Rates and Complications

Abstract

The management of adult acquired flatfoot is an evolving practice with the optimal lateral column lengthening procedure still left to considerable debate. The usual choices include lengthening with the use of autograft or allograft through a calcaneocuboid lengthening arthrodesis or Evans' calcaneal lengthening osteotomy. To our knowledge there is only one other study comparing autograft to allograft in adult lateral column lengthening procedures.(9) The purpose of this study was to evaluate differences with regard to union rates and complications when comparing the use of iliac tricortical autograft versus iliac tricortical allograft supplemented with platelet rich plasma (PRP) in adult acquired flatfoot lateral column lengthening procedures. The charts and radiographs of 49 patients (51 feet) were evaluated. Twenty total procedures were performed using iliac tricortical autograft and 31 procedures were performed using iliac tricortical allograft with PRP. Successful union was achieved in 14 of 20 (70%) autograft procedures and 29 of 31 (94%) allograft procedures. Thirteen of 20 (65%) of the autograft group and 11 of 31 (35%) of the allograft group had a documented complication other than nonunion. Average length of hospital stay for patients who had procedures using autograft was 3.6 days and those who had allograft was 2.5 days. The average charge for those receiving allograft with PRP, including hospital stay, was roughly $2,500 more than those receiving an autograft procedure. Although the numbers were small, we believe that equivalent if not better healing and complication rates are possible with the use of allograft with PRP versus autograft for lateral column lengthening procedures while allowing for similar correction of deformity.