Results of Autograft vs Allograft with Bone Marrow Aspirate Concentrate in Lateral Column Lengthening for Reconstruction of Progressive Collapsing Flatfoot Deformity

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Although Evan’s lateral column lengthening (LCL) calcaneal osteotomy is the standard joint-sparing surgical option to correct the forefoot abduction in Johnson and Strom Grade IIB progressive collapsing flatfoot deformity (PCFD), studies evaluating the choice of filling (autograft or allograft) for the osteotomy site on outcomes reveal heterogeneous results. The purpose of this study is to compare the results of graft choice on bony union, subsequent clinical outcomes and complication rates after LCL osteotomy. Methods: This was a retrospective study of 34 patients who underwent Evan’s LCL divided into 2 cohorts dependent on the type of graft used for the opening osteotomy (Group A used tricortical autograft harvested from the iliac crest, n = 24; Group B used tricortical allograft soaked in the patient’s own bone marrow aspirate concentrate, n = 10). Patient demographics, time to union, postoperative complications, and patient-reported outcome measures were compared among groups using univariable analyses. Minimum follow-up was 24 months. Results: Both groups demonstrated significant improvement in Visual Analogue Scale (VAS) of the midfoot and hindfoot, American Orthopaedic Foot & Ankle Society (AOFAS)-Mid and AOFAS-Hind scores at 6 months (P < 0.05) and continued experiencing improvement at 24 months postoperatively (P < 0.05). Nevertheless, there was no statistically significant difference in clinical outcomes or time to union between autograft and allograft when performing Evan’s LCL. In terms of complications, neither group experienced any non-union, though all who experienced surgical complications were from group A - 3 patients suffered peroneal tendinopathy, 1 patient experienced Achilles tendinopathy, 2 patients underwent removal of implants and 1 patient had chronic pain due to irritation to the plantar nerve. Conclusion: Significant and early improvement in clinical outcomes were observed in both groups with 100% union rates. Though Group A (iliac crest autograft) had higher rates of complications, it did not fare worse on patient-reported outcome measures when performing Evan’s LCL. Future studies involving larger sample sizes with standardized definitions for radiographic union will be critical to further elucidate graft-related impacts on outcomes after LCL.