Allograft Versus Autograft Osteochondral Transplant for Chondral Defects of the Talus: Systematic Review and Meta-analysis

Abstract

Background: It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. Purpose: A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications. Study Design: Systematic review; Level of evidence, 4. Methods: This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure. Results: Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score ( P > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; P = .04) and AOFAS (MD, 4.8; P = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups ( P = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; P < .0001) and failure (OR, 5.1; P < .0001). Conclusion: Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.

Functional biomaterials for osteoarthritis treatment: From research to application

“…There are three common cartilage transplantation methods: autologous osteochondral transplantation, allogeneic osteochondral transplantation, and cartilage transplantation based on tissue engineering techniques. 78,79 Autologous cartilage transplantation is suitable for patients with minor cartilage defects, and allogeneic transplantation is often used for large cartilage defects. However, cartilage graft therapy may fail when the defect is too large.…”

Contemporary Review: Autograft Bone Use in Foot and Ankle Surgery

“… 8 , 13 , 18 , 22 , 28 Bone autografts also pose no risk for rejection or disease transmission when compared to allografts. 17 , 18 , 25 The combination of these properties and benefits makes autografts an attractive option for adjunctive use in procedures like arthrodesis, with the goal of enhanced bone healing and, therefore, successful fusion. 7 , 28 Associated donor site morbidity, however, remains the main potential downside to autograft harvest.…”

“… 7 , 28 Associated donor site morbidity, however, remains the main potential downside to autograft harvest. 5 , 7 , 10 , 17 , 20 …”

“…7,28 Associated donor site morbidity, however, remains the main potential downside to autograft harvest. 5,7,10,17,20 Historically, the iliac crest was most commonly used to harvest autologous bone graft because of its ease of access and higher quantity of available graft. 3,18 However, iliac crest donor site morbidity and complications remain a concern, with frequent donor site pain and a reported complication rate as high as 49%.…”

Cell therapies for chondral defects of the talus: a systematic review

“…Focal chondral defects of the talus are common in the young and active population [ 1 , 2 ]. Given the limited healing potential of hyaline cartilage, these lesions are most likely unable to regenerate [ 3 , 4 ]. If left untreated, patients may experience chronic instability, persistent pain, and early onset osteoarthritis [ 5 – 7 ].…”