Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis

Seow, Dexter; Yasui, Youichi; Dankert, John F.; Miyamoto, Wataru; Calder, James; Kennedy, John G.

doi:10.2106/jbjs.20.01475

Cited by 3 publications

(2 citation statements)

References 51 publications

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“…47 Another meta analysis concluded that insufficient data are available to recommend the use of PDGF-derived biologics over bone autografts in hindfoot fusion. 39…”

Section: Discussionmentioning

confidence: 99%

“…47 Another meta-analysis concluded that insufficient data are available to recommend the use of PDGF-derived biologics over bone autografts in hindfoot fusion. 39 Despite the potential to optimize bone healing, orthobiologic augmentation is rarely used for primary surgical fixation of acute fractures. 7,43 This is attributable to the satisfactory union rates and times to union using wellestablished fracture fixation methods without orthobiologic augmentation.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures

Attia

Robertson²,

McKinley

et al. 2022

Am J Sports Med

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Background: The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated. Purpose: To determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through March 2021 to identify studies reporting on surgically managed Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the return to play (RTP) rate and time to RTP, whereas the secondary outcomes were time to union, union rate, and refractures. Data were presented by type of treatment (biologically augmented fixation or fixation alone). Results: In the biologically augmented fixation group, successful RTP was reported in 195 (98.98%) of 197 fractures (odds ratio [OR], 97.5%; 95% CI, 95.8%-100%; I2 = 0), with a mean time to RTP of 10.3 weeks (95% CI, 9.5-11.1 weeks; I2 = 99%). In the group that received fixation without biological augmentation, successful RTP was reported in 516 (99.04%) of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; I2 = 0], with a mean time to RTP of 9.7 weeks (95% CI, 7.84-11.53 weeks; I2 = 98.64%]. In the biologically augmented fixation group, fracture union was achieved in 194 (98.48%) of 197 fractures (OR, 97.6%; 95% CI, 95.5%-99.7%; I2 = 0%), with a mean time to fracture union of 9.28 weeks (95% CI, 7.23-11.34 weeks; I2 = 98.18%). In the group that received fixation without biological augmentation, fracture union was achieved in 407 (93.78%) of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; I2 = 0%), with a mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; I2 = 98.81%). Conclusion: Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone but similar rates of RTP and time to RTP. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high quality comparative studies are required to establish the indication for orthobiologic augmentation.

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“…47 Another meta analysis concluded that insufficient data are available to recommend the use of PDGF-derived biologics over bone autografts in hindfoot fusion. 39…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures

Attia

Robertson²,

McKinley

et al. 2022

Am J Sports Med

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Arthroscopic Subtalar Joint Arthrodesis: Posterior Approach

Wei

Akoh

Amendola

et al. 2022

Arthroscopic Techniques and Anatomy of the Foot and Ankle

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Ankle Fusion Rates using Composite Peptide-enriched Bone Graft

McKinnon,

Symes,

Wines

et al. 2024

TOORTHJ

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Introduction Joint fusion is a widely accepted treatment option for debilitating arthritis and deformity in the foot and ankle. Autologous bone grafting has long been accepted as the gold standard form of bone grafting; however, it can still be associated with non-union. This study aims to investigate joint fusion rates using Composite Peptide Enhanced Bone Graft (CPEBG) as an adjunct during ankle fusion surgery. Methods Data was collected retrospectively for patients over the age of 18 years, undergoing ankle fusion between June 2016 and August 2020 with autologous bone graft and CPEBG. All patients had their primary or secondary procedure performed by a single surgeon with follow-up at 6 and 12 months post-operatively. Data included baseline demographic data and procedural characteristics. The primary endpoint was to assess joint union at 6 and 12 months, respectively. Secondary objectives included post-operative pain, mobility and the use of walking aids. Results Radiographic union rates for the primary group were 40/48 (83%) and 43/48 (90%) at 6 and 12 months and 2/3 (67%) and 3/3 (100%) at 6 and 12 months for the secondary group, respectively. The overall non-union rate for primary ankle fusions was 8%, while no non-unions were observed in the secondary group. Conclusion CPEBG in foot and ankle fusion procedures yields similar union rates compared to other graft options. Further well-designed randomised control trials are warranted to confirm these findings.

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Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis

Cited by 3 publications

References 51 publications

Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures

Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures

Arthroscopic Subtalar Joint Arthrodesis: Posterior Approach

Ankle Fusion Rates using Composite Peptide-enriched Bone Graft

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