The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery

Abstract

Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments. Level of Evidence: Level V, expert opinion.

Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review

“…The osteoinductive, osteoconductive, osteogenic, and angiogenetic properties of the bone graft preparation used are responsible for the biologic effect to facilitate bone fusion. 6 Based on these principles, autologous bone graft has been considered the benchmark graft used in foot and ankle arthrodesis procedures because it provides all four aspects of an ideal bone graft. Disadvantages associated with the use of autograft include donor site complications, need for additional surgical incision, and variability of the quality of autograft harvested based on host factors and anatomic location used as the source, which can all affect clinical outcomes.…”

“…Given the high heterogeneity in the literature and the rapidly expanding research on this topic, [5][6][7] we only included comparative studies analyzing the outcomes after ankle or foot arthrodesis using different types of bone grafts, with primary focus on articles comparing newer biologic evidence against autograft, which remains the current benchmark.…”

Contemporary Review: Autograft Bone Use in Foot and Ankle Surgery

“…It is generally thought the amount and concentration of bone marrow MSCs decrease in each extremity from proximal to distal. 11 , 19 , 22 …”

“…Autologous bone grafts are frequently harvested for use in foot and ankle surgery. 8 , 12 , 18 , 22 , 25 , 28 , 32 Bone autografts have been reported to contain osteoconductive, osteoinductive, and osteogenic properties. These provide the scaffold, growth factors, signal proteins, and mesenchymal cells to facilitate healthy bone growth and healing.…”

“…These provide the scaffold, growth factors, signal proteins, and mesenchymal cells to facilitate healthy bone growth and healing. 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.…”