Early graft failure in lateral column lengthening

One hundred thirty feet in 96 children (47 girls, 49 boys) treated with lateral column lengthening to correct planovalgus foot deformities were retrospectively reviewed. Sixty-nine feet had lengthening through the neck of the calcaneus (39 allografts, 30 autografts) and 61 feet had calcaneocuboid joint lengthening and arthrodesis (58 allografts, 3 autografts). Radiographic evaluation before surgery, after surgery, and at follow-up was used to determine loss of correction, graft lucencies or fragmentation, and apparent loss of graft length. Collapse (loss of correction with concomitant loss of graft length) was observed between 0.3 and 1.3 years after surgery. Seventeen (29.3%) of the 58 calcaneocuboid joint allografts demonstrated collapse. None of the 69 intracalcaneal grafts (39 allografts, 30 autografts) and none of the 3 calcaneocuboid autografts collapsed. This series suggests that lateral column lengthening through the neck of the calcaneus may provide a more durable correction than lengthening with calcaneocuboid joint fusion.