Ankle Arthrodesis Using Fibular Bone Graft: A Depth Meta-analysis from 1991 to 2022

When conventional approaches are used, ankle arthrodesis can lead to substantial rates of failure or nonunion, especially in high-risk patients. This systematic review evaluates ankle arthrodesis outcomes in individuals receiving fibula transplants.

We have registered our protocol with PROSPERO (CRD42024511245). We did comprehensive searches in both Embase and Medline. The Joanna Briggs Institute (JBI) looked at the quality of the chosen works. A meta-analysis determined the differences between the AOFAS score, full weight-bearing (FWB) time, and bone union. The PRISMA guidelines were used to do this systematic study.

We retrieved 291 articles and then selected 20 for meta-analysis and systematic review. A total of 179 patients and ankles were included in the analysis. Eight articles reported a 100% union rate; the remaining four reported that the lowest union rate is about 82%. The AOFAS score significantly increased by 22.5 (95% CI 14.7-30.2) between the preoperative and postoperative evaluations. The average period to complete weight-bearing post-operation and bone healing is about 8.21 months (95% CI: 3.65-12.77) and 5.9 months (95% CI: 3.26-8.54), respectively.

Fibular bone graft had a favorable outcome in ankle arthrodesis, including in patients with comorbidities that have bone healing impairment. The union rate showed satisfactory results, and the AOFAS score improved.