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Published on: December 22, 2015
No Difference in Outcome Comparing Autograft and Allograft in Arthroscopic-Assisted Bone Grafting for Treating
Chih-Hsun Chang1,2, Chin-Hsien Wu3,4, Jung-Pan Wang5,6
1Department of Orthopedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
Purpose:
To compare arthroscopic bone grafting (ABG) with autograft and allograft for the treatment of scaphoid nonunion.
Methods:
Between 2012 and 2024, this retrospective comparative study included patients with unstable scaphoid nonunion who underwent ABG with either autograft or allograft. Eligible patients had symptomatic scaphoid nonunion treated with ABG and internal fixation and were followed for a minimum of 12 months. Radiographic assessments included healing of the nonunion site, scaphoid length, scapholunate angle, and radiolunate angle. Functional assessments included wrist range of motion, grip and pinch strength, pain scores measured using the visual analog scale, and patient-reported outcomes evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and modified Mayo Wrist Score.
Results:
There were 47 and 27 patients in the autograft and allograft groups, respectively. The mean follow-up was 20.4 months (range, 12-76) and 18.7 months (range, 12-130), with no significant difference (P = .715). There were 3 cases of nonunion in each group (6.4% vs. 11.1%; P = .667), with no significant difference (P = .667). The mean healing times were 3.4 ± 0.7 and 3.7 ± 1.1 months in the autograft and allograft groups, respectively, with no significant difference (P = .266). No other postoperative complications or donor-site morbidity were observed. Both groups showed significant restoration of scaphoid length compared with preoperative measurements. The allograft group showed significant postoperative improvement and achieved a more favorable mean scapholunate angle than the autograft group. Moreover, both groups showed significant postoperative improvement in the radiolunate angle. In the autograft and allograft groups, respectively, visual analog scale decreased from 3.9 to 0.4 and from 4.3 to 0.5, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire improved from 28.9 to 8.4 and from 29.0 to 9.1, and modified Mayo Wrist Score improved from 68.9 to 89.3 and from 70.2 to 87.9 (all P < .001). Minimal clinically important difference was achieved in 93.6% of the autograft group and 96.3% to 100% of the allograft group, with no significant differences (P > .05).
Conclusions:
ABG using autograft or allograft resulted in satisfactory union and acceptable radiographic and functional outcomes. Most patients achieved clinically meaningful improvement based on minimal clinically important difference. However, there is a possibility of low statistical power and a risk of type II error.
Level Of Evidence:
Level III, retrospective comparative case series.