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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 EFORT+Open+Rev
2017 ; 2
(6
): 272-280
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The role of orthobiologics in foot and ankle surgery: Allogenic bone grafts and
bone graft substitutes
#MMPMID28736619
Wee J
; Thevendran G
EFORT Open Rev
2017[Jun]; 2
(6
): 272-280
PMID28736619
show ga
Orthobiologics are biological substances that are used therapeutically for their
positive effects on healing skeletal and soft-tissue injuries. The array of
orthobiological products currently available to the foot and ankle surgeon is
wide, and includes bone allografts, bone substitutes, growth factors, and
chondral scaffolds. Nonetheless, despite the surge in interest and usage of
orthobiologics, there remains a relative paucity of research addressing their
specific applications in foot and ankle surgery. In this review, we attempt to
provide an overview of the literature on commonly available allogenic bone grafts
and bone substitutes.There is Level II, III and IV evidence addressing allogenic
bone grafts in primary arthrodesis and osteotomy procedures in foot and ankle
surgery, which compares favourably with autogenic bone grafts in terms of fusion
rates and clinical outcomes (often with fewer complications), and supports a
Grade B recommendation for its use.Pertaining to bone substitutes, the
multiplicity of products, coupled with a lack of large prospective clinical
trials, makes firm recommendations difficult. Level II and IV studies of calcium
phosphate and calcium sulphate products in displaced intra-articular calcaneal
fractures have found favourable results in addressing bone voids, maintaining
reduction and promoting union, meriting a Grade B recommendation. Evidence for
TCP is limited to level IV studies reporting similarly good outcomes in
intra-articular calcaneal fractures, warranting a Grade C recommendation. The use
of demineralised bone matrix products in hindfoot and ankle fusions has been
described in Level II and III studies, with favourable results in achieving
fusion and good clinical outcomes, supporting a Grade B recommendation for these
indications.Overall, despite the general lack of high-level evidence in foot and
ankle surgery, allogenic bone grafts and bone substitutes continue to hold
front-line roles in treating the bone defects encountered in trauma, tumour, and
deformity correction surgery. However, more investigation is required before firm
recommendations can be made. Cite this article: EFORT Open Rev 2017;2:272-280.
DOI: 10.1302/2058-5241.2.160044.