Skip to main content
Log in

Autograft and Allograft Unite Similarly in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

  • Original Article
  • Published:
HSS Journal ®

Abstract

Background

Lateral column lengthening (LCL) is used to address the forefoot abduction associated with the adult acquired flatfoot. This opening wedge osteotomy can be filled with either allograft or autograft bone.

Questions/Purposes

The investigators sought to determine union rates and any loss of correction in patients undergoing LCL with autograft versus allograft.

Methods

Over a 3-year period, 126 LCLs performed by five surgeons in 120 patients were reviewed. Autograft was used in 51 patients, allograft in 75 patients. Times to clinical and radiographic union were established for these patients. Any loss of correction of forefoot abduction as manifested by talonavicular uncoverage was recorded for those grafts that healed. Failure was defined as nonunion or loss of 50% or greater correction. The size of the implanted graft was assessed as a risk factor for failure.

Results

There were 20 total failures: seven in patients with autograft and 13 in patients with allograft (p = 0.63). The size of the implanted graft was larger in those patients that did fail (p = 0.04).

Conclusions

The rate of nonunion and loss of correction for LCL was not significantly different between allograft and autograft. The overall rate of nonunion may be higher than has previously been reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom, P. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am. 2002;84-A:716–720.

    PubMed  Google Scholar 

  2. Arangio GA, Chopra V, Voloshin A, Salathe EP. A biomechanical analysis of the effect of lateral column lengthening calcaneal osteotomy on the flat foot. Clin Biomech (Bristol, Avon). 2007;22:472–477.

    Google Scholar 

  3. Benthien RA, Parks BG, Guyton GP, Schon LC. Lateral column calcaneal lengthening, flexor digitorum longus transfer, and opening wedge medial cuneiform osteotomy for flexible flatfoot: a biomechanical study. Foot Ankle Int. 2007;28:70–77.

    Article  PubMed  Google Scholar 

  4. Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. 1983;174:28–42.

    Google Scholar 

  5. Chi TD, Toolan BC, Sangeorzan BJ, Hansen ST Jr. The lateral column lengthening and medial column stabilization procedures. Clin Orthop Relat Res. 1999;365:81–90.

    Google Scholar 

  6. Conti SF, Wong YS. Osteolysis of structural autograft after calcaneocuboid distraction arthrodesis for stage II posterior tibial tendon dysfunction. Foot Ankle Int. 2002;23:521–529.

    PubMed  Google Scholar 

  7. Danko AM, Allen B Jr, Pugh L, Stasikelis P. Early graft failure in lateral column lengthening. J Pediatr Orthop. 2004;24:716–720.

    Article  PubMed  Google Scholar 

  8. Deland JT. Adult-acquired flatfoot deformity. J Am Acad Orthop Surg. 2008;16:399–406.

    PubMed  Google Scholar 

  9. Deland JT, Page A, Sung IH, O'Malley MJ, Inda D, Choung S. Posterior tibial tendon insufficiency results at different stages. HSS J. 2006;2:157–160.

    Article  PubMed  Google Scholar 

  10. Dolan CM, Henning JA, Anderson JG, Bohay DR, Kornmesser MJ, Endres TJ. Randomized prospective study comparing tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for operative correction of adult acquired flatfoot deformity. Foot Ankle Int. 2007;28:8–12.

    Article  PubMed  Google Scholar 

  11. Dumontier TA, Falicov A, Mosca V, Sangeorzan B. Calcaneal lengthening: investigation of deformity correction in a cadaver flatfoot model. Foot Ankle Int. 2005;26:166–170.

    PubMed  Google Scholar 

  12. Ellis SJ, Yu JC, Johnson AH, Elliott A, O'Malley M, Deland J. Plantar pressures in patients with and without lateral foot pain after lateral column lengthening. J Bone Joint Surg Am. 2010;92:81–91.

    Article  PubMed  Google Scholar 

  13. Ellis SJ, Yu JC, Williams BR, Lee C, Chiu Y, Deland JT. New radiographic parameter assessing forefoot abduction in the adult acquired flatfoot deformity. Foot Ankle Int. 2009;30: 1168–1176.

    Article  PubMed  Google Scholar 

  14. Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br. 1975;57:270–278.

    PubMed  CAS  Google Scholar 

  15. Goulet JA, Senunas LE, DeSilva GL, Greenfield ML. Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop Relat Res. 1997;339:76–81.

    Google Scholar 

  16. Grier KM, Walling AK. The use of tricortical autograft versus allograft in lateral column lengthening for adult acquired flatfoot deformity: an analysis of union rates and complications. Foot Ankle Int. 2010;31:760–769.

    Article  PubMed  Google Scholar 

  17. Hintermann B, Valderrabano V, Kundert HP. Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int. 1999;20:622–629.

    PubMed  CAS  Google Scholar 

  18. Johnson, KA; Strom, DE: Tibialis posterior tendon dysfunction. Clin Orthop Relat Res. 1989;239:196–206.

    Google Scholar 

  19. Mosca VS. Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg Am. 1995;77:500–512.

    PubMed  CAS  Google Scholar 

  20. Sands AK, Tansey JP. Lateral column lengthening. Foot Ankle Clin. 2007;12:301–8, vi-vii.

    Article  PubMed  Google Scholar 

  21. Scott AT, Hendry TM, Iaquinto JM, Owen JR, Wayne JS, Adelaar RS. Plantar pressure analysis in cadaver feet after bony procedures commonly used in the treatment of stage II posterior tibial tendon insufficiency. Foot Ankle Int. 2007;28:1143–1153.

    Article  PubMed  Google Scholar 

  22. Thomas RL, Wells BC, Garrison RL, Prada SA. Preliminary results comparing two methods of lateral column lengthening. Foot Ankle Int. 2001;22:107–119.

    PubMed  CAS  Google Scholar 

  23. Toolan BC, Sangeorzan BJ, Hansen ST Jr. Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults. J Bone Joint Surg Am. 1999;81:1545–1560.

    PubMed  CAS  Google Scholar 

  24. Vora AM, Tien TR, Parks BG, Schon LC. Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. J Bone Joint Surg Am. 2006;88:1726–1734.

    Article  PubMed  Google Scholar 

Download references

Disclosures

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a significant conflict of interest in connection with the submitted article. One or more of the authors have or will receive monies from a commercial entity that may be perceived as a potential conflict of interest.

Each author certifies that his or her institution has approved the reporting of these cases and that all investigations were conducted in conformity with ethical principles of research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Turner Vosseller MD.

Additional information

Level of Evidence: Therapeutic Study (Comparative retrospective study): Level III. See Levels of Evidence for a complete description.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vosseller, J.T., Ellis, S.J., O’Malley, M.J. et al. Autograft and Allograft Unite Similarly in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity. HSS Jrnl 9, 6–11 (2013). https://doi.org/10.1007/s11420-012-9317-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-012-9317-5

Keywords

Navigation