Arthroscopy - 2026-08-29 - Journal Article
No Difference in Outcome Comparing Autograft and Allograft in Arthroscopic-Assisted Bone Grafting for Treating Unstable Scaphoid Nonunion.
Chang CH, Wu CH, Wang JP, Huang YC, Yin CY, Huang HK
Topics
Key Takeaway
Arthroscopic bone grafting for unstable scaphoid nonunion achieved union in 93.6% (autograft) vs. 88.9% (allograft) with no significant difference in union rate, healing time, or functional outcomes at mean 20 months follow-up.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective comparative study asked whether allograft is equivalent to autograft in arthroscopic-assisted bone grafting for unstable scaphoid nonunion. Both groups achieved significant functional improvement (QuickDASH 28.9→8.4 autograft; 29.0→9.1 allograft) and pain reduction (VAS 3.9→0.4 vs. 4.3→0.5), with persistent nonunion in 6.4% vs. 11.1% (P=.667). The allograft group achieved a more favorable postoperative scapholunate angle, though no other radiographic or functional metric differed significantly between groups.
Key Limitation
The 27-patient allograft group is underpowered to detect a clinically meaningful difference in the 4.7% nonunion rate gap, making the equivalence conclusion statistically unsupported.
Original Abstract
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.