Peripheral Nerve Repair Performed with an Autograft versus Allograft: Systematic Review & Meta-Analysis
Zachary Herman, BS1; Clay Townsend, BS2; Asif Ilyas, MD3
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 2Rothman Institute at Thomas Jefferson University Hopsital, Philadelphia, PA; 3Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
Peripheral nerve injuries to the upper extremity are common and can occur from trauma, surgery, or compression. When the peripheral nerve injury results in a defect or gap, classically nerve autografts have been considered the gold standard to repair the nerve injury. An alternative to the autologous nerve graft is the use of the processed nerve allograft. Currently, limited data exists in comparing sensory and motor outcomes of allograft versus autograft nerve repair in the upper extremity. In this systematic review and meta-analysis, we set out to cumulate results of motor and sensory outcomes of allograft peripheral nerve lesion repair and compare those results with outcomes of autograft repair.
Current literature on motor and sensory outcomes of autograft and allograft peripheral nerve repair were reviewed using British Medical Research Council (MRC) score for both sensory recovery and muscle strength grading system, and complication rates, as the outcomes of interest. A “meaningful recovery” was defined as a sensory recovery of S3 or greater and muscle strength grading of M3 or greater. After inclusion and exclusion criteria were applied, 12 articles were reviewed and 826 nerve repairs were analyzed.
The mean gap length for the allograft group and autograft group was 28.6 mm and 24.7 mm, respectively. Relative to MRC sensory recovery, 70% of allograft nerve repairs showed meaningful recovery compared to 45% of autograft nerve repairs (p<0.005). Relative to MRC motor recovery, 74% of allograft repaired showed meaningful recovery compared to 57% for autograft nerve repairs (p<0.005). Complication data differences were insignificant.
Based on the current systematic review and meta-analysis, we found that both autograft and allograft repair have reasonable outcomes. But, processed nerve allograft repair statistically out-performed autograft repair in peripheral nerve repairs of the upper extremity.
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