Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis: A Systematic Review and Meta- Analysis of Clinical Comparative Studies
Bibliographic record
Abstract
Category: Hindfoot; Ankle; Ankle Arthritis; Basic Sciences/Biologics; Trauma Introduction/Purpose: The purpose of this study was to evaluate the efficacy of biological adjuvants in hindfoot arthrodesis. Methods: A systematic review of the PubMed and Embase databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using specific search terms and eligibility criteria. Assessment of evidence was three-fold: level of evidence by criteria published by The Journal of Bone & Joint Surgery, quality of evidence by the Newcastle-Ottawa scale and conflicts of interest. Meta-analysis was performed by fixed-effects models for studies of low heterogeneity (I2 <25%) and random-effects models for studies of moderate to high heterogeneity (I2 >=25%). Results: Hindfeet totaled 1579 patients as protocol and 1503 patients per protocol. Final reported mean follow-up ranged from 2.8 months to 43 months. Twelve of the 17 included studies were comprised of patients with comorbidities associated with reduced healing capacity. Based on the random-effects model for non-union rates for autograft versus allograft, the risk ratio was 0.82 (95% CI, 0.13 to 5.21; I2 = 56%; p = 0.83) in favour of lower non-union rates for autograft and for autograft versus rhPDGF/ß-TCP, the risk ratio was 0.90 (95% CI, 0.74 to 1.10; I2 = 59%; p = 0.30) in favour of lower non-union rates for rhPDGF/ß-TCP. Conclusion: There is a lack of data to support the meaningful use of biological adjuvants compared to autograft/allograft for hindfoot arthrodesis. The meta-analysis favoured the use of autograft when compared to allograft, but favoured rhPDGF/ß-TCP instead when compared to autograft in the short-term follow-up.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.029 | 0.007 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".