A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits

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The systematic literature review and meta-analysis focused on the repair of peripheral nerve gaps using autografts, allografts, and conduits shows that, in nerve injuries with gaps larger than 5 mm and less than 70 mm, autograft and allograft repairs demonstrate comparable meaningful recovery (MR) rates. The study gathered data from 35 studies comprising 1559 nerve repairs, demonstrating that autografts and allografts effectively restore sensory and motor functions with no statistically significant differences between them. However, conduits, typically used for shorter gaps, were found to have lower MR rates and higher complication rates, particularly regarding sensory short gap repairs compared to autografts and allografts.<br /><br />Autograft repairs, which involve transplanting nerve tissue from another part of the patient's body, were associated with some donor-site complications like neuroma and donor-site pain. Allografts, which utilize donor nerve tissue, eliminated these donor-specific complications and showed comparable MR rates to autografts, as well as lower inpatient costs. This indicates that allografts could be a feasible alternative to autografts, bearing no additional economic burden and avoiding the complications associated with donor sites.<br /><br />The analysis underscores the importance of considering both clinical outcomes and economic impacts when choosing between nerve repair options. While autografts have been the historical standard due to their non-immunogenic nature and structural benefits, allografts present a comparable alternative in terms of recovery rates and costs, with the added benefit of reduced donor-site morbidity. Conduits, however, showed less favorable outcomes, particularly in short-gap sensory repairs. These findings suggest that further direct comparative studies could reinforce these results and clarify the best practices for specific nerve repair scenarios.

Keywords

peripheral nerve repair

autografts

allografts

nerve conduits

meta-analysis

sensory function restoration

motor function restoration

donor-site complications

economic impact

nerve injury recovery