Heifner JH, et al. - This study was sought to summarize the available literature on primary open ankle arthrodesis fixated with cannulated screws in order to evaluate the importance of bone graft in achieving more favorable rates of fusion. Researchers carried out to search PubMed and Embase for articles reporting on primary open ankle arthrodesis fixated with cannulated screws which-specified the use or non-use of bone graft. They conducted pooled data analysis. Reporting quality was evaluated by calculating Modified Coleman Methodology Scores. The available literature implies that in low-risk patients, a bone graft may not be required in routine tibiotalar arthrodesis. It has been considered that it may more significantly impact patients who are at high-risk of fusion failure, and dedicated research on this high-risk subset of individuals is needed.