Autologous bone graft remains the gold standard source of bone graft. Iliac crest has traditionally been the most popular source for autologous bone graft. However, iliac crest bone graft harvesting is associated with high donor site morbidity. Bone graft harvesting from the proximal tibia has shown great potential with reported low complication rates. However, there is a paucity of biomechanical studies concerning the safety as well as yield of proximal bone graft harvesting.
This biomechanical study was designed to investigate (1) the stability of the harvested proximal tibial during physiological loading, and (2) the maximum size of the cortical window that can be safely created and (3) volume of accessible bone graft.
Bone grafts were harvested from eleven cadaveric tibiae using a circular cortical window along the lateral proximal tibia. These harvested proximal tibiae were then loaded under physiological conditions (mean 2320N, range 1650–3120N) using a customized test fixture. Strain rosettes were mounted at 7 locations in the harvested proximal tibia to record the changes in strain at the harvested proximal tibia. The change in strain with increasing cortical window size (10–25 mm diameter) was also studied. Bone principal strains as well as volume of bone harvested were recorded.
A repeated measures ANOVA was used to analyze the change in bone strains with the cortical window size. Statistically significant (p < 0.05) increases in bone strains at the anterior and medial aspects of the tibia were observed with increasing size of osteotomies (−328.85 με, SD = 232.21 to −964.78 με, SD = 535.89 and 361.64 με, SD = 229.90 to −486.08 με, SD = 270.40 respectively), and marginally significant changes in strain at the lateral and posterior aspects. None of the tibiae failed under normal walking loads even with increasing osteotomies size of 10–25 mm diameter. A smaller osteotomy of 10 mm diameter yielded an average volume of 7.15 ml of compressed bone graft, while a larger osteotomy of 25 mm diameter yielded on average an additional 3.64 ml of bone graft. Bone grafting of the proximal tibia through the lateral approach with a circular osteotomy is a feasible option even with osteotomies of 25 mm diameter. Even though increased bone strains were observed, the strains did not exceed the yield strain of cortical bone when loaded under normal walking conditions. The quantity of bone harvested from the proximal tibia is comparable to that harvested from the iliac crest.
This biomechanical study demonstrated the stability of the harvested proximal tibia under conditions of full weight bearing ambulation. It has also refined the technique of proximal bone graft harvesting by determining the maximum size of the cortical window. The findings of this study add to the overall understanding of proximal tibial bone graft harvesting, providing objective data regarding stability as well as yield. This information would be useful during selection of source of autologous bone graft.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Injury
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Bone graft harvest site options in orthopaedic trauma: a prospective in vivo quantification study.Injury. 2012; 43: 323-326
- Bone graft harvesting from distant sites: concepts and techniques.Oral Maxillofac Surg Clin North Am. 2010; 22: 301-316
- Autogenous bone graft: donor sites and techniques.J Bone Joint Surg Am. 2011; 93: 2227-2236
- Tibia bone graft harvest technique.Atlas Oral Maxillofac Surg Clin North Am. 2005; 13: 119-126
- Technique for harvesting tibial cancellous bone modified for use in children.Br J Oral Maxillofac Surg. 1999; 37: 129-133
- Tibial autogenous cancellous bone as an alternative donor site in maxillofacial surgery.J Oral Maxillofac Surg. 1992; 50: 1258-1263
- Medial approach for tibial bone graft: anatomic study and clinical technique.J Oral Maxillofac Surg. 2003; 61: 358-363
- Surgical techniques: how I do it? Bone graft harvest from the proximal lateral tibia.Injury. 2010; 41: 242-244
- A modified technique of harvesting tibial cancellous bone and its use for sinus grafting.Clin Oral Implants Res. 2001; 12: 488-494
- Harvesting of autogenous cancellous bone graft from the proximal tibial metaphysis: a review of 230 cases.J Orthop Trauma. 1991; 5: 469-474
- Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction.J Korean Assoc Oral Maxillofac Surg. 2013; 39: 257-262
- The proximal tibia metaphysis: a reliable donor site for bone grafting?.Clin Orthop Relat Res. 2003; 414: 315-321
- Proximal tibial bone graft: the volume of cancellous bone, and strength of decancellated tibias by the medial approach.Int J Oral Maxillofac Surg. 2012; 41: 531-536
- Stability behavior of human tibias after bone removal—comparative examination in 15 cadaver tibia pairs.J Oral Maxillofac Surg. 2010; 68: 60-67
- Effect of tibial graft harvest on plateau compliance: a biomechanical study.J Oral Maxillofac Surg. 2008; 66: 52
- Tibial or hip BMD predict clinical fracture risk equally well: results from a prospective study in 700 elderly Swiss women.Osteoporos Int. 2009; 20: 1393-1399
- Cross sectional geometry of Pecos Pueblo femora and tibiae: a biomechanical investigation: method and general patterns of variation.Am J Phys Anthropol. 1983; 60: 359-381
- Bone grafting from the proximal tibia.J Trauma. 1999; 47: 555-557
- Anterior iliac crest, posterior iliac crest, and proximal tibia donorsites: a comparison of cancellous bone volumes in fresh cadavers.J Oral Maxillofac Surg. 2010; 68: 3015-3021
- In vivo measurement of human tibial strains during vigorous activity.Bone. 1996; 18: 405-410
- Mechanical properties and histology of cortical bone from younger and older men.Anat Rec. 1976; 185: 1-11
- Mechanical properties and composition of cortical bone.Clin Orthop Relat Res. 1978; 135: 192-217
- Dependence of yield strain of human trabecular bone on anatomic site.J Biomech. 2001; 34: 569-577
- Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue.J Biomech. 2004; 37: 27-35
- Fatigue of bone and bones: an analysis based on stressed volume.J Orthop Res. 1998; 16: 163-169
- The weight bearing function of fibula. A strain gauge study.J Bone Joint Surg Am. 1971; 53: 507-513
- Role of the Fibula in weight bearing.Clin Orthop Relat Res. 1984; 184: 289-292
- Dynamic function of the human fibula.Am J Anat. 1973; 138: 145-149
Published online: September 09, 2016
© 2016 Elsevier Ltd. All rights reserved.