Bone grafting plays a crucial role in various orthopedic procedures. The selection of an optimal autograft site is vital to ensure successful outcomes with minimal patient discomfort and complications.
Frequently, the posterior superior iliac spine has been the most reliable source for autologous bone in prone positioned patients. For supine positioned patients, the anterior iliac crest (AIC) has been the traditional donor site option; however, recent research has shed light on the potential advantages of the proximal tibia (PT), as an alternative harvesting site.
In this blog we explore the key findings of a systematic review and meta-analysis titled “Comparison of Anterior Iliac Crest Versus Proximal Tibia Autologous Bone Graft Harvesting – A Systematic Review and Meta-Analysis” published by The Journal of Foot and Ankle Surgery.
It should be noted that this systematic review study included all forms of bone graft harvesting, open and minimally invasive.
Pain Reduction
One of the primary concerns associated with bone graft harvesting is postoperative pain. The meta-analysis revealed a significant reduction in pain favoring PT harvesting at the 24-hour mark. The effect size indicated a consistent decrease in pain across studies. However, this effect was not observed after one month, suggesting that the initial advantage of PT harvesting in terms of pain reduction may be temporary.
Complication Rates
The review assessed the complication rates associated with both AIC and PT harvesting techniques. The finding suggested that PT harvesting is associated with a lower risk of complications compared to AIC harvesting. The reduced complication rate is a significant advantage, as it minimizes patient discomfort and the potential need for additional medical intervention.
Bone Graft Quantity and Quality
The analysis included cadaveric and cell-based studies to evaluate the quantity and quality of the bone graft obtained from both AIC and PT. The majority of the cadaveric studies favored PT harvesting, demonstrating a higher volume of bone graft obtained compared to AIC. This finding highlights the greater availability of bone in the proximal tibia, making it a more accessible repository for grafting purposes.
Regarding the quality of the bone graft, the results were less conclusive. While only one cell-based study favored AIC, further research is needed to draw definitive conclusions. However, the fact that PT harvesting showed comparable or better outcomes in terms of bone graft quantity and cellular properties provides a strong rationale for its consideration as a viable alternative.
In Summary
While the systematic review and meta-analysis support the use of PT as a reliable option for bone grafting, it is important to acknowledge that this study did not establish relative efficacy in terms of bone healing. The evidence available to date, however, suggests that PT harvesting offers several advantages over AIC harvesting, including lower complication rates, reduced postoperative pain (at least in the short term), and greater bone graft quantity.
For surgeons performing bone graft procedures in the supine position of other positions in which the proximal tibia is readily accessible, it is important to raise awareness of the benefits and availability of this technique. Encouraging surgeons to acquire experience and expertise in PT harvesting can enhance patient outcomes and improve the overall efficiency of autologous bone grafting procedures.
The comparative analysis presented in the systematic review and meta-analysis supports the notion that proximal tibia harvesting is a viable alternative to anterior iliac crest harvesting. Its accessibility, lower complication rates, and favorable clinical outcomes make it an attractive option for surgeons performing anterior approach spine surgery (including anterior cervical fusions) as well as other supine positioned procedures, such as foot and ankle surgery.
To further enhance the field of bone grafting and improve patient experiences, it is important to embrace innovative devices and techniques. By incorporating cutting-edge tools like the COREX minimally invasive bone harvester, we can minimize harvest site morbidity and maximize the benefits of bone grafting procedures.
We invite you to be part of this transformative journey in spine surgery and bone grafting. Contact us today to learn more about the latest advancements and explore the potential of proximal tibia harvesting. Together, we can shape the future of orthopedic surgery and ensure optimal outcomes for our patients. Request your free sample and join us as we pave the way for innovation and excellence in bone grafting procedures.
