Tibial Bone Graft Research Articles

Tibial Cancellous Bone Grafting in Jaw Reconstruction: 10 Years of Experience in Taiwan

Use of proximal tibia as a donor site has been applied in jawbone reconstruction since the 1990s. Catone and colleagues described a U-shaped incision made on the iliotibial tract during tibial cancellous bone procurement for maxillofacial reconstruction in 1992. We used a curvilinear incision on the iliotibial tract in lateral approach in our tibial cancellous bone harvesting procedure. The objectives of this retrospective study are to describe our modified lateral approach for procuring cancellous graft from the proximal tibia and to assess the bone volume, donor site morbidity, and associated complications. Eighty consecutive jawbone reconstructions utilizing autogenous tibial cancellous bone grafts in 78 patients from March 1998 through March 2008 were reviewed. The patient group consisted of 45 males and 33 females, ages 18 to 76 (average age 36.1 ± 12.3). Minimal postoperative follow-up period was 3 months. Unlike the traditional U-shaped trapdoor incision on the iliotibial tract, our curvilinear incision was made almost parallel to the fibers of that tract. Only mild complications were observed at donor sites, including temporary paresthesia, gait disturbance, and an unpleasant scar. The average procured graft volume was 17.8 mL. We also present the first case of reconstruction of mandibular continuity defects of up to 6 to 7 cm lengthwise by tibial cancellous bone grafting, which has not previously been reported in the English literature. The modified incision on the iliotibial tract allowed access to obtain an equally good bone volume from the lateral aspect of the proximal tibia, and it rendered wound closure much easier than the procuring techniques described in the earlier literature.

Comparison of Glenohumeral Contact Pressures and Contact Areas After Glenoid Reconstruction With Latarjet or Distal Tibial Osteochondral Allografts

Background: Glenoid reconstruction with distal tibial allografts offers the theoretical advantage over Latarjet reconstruction of improved joint congruity and a cartilaginous articulation for the humeral head. Hypothesis/Purpose: To investigate changes in the magnitude and location of glenohumeral contact areas, contact pressures, and peak forces after (1) the creation of a 30% anterior glenoid defect and subsequent glenoid bone augmentation with (2) a flush Latarjet coracoid graft or (3) a distal tibial osteochondral allograft. It was hypothesized that the distal tibial bone graft would best normalize glenohumeral contact areas, contact pressures, and peak forces. Study Design: Controlled laboratory study. Methods: Eight cadaveric shoulder specimens were dissected free of all soft tissues and randomly tested in 3 static positions of humeral abduction with a 440-N compressive load: 30°, 60°, and 60° of abduction with 90° of external rotation (ABER). Glenohumeral contact area, contact pressure, and peak force were determined sequentially using a digital pressure mapping system for (1) the intact glenoid, (2) the glenoid with a 30% anterior bone defect, and (3) the glenoid after reconstruction with a distal tibial allograft or a Latarjet bone block. Results: Glenoid reconstruction with distal tibial allografts resulted in significantly higher glenohumeral contact areas than reconstruction with Latarjet bone blocks in 60° of abduction (4.87 vs 3.93 cm2, respectively; P < .05) and the ABER position (3.98 vs 2.81 cm2, respectively; P < .05). Distal tibial allograft reconstruction also demonstrated significantly lower peak forces than Latarjet reconstruction in the ABER position (2.39 vs 2.61 N, respectively; P < .05). Regarding the bone loss model, distal tibial allograft reconstruction exhibited significantly higher contact areas and significantly lower contact pressures and peak forces than the 30% defect model at all 3 abduction positions. Latarjet reconstruction also followed this same pattern, but differences in contact areas and peak forces between the defect model and Latarjet reconstruction in the ABER position were not statistically significant (P > .05). Conclusion: Reconstruction of anterior glenoid bone defects with a distal tibial allograft may allow for improved joint congruity and lower peak forces within the glenohumeral joint than Latarjet reconstruction at 60° of abduction and the ABER position. Although these mechanical properties may translate into clinical differences, further studies are needed to understand their effects. Clinical Relevance: Glenoid bone reconstruction with a distal tibial osteochondral allograft may result in significantly improved glenohumeral contact areas and significantly lower glenohumeral peak forces than reconstruction with a Latarjet bone block, which could play a role in improving postoperative outcomes after glenoid reconstruction.

Comparison of Glenohumeral Contact Pressures and Contact Area After Glenoid Reconstruction with Latarjet or Distal Tibial Osteochondral Allograft

Multiple bone grafting procedures have been described for patients with glenoid bone loss and shoulder instability. Although long-term studies have demonstrated favorable results with regard to shoulder stability and function after autologous bone grafting procedures, such as the Latarjet reconstruction, multiple concerns remain. Glenoid reconstruction with distal tibial osteochondral allograft offers the theoretical advantage of improved joint congruity and a cartilaginous articulation for the humeral head. The purpose of this study was to investigate changes in the magnitude and location of glenohumeral contact area, contact pressure, and peak forces after (1) creation of 30% anterior glenoid defect, (2) subsequent glenoid bone augmentation with a flush Latarjet coracoid graft or a distal tibia osteochondral allograft. It is hypothesized that bone augmentation with a distal tibial bone graft will best normalize articular contact area, contact pressures, and peak forces seen within the glenohumeral joint.

Autogenous Cancellous Bone Graft Harvested from Proximal Tibia in Foot and Ankle Surgery

Purpose: The aim of this study was to evaluate clinical availability and advantage of autogenous cancellous bone graft from proximal tibia metaphysis. Materials and Methods: A retrospective review was conducted of 58 cases of foot and ankle surgeries using bone graft from the ipsilateral proximal tibia from August 2008 to March 2012 in Konkuk University Medical Center (Seoul, Korea). The group included patients with isolated reconstructions as well as trauma in the foot and ankle area. Results: The mean volume of cancellous bone harvested from the proximal tibia was 14 ml (range, 5 to 28 ml) and allograft was added to the autogenous bone graft in order to fill the large bone defect for six cases. The bone graft was performed for 41 arthrodesises, seven supramalleolar tibial osteotomies, eight open reduction and internal fixation procedures, and two curettage and bone grafts of bone tumor. At final follow-up, one case (1.7%) showed mild pain on the donor site and the mean visual analogue scale score for pain was 0.1 (range, 0 to 2). There was no occurrence of major post-operative complication at the donor site. Solid union at final follow-up was observed in 97% of cases. Conclusion: Proximal tibial bone graft was found to be a viable alternative to the iliac crest bone graft in the aspect of cancellous bone graft with relatively sufficient quantity and minimal donor site morbidity.

Bone Graft from the Distal Medial Tibia in Foot and Ankle Surgery

Autogenous bone graft is the ideal substrate for primary and revisional foot and ankle surgery. The distal medial tibia is an easily accessible site that provides both cancellous and corticocancellous autograft. Thirty cases of distal tibial bone graft with a minimum follow-up of 1 year are presented. There was an 86% union rate, and there were no stress fractures, persistent pain, or reported nerve injuries at the donor site. An efficient and versatile technique for harvesting both cancellous bone graft and corticocancellous graft is described. The use of distal tibial bone graft eliminates the need for a second surgeon and more lengthy harvest procedure and offers sufficient autograft material for foot and ankle applications with a low rate of complications. Therapeutic, Level IV.

Long-term follow-up of tibial bone graft for correction of alveolar cleft

Aims:The aim of this prospective study was to evaluate the quality and stability of autogenous tibial bone graft for the correction of alveolar bone defects in cleft patients in a long-term study as well as to evaluate the postoperative morbidity and risk of complications.Materials and Methods:A total of 47 patients with 55 donor sites were involved in this study. The first author performed all the procedures from 2003 to 2011. Medial and lateral approaches were used to harvest the bone with standardized surgical technique. Evaluation in both donor and recipient sites was done by clinical examination, postoperative pain and recovery, and radiographic examination by Panoramic and occlusal X-rays and lateral X-ray for the tibia. Moreover, the donor site was assessed for functionality and mobility based on the Lysholm score. Finally, the patient's experience was evaluated subjectively utilizing a visual analog scale.Results:The surgical outcome was satisfied in all except two cases with total graft resorption for unknown reasons. Regarding the postoperative patient experience we found that patients experienced pain in the recipient site more than they did at the donor site at 24-hour and two-week follow-ups.Conclusion:We conclude that the proximal tibia is a safe site from which cancellous bone graft can be harvested to repair the alveolus as it carries less early and late morbidity. Thus, we suggest that the tibia is an excellent choice as a donor site for alveolar bone grafting in children and adult with cleft lip and palate with satisfactory long-term stability.

Proximal tibial bone graft: the volume of cancellous bone, and strength of decancellated tibias by the medial approach

This study aimed to assess the volume of cancellous bone harvested by the medial approach from proximal tibia and compare the maximal compressive strength of decancellated tibias with intact tibias. Twelve cadavers were studied (11 male; 1 female). Cadavers with a history of bone disease and female cadavers over 60 years of age were excluded. Cancellous bone was taken from the right proximal tibia by the medial approach. Non-compressed and compressed cancellous bone volume was measured. Maximal compressive strength of decancellated tibias and intact tibias was measured and compared. The mean volume of bone harvested was 14.58±3.30ml with the non-compress technique (range 10.5–19.5ml) and 6.62±1.60ml (range 4.0–9.2ml) with the compress technique. There was no significant difference between the maximal compressive strength of the decancellated tibias and the intact tibias (P=0.085). Sufficient volume of cancellous bone for bone grafting in the oral maxillofacial surgery region can be harvested from the proximal tibia by the medial approach. The strength of decancellated tibias and intact tibias after harvesting cancellous bone graft were not different.

Cortical Tibial Bone Graft for Nasal Augmentation

This study sought to determine the efficacy of cortical tibial bone graft for nasal augmentation. Nine cases of augmentation rhinoplasty with cortical tibial bone graft are presented. This prospective study evaluated the postoperative results of nine patients who underwent augmentation rhinoplasty using cortical tibial bone graft. There were six males and three females aged between 21 and 36years (mean age 29). All the nine cases were treated through closed rhinoplasty incisions. Nine patients were operated on and the average follow up was 18months. The results were favorable. The aesthetic results were gratifying; with good nasal projection in every case without any significant postoperative effects or complications requiring surgery were noted during the follow up. The findings of this study support the use of cortical tibial bone graft for nasal augmentation although further studies with more sample size are required.

Reconstruction of Post-traumatic Anterior Maxillary Osseous Deficits, using Corticocancellous Tibial Graft in Preparation for Implant Rehabilitation

Dentoalveolar fractures of the anterior maxilla usually result in a scooped out defect of the region. This causes loss of lip support and aless than optimal condition for implant placement. The present study aims to study the merits and demerits of using autogenous tibialgraft for augmenting the anterior maxillary region. The study was carried out in 10 patients with post-traumatic anterior maxillary defects.The results of using tibial bone graft are presented.

Maxillary Sinus Augmentation With Autogenous Tibial Bone Graft as an In-Office Procedure

This retrospective study evaluates the efficacy of maxillary sinus grafting using autologous tibial bone in an outpatient setting. Twenty-seven patients undergoing lateral proximal tibial bone graft with subsequent sinus lifts were involved in this study. All surgeries were performed by the same surgeon in a private practice setting. A total of 28 tibial bone grafts and sinus lifts were performed on 27 patients. All subjects had minimal morbidity without any major complications. At the 1-year follow-up all implants that were placed into the grafted sites maintained stability, and no implants were lost. Two patients complained of hypertrophic scars at the site of bone harvesting (7.4%). One patient complained of leg pain for 10 weeks after the procedure, which resolved completely (2.7%). Overall complication rate was 10.1%. We conclude that the surgical harvesting of proximal tibial bone is associated with a low incidence of overall complications, mild postoperative pain, relative ease of harvest, minimal operative time, immediate ambulation, and rapid recovery, which make it an ideal office procedure when a significant amount of corticocancellous bone is required for maxillary sinus grafting.

Withdrawn: Poster Board Number: 44: Tibial Growth Arrest Secondary to Cancellous Graft Harvest on a Pediatric Patient: Case Report

Statement of the Problem: Maxillofacial surgeons have used bone grafting for augmentation of deficient regions of the facial skeleton for many years. Donor site and techniques used vary depending on surgeon preference, patient characteristics, and indications for surgery. Tibial bone grafts are an alternative source of cancellous bone and have been used for alveolar cleft reconstruction. When compared to the anterior iliac crest graft, tibial grafts are attractive because of simplicity and less patient discomfort and post-operative morbidity.

Comparison Between Interpositional Bone Grafting and Osteogenic Alveolar Distraction in Alveolar Bone Reconstruction

The aim of this study was to compare the quality and quantity of bone produced by alveolar distraction and interpositional bone grafting. Twelve patients requiring alveolar reconstruction were randomly divided into 2 groups. Six patients were treated with alveolar distraction osteogenesis, and 6 were treated with the sandwich osteotomy technique and tibial bone grafting. Bone width and vestibular depth were measured before alveolar reconstruction and after reconstruction. Computed tomography bone densitometry was performed to evaluate the densities of the new bones. In the alveolar distraction group, the mean alveolar bone width and vestibular depth were 10.6 mm and 7.5 mm, respectively, preoperatively. The postoperative values were 10.1 mm and 9.6 mm, respectively. Newly formed bone had a mean density of 512.5 Hounsfield units (HU) compared with 796.3 HU for surrounding bone. In the bone grafting group, the mean alveolar bone width and vestibular depth were 10.5 mm and 7.8 mm, respectively, preoperatively. The postoperative values were 11.5 mm and 6.8 mm, respectively. Newly formed bone had a mean density of 490.6 HU compared with 795.6 HU for surrounding bone. There was no significant difference between the amount of bone width produced by each of the techniques. The changes in vestibular depth were also insignificant. Compared with the surrounding bone, the density of new bone was reduced with both techniques, but the density of the bone graft was significantly lower than the density of bone newly formed by alveolar distraction.

Post-Operative Assessment of an Implant Fixation in Anterior Cruciate Ligament Reconstructive Surgery

The objective of this paper is to numerically simulate the behaviour of an anterior cruciate ligament (ACL) reconstructed knee using interference screw fixation under a single cycle loading or a cyclic loading test and to compare the numerical results with experimental tests using porcine samples of knee joint. A hyper-elastic material model was used to model the tendon graft and evaluate its elongation during continuous and cyclic tensile loading. The rigidity of the interference screw fixation was also examined using the finite element based numerical model. The finite element model uses the benefit of an anatomical 3D geometry of the tibial bone and tendon graft which was created from a CT scan of a patient.

Histological Differences in Iliac and Tibial Bone Graft

Cancellous bone graft is frequently used during orthopedic procedures. While the iliac crest has traditionally been the most common donor site, the proximal tibia is an alternative donor site, especially for foot and ankle procedures. This study tested the null hypothesis that the histologic composition of iliac and tibial bone grafts is similar. Specimens from the iliac crest (n = 10) and tibia (n = 10) in excess of that needed for patients undergoing foot or ankle fusion were examined histologically. Iliac samples were taken from the anterior iliac crest. Tibial samples were harvested from the region of Gerdy's tubercle. Specimens were graded based on the percent of bone surfaces that opposed active hematopoietic marrow, with Grade I at 0%, through Grade VI at 81% to 100%. Differences between iliac and tibial grafts were evaluated with Fisher's Exact Test. Iliac crest and tibial bone grafts both showed trabecular fragments with abundant osteocytes. All iliac grafts contained active hematopoietic marrow. In contrast, the medullary space of tibial grafts contained fat and little hematopoietic marrow. Nine iliac grafts were graded V or VI; whereas the ten tibial bone grafts were all graded I or II (p = 0.0001). The difference in the numbers of samples in each group ranked as grade VI was also statistically significant (p = 0.005). Iliac bone grafts contained active hematopoietic marrow, whereas quiescent medullary fat predominated in tibial grafts. These findings raise questions about the cellular contributions of different sources of bone graft to bone healing.

A Case of Mandibular Reconstruction of Tibial Autogenous Bone Grafts with Titanium Mesh：Bone Change of Mandibular Reconstruction after 5 Years

A Case of Mandibular Reconstruction of Tibial Autogenous Bone Grafts with Titanium Mesh：Bone Change of Mandibular Reconstruction after 5 Years

Tantalum is a good bone graft substitute in tibial tubercle advancement

Porous tantalum is reportedly a good substitute for structural bone graft in several applications. So far, its use has not been reported in tibial tuberosity anteriorization (TTA) for treatment of isolated degenerative chondral lesions of the patellofemoral joint. We asked whether the use of this material would produce similar standardized functional scores, pain (VAS), fusion rates, complications, and patient satisfaction to those for bone graft. We performed a randomized, controlled trial in 101 patients (108 knees) scheduled for TTA comparing a porous tantalum implant (57 knees) with an autologous local tibial bone graft (51 knees). The minimum followup was 5 years (mean, 6.2 years; range, 5-8 years). At the last followup, clinical scores, fusion rates, and maintenance of the anteriorization either were better or similar for the TTA using the tantalum implant depending on the respective parameter. The operative technique was easier and shorter with the tantalum device. Complication and failure rates were greater using bone graft. Patient satisfaction was greater using the tantalum implant. Porous tantalum provided a reasonable alternative to bone graft in TTA. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Venous Thromboembolism in Oral and Maxillofacial Surgery Patients Undergoing Ether Iliac Crest or Tibial Bone Grafting Procedures

Venous Thromboembolism in Oral and Maxillofacial Surgery Patients Undergoing Ether Iliac Crest or Tibial Bone Grafting Procedures

S332: Tibia Bone Graft in the OR and in the Office

S332: Tibia Bone Graft in the OR and in the Office

Barrier Membranes Used for Ridge Augmentation: Is There an Optimal Pore Size?

To identify the optimal pore size of barrier membranes for successful alveolar ridge reconstruction procedures, to determine if cortical perforations have any effect on bone regeneration, and to reiterate that bone graft containment is an important parameter for successful regeneration. This was a prospective, randomized, controlled study performed on hound dogs. Corticocancellous tibial bone grafting was performed to the lateral border of the mandible and protected with barrier membranes (meshes). The experiment analyzed three different pore sized meshes, compared with controls without the mesh. Two meshes (macroporous and microporous) were made of titanium, and one was a resorbable mesh. Meshes were preformed into the shape of a cube with one face open. Each side of the cube measured approximately 10 mm. Cubes were open-faced on one side, to facilitate packing of the graft material. The dogs received bilateral ramus grafts. Cortical perforations were created on the left ramus of all the dogs and compared with the right side, which did not have perforations. The dogs were randomly divided into 3 groups and sacrificed at intervals of 1, 2, and 4 months. Before sacrifice, all dogs received 2 doses of tetracycline as a marker for new bone formation. Histomorphometry was performed by using Bioquant image-analysis software. Areas of new bone and soft tissue were measured. The rate of mineral apposition was also calculated. All values obtained via histomorphometry were statistically analyzed with a t test. Thirty-one experimental sites were evaluated. The amount of new bone growth into the macroporous mesh was significantly higher than in the other groups. The mean area of new bone formation in large and small meshes was 66.26 +/- 13.78 mm(2) and 52.82 +/- 24.75 mm(2), respectively. In the resorbable mesh group, the mean area of new bone formed was 46.76 +/- 21.22 mm(2). The amount of new bone formed in the control group was 29.80 +/- 9.35 mm(2). There was no significant difference in amount of bone formation between left and right sides (P = .3172). Resorbable meshes had significant soft tissue ingrowth (23.47 mm(2)) compared with macroporous mesh (16.96 mm(2)) and microporous mesh (22.29 mm(2)). Controls had the least amount of soft tissue ingrowth (9.41 mm(2)). Mineral apposition rate was found to be higher in the resorbable group (2.41 microm/day), and the rate was lowest (1.09 microm/day) in the large pore mesh group. Macroporous membranes facilitated greater bone regeneration compared with microporous and resorbable membranes. Macroporous mesh also prevented significant soft tissue ingrowth compared with other meshes. Containment of a bone graft is the most critical parameter in successful bone regeneration. Cortical perforations did not have any effect on the quantity of regenerated bone. Further research should be directed toward identifying a critical pore size and manufacturing a reliable mesh that would prevent excessive soft tissue ingrowth in ridge augmentation procedures.

The effect of bone graft geometry on spinal fusion vertebral stresses.

Spinal fusion is a frequent surgical technique in which the success is uncertain due to post-operative changes in the biomechanics of the spine. Bone grafts are good candidates for disc and vertebra substitutes due to their similar bone properties and their good osteogenic properties. However, the effect of the anatomic harvest location of the bone graft on the load transfer is unknown. A physiologic three-dimensional (3D) finite element model of a lumbar spine was modified to model spinal fusion with a fixator and a bone graft. Bone grafts were taken either from the femur, the tibia, or from the fibula in a configuration of three or six fragments. The configurations were submitted to physiological loadings, and strain and stress distributions were calculated within the vertebrae, the fixator and the bone grafts. Quantitative differences were found from one type of bone graft to another. It was found that fibula bone grafts provided better stability by carrying a large part of the load. However, femoral and tibial bone grafts provided a more similar strain distribution within the vertebrae compared to the physiologic model. For tibial bone grafts, load transfer was found to be sensitive to the orientation used during the surgery. The use of a femoral bone graft to replace one vertebra and two intervertebral discs was found to give a better biomechanical function than using a tibial or fibula bone graft. This surgical technique is proposed to be beneficial in the case of severe spinal trauma providing good interface is obtained between the bone graft and the vertebrae.