Maximum Quantity of Bone Available for Harvest From the Anterior Iliac Crest, Posterior Iliac Crest, and Proximal Tibia Using a Standardized Surgical Approach: A Cadaveric Study

Abstract

Purpose: The 3 most common sites for obtaining autogenous bone grafts are the anterior iliac crest (AIC), posterior iliac crest (PIC), and proximal tibia (PT). The purpose of this study was to determine the maximum amount of corticocancellous bone that could be harvested from the AIC, PIC and PT when using a standardized surgical approach.

Materials and methods: The maximum volume of cortical and cancellous bone from the AIC, PIC, and PT was harvested from 44 cadavers using approaches from a review of the literature. Uncompressed and compressed corticocancellous bone volumes were measured by water volume displacement. Bivariate analyses of bone volumes, gender, and medical comorbidities were performed using the exact Wilcoxon rank-sum test. A general linear model using ranks was used to assess the effect of gender, medical comorbidity, and site separately for total uncompressed and compressed bone measurements.

Results: Forty-two AIC corticocancellous grafts provided an uncompressed total average of 26.29 mL and a compressed total average of 20.58 mL. Thirty-three PIC grafts yielded a total average of 33.82 mL of uncompressed bone and 24.11 mL of compressed. Thirty-eight PT samples provided a total average of 18.11 mL of uncompressed bone and 9.03 mL of compressed bone. No statistically relevant correlations were found between compressed bone volumes and body mass index or age. No statistically relevant association was found between bone quantity and medical comorbidity for any of the graft sites. The average rank of bone volume per site after controlling for gender and medical comorbidity showed that the PIC yielded the most and the PT yielded the least compressed and uncompressed bone amounts (P < .001).

Conclusion: Results indicate that the PIC has a larger maximum amount of corticocancellous bone than the AIC and PT with a standardized approach. The maximum volumes of attainable bone from the AIC, PIC, and PT were lower than commonly cited in the literature.