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. 2023 Apr 30;10(1):50.
doi: 10.1186/s40634-023-00612-0.

A technical note on autologous iliac crest bone grafting for restoration of the distal tibial articular surface

Bahaa Zakarya Hasan  1 , Mohamed Kamal Mesregah  2
Affiliations

A technical note on autologous iliac crest bone grafting for restoration of the distal tibial articular surface

Bahaa Zakarya Hasan et al. J Exp Orthop. .

Abstract

Purpose: This technical note describes a reconstructive technique of the distal tibial articular surface using autologous iliac crest bone graft.

Methods: Following curettage and high-speed burring of giant cell tumor of bone (GCTB) of the distal tibial articular surface, the resulting cavity was filled, and the articular surface was reconstructed using autologous tricortical iliac crest bone graft. The graft was fixed to the tibia with a plate.

Results: The smooth congruent articulating surface of the distal tibia was restored. Full ankle range of motion was achieved. No recurrence was detected in the follow-up imaging.

Conclusions: The currently reported technique using autologous tricortical iliac crest bone graft is a viable option for reconstructing the articular surface of the distal tibia.

Keywords: Articular surface reconstruction; Curettage; Distal tibia; Giant cell tumor; High-speed burr; Iliac crest grafting.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A 22-year-old female presented with limping, pain aggravated on walking, and restricted movement of the left ankle for 7 months. The patient had no history of trauma and no constitutional symptoms. Examination revealed tenderness over the anterior aspect of the distal tibia, with painful and restricted range of motion of the left ankle. A Preoperative anteroposterior and lateral X-rays showing a well-defined expansile osteolytic lesion in the epi-metaphyseal region of the left distal tibia suggestive of GCTB. The tumor was classified as Campanacci grade III. B Sagittal, coronal and axial CT scans showing an osteolytic lesion occupying the anterior two-thirds of the epi-metaphyseal region of the left distal tibia with erosion of the articular surface. C Sagittal and coronal MRI images showing an eccentric expansile osteolytic lesion measuring 4 (craniocaudal) × 3.5 (transverse) × 2.5 (anteroposterior) cm breaching the articular surface with only the posterior one-third of the tibial plafond preserved with no soft tissue or intra-articular extension
Fig. 2
Fig. 2
Intraoperative photographs A) Curettage of the lesion using different-sized curettes. B The cavity after curettage and high-speed burring with exposed articular cartilage of the talus. C The harvested tricortical iliac crest autograft. D Testing the shape and size of the graft in relation to the defect. E Placing the graft in the defect after trimming and fashioning. F Fixation of the graft to the tibia using a distal radius plate
Fig. 3
Fig. 3
Immediate postoperative anteroposterior and lateral X-rays
Fig. 4
Fig. 4
Six months follow-up radiological images showing complete union of the graft and reconstruction of the distal tibial articular surface. No donor site morbidity symptoms were reported. Clinical photos showing pain-free full range of motion of the ankle joint. A Anteroposterior and lateral plain X-rays. B Sagittal CT cuts. C Coronal CT cuts. D Axial CT cuts. E Ankle dorsiflexion. F Ankle plantar flexion
Fig. 5
Fig. 5
Fifteen months anteroposterior and lateral plain X-rays showing no signs of local recurrence
See this image and copyright information in PMC

References

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