Novel, vacuum-assisted method for harvesting autogenous cancellous bone graft and bone marrow from the proximal tibial metaphysis

Category: Other Introduction/Purpose: Autogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures. Autologous graft is considered the gold standard as it is osteogenic, osteoinductive, and osteoconductive, and is without the potential risks of graft-associated infection and immunologic reaction. Disadvantages include graft harvest time and donor site morbidity due to the surgical incision, approach and bone corticotomy. This study evaluated the safety and efficacy of a novel vacuum-assisted bone graft harvesting device which was able to obtain both cancellous bone and bone marrow for insertion into the arthrodesis sites of patients undergoing complex primary and revision lower extremity fusion procedures. Methods: Between March and November 2017, 9 patients had a foot and/or ankle complex primary or revision arthrodesis performed, with autogenous cancellous graft and bone marrow harvested from the ipsilateral proximal tibia. All patients were 18 years or older with no prior history of knee pain, injury, or surgery at the proximal tibia. Following a circular corticotomy, cancellous bone was harvested using a novel suction-powered, hand-driven bone curettage system (Avitus Orthopaedics, Farmington, CT). The donor site was backfilled with bone graft substitute. Incision length was recorded as well as surgical time from donor site incision to completion of graft acquisition. The volume of cancellous graft and bone marrow were separately recorded. All patients were non-weight bearing on the involved extremity for a minimum of 6 weeks post-operatively and all were evaluated at 2 and 6 weeks post-operatively for donor site pain and associated complications. Results: There were five male and four female patients with an average age of 51 years and 8 months. Procedures included six complex primary fusions and three revision subtalar or tibio-talar-calcaneal fusions for nonunion. Mean incision length was 2 cm (range 1.80-2.75 cm). Mean volume of obtained graft material included 25 cm3 of cancellous bone (range 9-30 cm3) and 21 cm3 bone marrow aspirate (range 10-40 cm3). Mean procedure time was 5 mins (range 4-8 mins), and average blood loss was less than 1 mL. Two patients had mild pain at 2 week follow-up; however, no patients reported donor site pain at 6 week follow-up. There were no major or minor complications including fracture, infection, hematoma formation, sensory changes, or wound healing issues. Conclusion: The use of an innovative, vacuum-assisted bone harvesting device allows large volumes of autogenous cancellous bone graft and marrow to be rapidly and readily obtained from the ipsilateral proximal tibia with minimal donor site morbidity.

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Novel Vacuum-Assisted Method for Harvesting Autologous Cancellous Bone Graft and Bone Marrow From the Proximal Tibial Metaphysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420981901 ◽

2021 ◽

Vol 6 (1) ◽

pp. 247301142098190

Author(s):

Adam M. Lukasiewicz ◽

Paul S. Bagi ◽

Kristin E. Yu ◽

Vineet Tyagi ◽

Raymond J. Walls

Keyword(s):

Bone Marrow ◽

Bone Graft ◽

Cancellous Bone ◽

Proximal Tibia ◽

Donor Site ◽

Graft Material ◽

Cancellous Bone Graft ◽

Foot And Ankle ◽

Tibial Metaphysis ◽

Bone Harvesting

Background: Autogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures to enhance fusion potential, and frequently in revision situations where bone loss and osteolysis may be a feature. The tibial metaphysis is a common donor site for bone graft, with the procedure typically performed using a curette or trephine to harvest the cancellous bone. Some limitations of this technique include suboptimal harvest of the marrow portion in particular, incomplete graft harvest, and loss of graft material during the harvest process. We describe a novel vacuum-assisted bone harvesting device to acquire cancellous bone and marrow from the proximal tibia. Methods: This is a retrospective study of a single surgeon’s consecutive patients who underwent foot and ankle arthrodesis procedures using proximal tibia autograft obtained using a vacuum-assisted bone harvesting device. Descriptive statistics were used to summarize patient and operative characteristics and outcomes. We identified 9 patients with a mean age of 51 years, 4 of whom were female. Results: On average, the skin incision was slightly more than 2 cm, and 27 mL of solid graft and 16 mL of liquid phase aspirate were collected. At 6 weeks after the procedure, there was minimal to no pain at the donor site, and we did not observe any fractures or other complications. Conclusions: We report the use of a novel vacuum-assisted curette device to harvest bone graft from the proximal tibial metaphysis for use in foot and ankle fusions. This device has been reliable and efficient in clinical practice. Level of Evidence: Level IV, retrospective case series.

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Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1024 ◽

2015 ◽

Vol 2 (1) ◽

pp. 27-30

Author(s):

Rakesh B Dalal ◽

Rajesh Rachha ◽

Hari Kovilazhikathu Sugathan

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Proximal Tibia ◽

Donor Site ◽

Asia Pacific ◽

Cancellous Bone Graft ◽

Foot And Ankle ◽

Tibial Bone ◽

Ankle Surgery ◽

Bone Graft Harvesting

ABSTRACT Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries. How to cite this article Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):27-30.

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Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1041 ◽

2016 ◽

Vol 3 (1) ◽

pp. 6-9

Author(s):

Rajesh Rachha ◽

Hari Kovilazhikathu Sugathan ◽

Rakesh Dalal

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Proximal Tibia ◽

Donor Site ◽

Asia Pacific ◽

Cancellous Bone Graft ◽

Foot And Ankle ◽

Tibial Bone ◽

Ankle Surgery ◽

Bone Graft Harvesting

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More weighted cancellous bone can be harvested from the proximal tibia with less donor site pain than anterior iliac crest corticocancellous bone harvesting: retrospective review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02364-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hanju Kim ◽

Ajit Kumar Kar ◽

Aditya Kaja ◽

Eic Ju Lim ◽

Wonseok Choi ◽

...

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Iliac Crest ◽

Proximal Tibia ◽

Donor Site ◽

Autogenous Bone ◽

Vas Score ◽

Donor Site Pain ◽

The Mean ◽

Site Pain

Abstract Background Iliac crest is the most preferred autogenous bone graft harvesting donor site while it has sorts of complications like prolonged pain, hematoma, and fracture. Harvesting cancellous bone from proximal tibia is also increasingly being used because of lower complications and less donor site pain. However, there are lack of studies to compare these two donor sites in detail. Thus, we proposed to investigate the available amount of autogenous bone graft from the proximal tibia. Methods Fifty-one patients who underwent simultaneous bone graft harvest from the PT and the AIC to fill up the given critical sized bone defects were enrolled in this study. We prospectively collected data including the weight of the harvested bone, donor site pain using the visual analog scale (VAS) score, and complications between the two sites. Results The mean weight of cancellous bone harvested from the PT was greater than AIC (33.2g vs. 27.4g, p = 0.001). The mean VAS score was significantly lesser in the PT up to 60 days after harvesting (p < 0.001). There was persistent pain up to 90 days in four PT patients and in seven AIC patients. The major complication was reported only in AIC patients (11.8%). Conclusions Harvesting cancellous bone from the PT is an acceptable alternative to the AIC for autogenous bone grafting owing to availability of more weighted graft bone and less donor site pain.

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Management of Hepple Stage V Osteochondral Lesion of Talus with Platelet-Rich Plasma (PRP) Scaffold

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000367 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Zhongmin Shi

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Platelet Rich Plasma ◽

Short Form ◽

Osteochondral Lesion ◽

Surgical Techniques ◽

Cancellous Bone Graft ◽

Sf 36 ◽

Osteochondral Lesion Of Talus

Category: Ankle Introduction/Purpose: There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs. Methods: 14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded. Results: 13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P<0.0001) without obvious complications. Conclusion: We suggest that for the patients of Hepple stage V OLTs, cancellous bone graft with PRP scaffold may be a safe and effective treatment.

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Distal Femur as a Donor Site of Autogenous Cancellous Bone Graft

Journal of Orthopaedic Trauma ◽

10.1097/00005131-199504000-00010 ◽

1995 ◽

Vol 9 (2) ◽

pp. 145-151 ◽

Cited By ~ 19

Author(s):

John O. Krause ◽

Clayton R. Perry

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Distal Femur ◽

Donor Site ◽

Cancellous Bone Graft

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Comparison between Autogenous Bone Graft and Allogenous Cancellous Bone Graft in Medial Open Wedge High Tibial Osteotomy with 2-Year Follow-up

Knee Surgery and Related Research ◽

10.5792/ksrr.2013.25.3.117 ◽

2013 ◽

Vol 25 (3) ◽

pp. 117-125 ◽

Cited By ~ 20

Author(s):

Sung Won Cho ◽

Dong Hwi Kim ◽

Gwang Chul Lee ◽

Sang Hong Lee ◽

Sang Ha Park

Keyword(s):

Bone Graft ◽

High Tibial Osteotomy ◽

Cancellous Bone ◽

Autogenous Bone Graft ◽

Autogenous Bone ◽

Tibial Osteotomy ◽

Cancellous Bone Graft ◽

Open Wedge ◽

Wedge High Tibial Osteotomy

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Biologic tendon fixation to metallic implant augmented with autogenous cancellous bone graft and bone marrow in a canine model

Journal of Orthopaedic Research® ◽

10.1016/s0736-0266(02)00037-2 ◽

2002 ◽

Vol 20 (5) ◽

pp. 957-966 ◽

Cited By ~ 37

Author(s):

Nozomu Inoue ◽

Kazuo Ikeda ◽

Hannu T. Aro ◽

Frank J. Frassica ◽

Franklin H. Sim ◽

...

Keyword(s):

Bone Marrow ◽

Bone Graft ◽

Cancellous Bone ◽

Canine Model ◽

Cancellous Bone Graft ◽

Metallic Implant

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Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold

BioMed Research International ◽

10.1155/2017/6525373 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Wenqi Gu ◽

Tanzhu Li ◽

Zhongmin Shi ◽

Guohua Mei ◽

Jianfeng Xue ◽

...

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Platelet Rich Plasma ◽

Short Form ◽

Osteochondral Lesion ◽

Osteochondral Lesions ◽

Cancellous Bone Graft ◽

Sf 36 ◽

American Orthopaedic

There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form 36 (SF-36) score. The range of motion (ROM) of the ankle joint and complications also were recorded. Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients. The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (allP<0.001) without obvious complications. We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

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