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

Purpose: The three most common sites for obtaining autogenous bone grafts are the anterior iliac crest (AIC), posterior iliac crest (PIC) and proximal tibia (PT). Previously cited volumes of uncompressed bone from these sites are: 25-40 cc cancellous bone from the PT, 50 cc corticocancellous bone from the AIC, and 100-125 cc corticocancellous bone from the PIC. Based upon literature review and the authors' experience, the amount of bone harvested appears to be significantly less than previously reported. The purpose of this study was to determine the maximum amount of corticocancellous bone that can be harvested from the AIC, PIC and PT when using a standardized approach.

Methods: Cortical and cancellous bone from the AIC, PIC and PT was harvested from 44 cadavers (average age 80.5 years, 19 females, 25 males) using techniques from literature review. For the AIC, a medial approach was utilized with osteotomies beginning 2 cm posterior to ASIS and extending posteriorly until the ilium narrowed and bone became monocortical. For the PIC, a lateral approach was used with osteotomies beginning 2 cm superior to PSIS and extending anteriorly until bone became monocortical. The inferior extent of the osteotomies for both the AIC and PIC grafts was 5 cm or monocortical bone. 1 cm strips were obtained from 1 cm posterior to the ASIS and 1 cm anterior to the PSIS as this specimen represents the extent used by some authors for larger harvests. For the PT, a 1.5 cm diameter circular osteotomy was placed over Gerdy’s tubercle. The cortical window and cancellous bone was harvested within the cavity up to 2cm from the tibial plateau. The maximum amount of bone was harvested for each graft site. Uncompressed and compressed corticocancellous bone volumes were measured by water volume displacement.  Maximal palmar pressure was utilized to obtain compressed volumes with removal of fat, air and debris.

Results: 42 AIC corticocancellous grafts provided an uncompressed average of 26.29 +/- 8.41 cc and a compressed average of 20.58 +/- 6.92 cc total (large segment + 1 cm segment). 33 PIC grafts yielded an average of 33.82 +/- 8.19 cc uncompressed bone and 24.11 +/- 6.04 cc compressed total (large segment + 1 cm segment). 38 PT samples provided an average of 18.11 +/- 1.69 cc uncompressed, 9.03 +/- 1.09 cc compressed.

No statistically significant correlations were found between bone compressed volume amounts and BMI or age. There were correlations between compressed bone volume amounts for all sites (p<0.03) except for PT and PIC Compressed (Anterior, p=0.0682). No statistically significant association was found between bone quantity and medical comorbidity for all of the cadaver sites. Male graft sites produced more uncompressed bone than females for AIC Main and PIC Main and more compressed bone for the AIC main and PT segments (p<0.01). Comparing data within the same subjects, the average rank in terms of bone volume per site showed the PIC yielded the most and PT produced the least compressed and uncompressed bone.

 Conclusions: Results from this study reveal that the PIC has a higher availability of corticocancellous bone than the AIC and PT when obtaining the maximal amount of bone using a standardized approach. The maximum volume of attainable bone from the AIC, PIC and PT were all lower than commonly cited volumes in the literature. 

1. Engelstad ME1, Morse T. Anterior iliac crest, posterior iliac crest, and proximal tibia donor sites: a comparison of cancellous bone volumes in fresh cadavers. J Oral Maxillofac Surg. 2010 Dec;68(12):3015-21. 

2. Zouhary KJ. Bone graft harvesting from distant sites: concepts and techniques. Oral Maxillofac Surg Clin North Am. 2010 Aug;22(3):301-16.