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Comparison of anterior iliac crest versus proximal tibia autologous bone graft harvesting: A systematic review and meta-analysis

  • Gregorio Alejandro Villarreal-Villarreal
    Affiliations
    Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, P.C. 64460
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  • Mario Simental-Mendía
    Affiliations
    Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, P.C. 64460
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  • Augusto Andres Gamboa Alonso
    Affiliations
    Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Plataforma Invest-KER Unit Mexico, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, P.C. 64460
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  • Félix Vilchez-Cavazos
    Affiliations
    Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Plataforma Invest-KER Unit Mexico, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, P.C. 64460
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  • Carlos Alberto Acosta-Olivo
    Affiliations
    Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, P.C. 64460
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  • Víctor Manuel Peña-Martínezm
    Correspondence
    Corresponding author: Víctor Manuel Peña-Martínez, MD PhD, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, C.P. 64460, Phone: +52 (81) 8347-6698
    Affiliations
    Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Av. Francisco. I. Madero and Dr. José Eleuterio González s/n, Colonia Mitras Centro, Monterrey, Nuevo León, México, P.C. 64460
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Published:October 23, 2022DOI:https://doi.org/10.1053/j.jfas.2022.10.004

      Abstract

      Anterior iliac crest is the preferred option for bone grafting; however, pain and complications are reported. Proximal tibia is a sourceful site for bone grafting with lower complications. MEDLINE, EMBASE, and Scopus were searched to identify studies comparing anterior iliac crest (AIC) and proximal tibia (PT) autograft procedure. The main outcome was pain and complication rate. As well as cadaveric and cell-based studies were analyzed for quantity and quality of AIC and PT autograft. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index.
      Fifteen studies were included in the meta-analysis. Six studies and 248 patients were included for clinical outcomes. A significant pain reduction favoring PT at 24 hours was detected after meta-analysis and corresponding sensitivity analysis. The estimated effect size ranged from -2.31 to -2.93 cm, with confidence intervals aligned to the left indicating a robust steady decrease in pain across studies. This effect was not observed after 1 month. A total of 18 complications were reported, 13 in the AIC group and 5 in the PT group. Four cadaveric studies were included, three favored PT on the quantity of bone graft harvested. Five cell-based studies were included, only one study favored AIC for quality of bone graft. Our study concludes that PT bone harvest is a reliable option for bone grafting regarding morbidity, complications, volume graft obtained, and cellular and molecular properties. However, the current evidence is still insufficient to draw definitive conclusions, especially in terms of bone healing.

      Level of clinical evidence

      III

      PROSPERO Register

      CRD42020198150

      Keywords

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