ABSTRACT
Anterior iliac crest (AIC) is the preferred option for bone grafting; however, pain
and complications are reported. Proximal tibia (PT) is a sourceful site for bone grafting
with lower complications. MEDLINE, EMBASE, and Scopus were searched to identify studies
comparing AIC and 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, 3 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.
PROSPERO Register: CRD42020198150
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: October 23, 2022
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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