Nathan Steele1 and J. Michael Ray2
1Private Practice, Cheyenne Oral and Maxillofacial Surgery, Cheyenne, Wyoming, USA
2Private Practice, DFW Facial and Surgical Arts, Dallas, Texas, USA
A surgical procedure for harvesting cancellous bone from the proximal tibia.
- The need for autogenous bone in a quantity greater than can be harvested intraorally
- Hard tissue maxillofacial defects requiring 30 mL or less of cancellous bone
- Reconstruction of maxillofacial defects requiring more than 30 mL of cancellous bone
- Severe peripheral vascular disease
- Total knee arthroplasty
- Skeletally immature patient
- Gerdy’s tubercle: The lateral tubercle on the proximal metaphysis of the tibia, which serves as the insertion of the iliotibial tract superiorly and the anterior tibialis muscle inferiorly
- Preoperative intravenous antibiotics are recommended. The procedure may be performed with general endotracheal intubation or with intravenous sedation dependent on the patient’s anxiety level and the invasiveness of the coinciding reconstructive procedure.
- The patient is positioned supine with a knee bump (i.e., towels, a sand bag, or an intravenous fluid bag) placed under the ipsilateral knee, providing a medial rotation of the tibia.
- The surgical site is prepped and draped in a sterile fashion. Pertinent anatomy is marked to include the patella, the patellar tendon, Gerdy’s tubercle, the tibial tuberosity, the fibular head, and the planned incision (Figure 55.1).
- Local anesthetic containing a vasoconstrictor is infiltrated subcutaneously and deep to the periosteum.
A 2–3 cm length oblique incision is placed overlying Gerdy’s tubercle. The incision initially extends through skin and subcutaneous tissue (Figure 55.2). A Weitlaner retractor may be placed to assist in the retraction of the supraperiosteal tissues (Figure 55.3).
- The periosteum is incised, and a subperiosteal dissection is performed to expose Gerdy’s tubercle. A 701 bur with copious irrigation is used to remove the cortical bone overlying Gerdy’s tubercle. The cortical bone should be removed en bloc so that it may be used at the recipient site (Figure 55.4).
- Gouges or curettes are used to remove cancellous bone from the tibial plateau and the proximal portion of the shaft. The amount of cancellous bone harvested is dependent on the size of the proximal tibia. Typically, 10 to 30 mL of uncompressed cancellous bone can be harvested (Figure 55.5).
- Once the graft harvest is complete, the surgical site is irrigated with normal saline (Figure 55.6), and microfibrillar collagen is placed within the surgical site to aid in he/>