Autologous Bone Graft in Foot and Ankle Surgery

Foot and ankle surgeons have several options when it comes to harvesting autologous bone graft. The iliac crest has been the common donor site and is still frequently used. However, sufficient bone may also be expeditiously harvested from the proximal and distal tibial metaphyses, the calcaneus, and the intramedullary canals of both the tibia and femur. The decision as to which harvest site to use is made on a case-by-case basis and depends on several factors. These factors include anatomic proximity, the volume of graft desired, the need for structural graft, and the intrinsic biology of the particular donor site. Most autograft can be obtained safely and reliably with minimal increase in operating time. Nevertheless, patients should be appropriately counseled about the risks and potential complications, including donor site pain, of the graft the surgeon plans on using. Fortunately, most complications are minor and do not cause long-term morbidity.