Abstract
Purpose
The study is aimed at evaluating the long-term (at a minimum follow-up of 10 years) impact of non-vascularized fibular harvest on the donor limbs.
Methods
There were 27 donor limbs (n = 19 children) available for retrospective radiological review. The graft was obtained bilaterally in eight patients. The following parameters were evaluated in the follow-up radiographs: continuity/non-continuity of fibular regenerate, width of the regenerated fibula, distal fibular station, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle (LDTA), anterior distal tibial angle, and tibia diaphyseal angulation (interphyseal angles). For analysis and comparisons, the donor limbs were compared to the healthy limbs (controls) of the children with unilateral harvest. Additionally, the impact of continuous and non-continuous fibular regeneration was separately analyzed.
Results
The mean child’s age at the time of fibular harvest was four years. The mean follow-up was 12.8 years. The fibula was found regenerated in continuity in 22 limbs of 15 children (81.5%). When analyzed as a combined group (both continuous and non-continuous fibular regenerations), all the donor limb radiological parameters matched those of healthy limbs except LDTA (p = 0.04). In the subgroup analysis between non-continuous and continuous fibulae, significant abnormalities were again obvious in LDTA (p = 0.0001). The non-continuous fibulae were significantly lesser in width. All limbs with non-continuous fibular regeneration manifested ankle valgus.
Conclusions
The non-vascularized fibula emerged as a relatively safe procedure in the long term with minimal affections of the knee, ankle, or tibial anatomy when longitudinal integrity of fibula was restored. The non-regenerations of the fibula may be prone to developing ankle valgus.
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Anil Agarwal: conception, analysis and interpretation of data, drafting the manuscript, and approval of the final version. Ankita KS: analysis and interpretation of data and approval of final version. Kishmita Sachdeva: analysis and interpretation of data and approval of final version. Lokesh Sharma: analysis and interpretation of data, drafting the manuscript, and approval of the final version. Varun Garg: analysis and interpretation of data, drafting the manuscript, and approval of the final version.
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Agarwal, A., KS, A., Sachdeva, K. et al. Effect of non-vascularized fibular harvest on the donor limb: radiological evaluation at a mean follow-up of twelve point eight years. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06150-3
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DOI: https://doi.org/10.1007/s00264-024-06150-3