Biomechanical analysis of proximal tibia bone grafting and the effect of the size of osteotomy using a validated finite element model

  • David Q. K. Ng
  • Chin Tat LimEmail author
  • Amit K. Ramruttun
  • Ken Jin Tan
  • Wilson Wang
  • Desmond Y. R. Chong
Original Article


Harvesting bone graft from the proximal tibia is gaining popularity, with lower complication rates and adequate quantity of cancellous bone. The amount of harvested bone is dependent on the size of the cortical window introduced via osteotomy onto the proximal tibia, and its mechanical strength after surgery could be compromised. The aim of the study was to investigate the proximal tibia’s mechanical stability after bone harvesting and the effect of varying window sizes using a validated finite element model. Two cadaveric tibiae were tested with bone strains measured for different circular cortical window diameters (10–25 mm). Sixteen finite element models of the intact and harvested tibia were simulated and validated with experimental data. The experimental and predicted max/min principal bone strains were fitted into regression models and showed good correlations. It was predicted the maximum principal bone stresses were greatest and concentrated at postero-inferior and antero-superior regions of the cortical window. A stress line progressed from the edge of the window to the posterior side of the tibia, which became more prominent with the increase of size of the cortical window. It was found that large circular osteotomies for bone harvesting at the proximal tibia induced stress concentrations and stress lines which could lead to eventual failure.

Graphical abstract

The formation of a stress line in the harvested tibia initiated from the postero-inferior edge of the window and progressed to the medial side. The stress line became more prominent with the increase of the size of the cortical window from 10 to 25 mm in diameter.


Bone graft harvesting Tibia bone harvesting Finite element modelling Stress concentration Circular osteotomy 



This study was funded by the National Medical Research Council, Singapore, grant number NMRC/CNIG/1097/2012. This article does not contain any studies with human participants or animals performed by any of the authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© International Federation for Medical and Biological Engineering 2019

Authors and Affiliations

  • David Q. K. Ng
    • 1
    • 2
  • Chin Tat Lim
    • 1
    Email author
  • Amit K. Ramruttun
    • 3
  • Ken Jin Tan
    • 3
  • Wilson Wang
    • 1
    • 3
  • Desmond Y. R. Chong
    • 4
  1. 1.Department of Orthopaedic SurgeryNational University HospitalSingaporeRepublic of Singapore
  2. 2.Department of Biomedical EngineeringNational University of SingaporeSingaporeRepublic of Singapore
  3. 3.Department of Orthopaedics, Yong Loo Lin School of MedicineNational University Health SystemSingaporeRepublic of Singapore
  4. 4.Engineering ClusterSingapore Institute of TechnologySingaporeRepublic of Singapore

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