Bone grafts may be needed for various orthopaedic surgeries of the foot and ankle. Bone grafts provide bony support and/or fill in areas where bone is missing. Bone grafts are either taken from the patient (autograft), or taken from a bone donor (allograft). The best bone graft provides enough bone and healing with minimal problems for the patient.

Proximal tibial bone graft (PTBG) is a type of autograft. The proximal tibia is the upper portion of the leg or shin bone that is just below the knee joint. Getting bone graft from this body part usually is less painful than from other areas like the pelvis.


PTBG is done when there is not enough bone to allow healing of one bone to another or when your foot and ankle orthopaedic surgeon is trying to improve the chances of your bones healing. This typically includes certain fractures or fractures that have not healed and any fusions (forcing two or more separate bones to grow together) of foot/ankle joints.

The main reason to not have a PTBG is if you have hardware in the upper leg. Such devices include knee replacements, plates, and screws and rods. Other reasons to avoid a PTBG include skin problems or infection at the upper leg. Also, some orthopaedic procedures require a specifically shaped graft that the proximal tibia cannot provide. This kind of graft may need to be taken from the pelvis.


The graft usually is taken from the leg above the foot/ankle being operated on. An incision is made over an area of the upper leg. The incision may be small or large depending on how much graft is needed for the patient’s foot/ankle.

Two types of bone can be taken from the proximal tibia. The first is a harder, outer shell of bone that can be removed as a strip. The second is the spongier bone within the proximal tibia. Tools such as drills, chisels, and scoops are used for a PTBG. At times, the surgeon may leave a drain in the leg at the bone for a short time to prevent excessive blood collection. The skin incision typically is closed with sutures or skin staples.


Recovery from a PTBG is related to healing of the wound. This usually takes a couple of weeks. You may bear weight on your leg from which the bone was taken if the foot/ankle surgeries done at the same time allow for it. Bending the knee is usually allowed immediately after a PTBG.


Potential problems after a PTBG include infection, fracture of the proximal tibia and pain related to the procedure.


If proximal tibial bone graft is taken from my knee, will this prevent me from being able to have other procedures done in this area, such as knee replacement?
No. Most surgeries to treat knee problems can be done safely in the future.

Does harvesting tibial bone grafting damage the knee joint?
No. The graft is taken just below the actual joint with great care taken to protect the knee at all times.

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