Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft.
BACKGROUND
Medial opening-wedge high tibial osteotomy has been gaining popularity in recent years, and autogenous iliac crest bone is the gold standard graft; however, the surgical time, risk, and morbidity associated with its harvest are significant. The question of a satisfactory bone-graft substitute has yet to be clearly answered.


OBJECTIVE
A corticocancellous proximal tibial wedge allograft is a satisfactory graft choice when evaluating union in medial opening-wedge high tibial osteotomy.


METHODS
Case series; Level of evidence, 4.


METHODS
Fifty consecutive patients who underwent medial opening-wedge high tibial osteotomy from May 2001 to May 2006 were included in the study. The amount of correction ranged from 5 degrees to 17.5 degrees, with a mean of 10.1 degrees. Forty patients had fixation with a stainless steel plate and screws and 10 with a titanium interlocking plate and screws. The graft used in each case was a corticocancellous proximal tibial wedge allograft. No osteoinductive supplements were added. Patients started continuous passive motion immediately after surgery and began weightbearing at 8 weeks (if bone healing was progressing). Clinical and radiographic evaluation was performed monthly until full union and twice thereafter. Follow-up ranged from 5 months to 6 years, with a mean of 2.1 years.


RESULTS
The average time to bone union was 12.1 weeks (range, 8-24). Two patients (4%) had a nonunion, defined as not healed at 6 months. Only 1 patient (a nonunion patient) had loss of correction at the osteotomy site, defined as collapse of the opening wedge (this occurred at 6 months after surgery). There were no cases of infection, no wound-healing problems, no cases of arthrofibrosis, and no neurovascular injuries.


CONCLUSIONS
When union is assessed, a corticocancellous proximal tibial wedge allograft is a satisfactory graft choice in medial opening-wedge high tibial osteotomy.
Yacobucci
Gerald N
GN
The Orthopedic Clinic Association, 2222 East Highland Avenue, Suite 300, Phoenix, AZ 85016, USA. gyacobucci@tocamd.com
Cocking
Matthew R
MR
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D013977:Tibia / Q000601:surgery* / Q000637:transplantation; D014184:Transplantation, Homologous / Q000379:methods; D014481:United States