title: Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes.
abstract: OBJECTIVE
  Bone grafting in opening wedge high tibial osteotomy (OWHTO) is still controversial. The purpose of this study is to compare the radiological outcomes of OWHTO with bone graft (autogenous, allogenous, and synthetic bone graft) and those without bone graft.
  
  
  METHODS
  PubMed, MEDLINE, EMBASE and Cochrane Register of Studies databases were searched using specific inclusion and exclusion criteria for radiological studies involving OWHTO with bone graft and without bone graft groups. All reported delayed union, nonunion and correction loss were analyzed. Data were searched from the time period of January 2000 through July 2014. In addition, a modified Coleman methodology score (CMS) system was used to assess the methodological quality of the included studies.
  
  
  RESULTS
  Twenty-five studies with a mean CMS value of 77 (range, 61 to 85 score) were included. In total, 1,841 patients underwent OWHTO using 4 different procedures for bone graft: autobone graft (n=352), allobone graft (n=547), synthetic bone graft (n=541) and no bone graft (n=401). There was a similar tendency for delayed union, nonunion and correction loss rate among the osteotomy space filling methods.
  
  
  CONCLUSIONS
  The meta-analysis showed there was a similar tendency for radiological union and correction maintenance among patients undergoing OWHTO regardless of the type of bone in all of the studies. However, the currently available evidence is not sufficient to strongly support the superiority of OWHTO with bone graft to OWHTO without bone graft.
authors.affiliation: Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Jae Hwi
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Preventive Medicine, Institute for Evidence-based Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Jae Gwang
authors.initials: JG
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic Surgery, Bhandare Hospital, Panaji, India.
authors.forename: Nikhl N
authors.initials: NN
authors.lastname: Bhandare
authors.affiliation: Department of Orthopaedic Surgery, Army General Hospital, Bonifacio, Philippines.
authors.forename: Aldrich Raymund
authors.initials: AR
authors.lastname: Fernandez
authors.affiliation: Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Kyung Wook
authors.initials: KW
authors.lastname: Nha
keywords: Bone graft; Knee; Meta-analysis; Osteoarthritis; Osteotomy