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First published on January 28, 2008, doi:10.1177/0363546507312646
This version was published on April 1, 2008
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The American Journal of Sports Medicine 36:713-719 (2008)
© 2008 American Orthopaedic Society for Sports Medicine

Union of Medial Opening-Wedge High Tibial Osteotomy Using a Corticocancellous Proximal Tibial Wedge Allograft

Gerald N. Yacobucci, MD* and Matthew R. Cocking, PA-C

From The Orthopedic Clinic Association, Phoenix, Arizona

* Address correspondence to Gerald N. Yacobucci, MD, The Orthopedic Clinic Association, 2222 East Highland Avenue, Suite 300, Phoenix, AZ 85016 (e-mail: gyacobucci{at}tocamd.com).

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.

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

Study Design: 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° to 17.5°, with a mean of 10.1°. 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.

Conclusion: When union is assessed, a corticocancellous proximal tibial wedge allograft is a satisfactory graft choice in medial opening-wedge high tibial osteotomy.

Key Words: wedge allograft • high tibial osteotomy • bone union • reduced morbidity






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