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Opening Wedge High Tibial Osteotomy

An Operative Technique and Rehabilitation Program to Decrease Complications and Promote Early Union and Function

From the Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio

^* Address correspondence to Sue D. Barber-Westin, c/o Cincinnati Sportsmedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242 (e-mail: sbwestin{at}csmref.org).

Background: High tibial osteotomy has been associated with significant complications, including delayed union or nonunion, loss of correction, arthrofibrosis, and patella infera.

Hypotheses: A technique for opening wedge osteotomy that incorporates an autogenous iliac crest bone graft will prevent delayed union or nonunion, allow early rehabilitation and weightbearing, and prevent knee arthrofibrosis and patella infera. Secondly, the authors’ methods for calculating the desired correction of valgus alignment prevent undesired alterations in tibial slope.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 55 consecutive patients who underwent high tibial osteotomy were observed at a mean of 20 months postoperatively. Preoperative and postoperative measurements of radiographs were conducted by independent examiners for bony union, tibial slope, and patellar height. The osteotomy opening size ranged from 5 to 17.5 mm; 35 knees (64%) had openings 10 mm, and 20 knees (36%) had openings >11 mm.

Results: The osteotomy united in all patients. Three patients had a delay in union, which resolved by 6 to 8 months postoperatively. A loss of fixation occurred in 1 patient, who admitted to full weightbearing immediately after surgery; the osteotomy required revision. The iliac crest graft site healed without complications, and there were no infections, loss of knee motion, nerve or arterial injuries, alterations in tibial slope, or cases of patellar infera postoperatively. Full weightbearing was achieved at a mean of 8 weeks (range, 4–11 weeks) postoperatively.

Conclusions: The operative technique including use of an autologous iliac crest bone graft in addition to a progressive rehabilitation program successfully prevented nonunion, change in tibial slope, and knee arthrofibrosis in this study.

Key Words: opening wedge osteotomy • tibial slope • bone graft • complications

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				G. N. Yacobucci and M. R. Cocking Union of Medial Opening-Wedge High Tibial Osteotomy Using a Corticocancellous Proximal Tibial Wedge Allograft Am. J. Sports Med., April 1, 2008; 36(4): 713 - 719. [Abstract] [Full Text] [PDF]