Proximal Tibial Osteotomy: Stabilization of the Medial Opening With a Tricortical Iliac Bone Graft

Abstract

Objective: Radiographic assessment of lower limb alignment, in the frontal and sagittal planes, after high tibial osteotomy. To stabilize the osteotomy, a tricortical iliac graft was used, along with a positioning screw. Methods: Prospective study on 46 patients with ages ranging from 17 to 61 years. Among them, 42 patients presented genu varum secondary to knee osteoarthritis and four from other causes. Teleradiography was performed for surgical planning, using the Frank Noyes method, as modified by Fugizawa. A conventional surgical access of 3 cm was made to harvest a tricortical iliac graft. Osteotomy was performed under radioscopic control, by means of an anteromedial incision of 3 cm with release of the superficial portion of the medial collateral ligament. The graft was placed in the posterior portion of the osteotomy, to maintain an unaltered tibial slope. The screw crossed the osteotomy orthogonally to protect the lateral cortex. Pre and postoperative radiographic criteria were established to assess the results. Results: There was consolidation in 100% of the cases and maintenance of the mechanical axis, obtained intraoperatively, in 94% of the cases. The posterior slope of the tibial plateau in the sagittal plane ranged from 7° to 12°. Joint mobility was restored in all the patients. Eleven patients presented temporary pain at the site of graft harvesting, but none had paresthesia. The incidence of complications was 8% (infection, loss of correction and joint fracture). Conclusion: The technique was shown to be reproducible, simple, biological, accurate and low-cost, and it may be an alternative to the existing techniques.

Tibial cancellous bone auto-grafting for medial open-wedge high tibial osteotomy: bone void filling with tissue harvested from osteotomized medullary canal

“…The disadvantages of this techniqueis the gap after osteotomy, and need for bone void filling.Variable grafts were used in order to fill this gap (12,13). Autogenic bone grafts harvested from the iliac crest is considered the goldstandard graft material in high tibial osteotomy with satisfying results (3). The major advantages of iliac crest bone graft includeosteo-conduction, osteo-induction and osteogenesis (14).…”

“…Various bone void fillers have been described. Tricortical auto-graft from the iliac crest is the "gold standard" graft material and has been used for the gaps and successful results have been reported (3). OWHTO without grafting was practiced previously, but delayed union and also nonunion problems were reported (4).…”