The use of allografts in high tibial osteotomy: Opening wedge technique

As active, aging athletes increasingly present with symptomatic focal articular cartilage pathology, alternative operative treatments to total knee arthroplasty are gaining popularity. Significant interest and attention had been turned toward the application of valgus-producing proximal tibial osteotomies to offload the symptomatic medial compartment and shift the mechanical axis of the lower extremity to the less-affected compartment of the knee. High tibial osteotomy (HTO) has been shown to be an effective treatment option for active patients with symptomatic varus malalignment and medial tibiofemoral arthrosis or those undergoing concomitant articular cartilage resurfacing or meniscal transplant. HTO can be accomplished with either a closing or an opening wedge osteotomy; however, the opening wedge osteotomy offers some technical advantages and has more recently drawn clinical attention. The technique of medial opening wedge high tibial osteotomy with use of a cortico-cancellous wedge allograft is described and discussed. Clinical assessment, radiographic templating, operative techniques, and technical pearls to facilitate the procedure and postoperative management are reviewed and illustrated. The advantages and disadvantages of autograft, allograft, and bone graft substitutes are discussed.