The biomechanical effects of allograft wedges used for large corrections during medial opening wedge high tibial osteotomy

The inclusion of an allograft wedge during medial opening wedge high tibial osteotomy has been shown to lead to satisfactory time-to-union in larger corrections (> 10 degrees). Such large corrections are associated with greater incidences of intraoperative hinge fracture and reduced construct stability. The purpose of this study was to investigate the biomechanical stability that an allograft wedge brings to an osteotomy. Ten medium-size fourth generation artificial sawbone tibiae underwent 12 mm biplanar medial opening wedge high tibial osteotomy with a standard Tomofix plate. Five tibiae had an allograft wedge inserted into the osteotomy gap prior to plate fixation (allograft group). The gap in the remaining tibiae was left unfilled (control group). Each group underwent static compression testing and cyclical fatigue testing until failure of the osteotomy. Peak force, valgus malrotation, number of cycles, displacement and stiffness around the tibial head were analysed. Intraoperative hinge fractures occurred in all specimens. Under static compression, the allograft group withstood higher peak forces (6.01 kN) compared with the control group (5.12 kN). Valgus malrotation was lower, and stiffness was higher, in the allograft group. During cyclical fatigue testing, results within the allograft group were more consistent than within the control group. This may indicate more predictable results in large osteotomies with an allograft. Tibial osteotomies with allograft wedges appear beneficial for larger corrections, and in cases of intraoperative hinge fracture, due to the added construct stability they provide, and the consistency of results compared with tibial osteotomies without a graft.