Radiological and clinical outcomes of open-wedge high tibial osteotomy with and without grafting

ObjectiveThe role of autologous bone grafting in medial open-wedge high tibial osteotomy remains controversial. This study compares the clinical and radiological outcomes of open-wedge high tibial osteotomy performed with and without autologous bone grafting.MethodsThis nonrandomized two-center prospective cohort study recruited 73 patients who underwent open-wedge high tibial osteotomy. The radiological union status was assessed using a modified van Hemert scoring system and modified Radiological Union Scale for Tibia score. Clinical measures included the International Knee Society Score, clinical union time, and postoperative complications with a minimum 1-year follow-up.ResultsRadiological union at 1 year was significantly higher in the graft group, with 80.0% achieving complete union across all five zones compared with 44.7% in the no-graft group (p = 0.002). However, no significant differences were observed in the postoperative International Knee Society Scores (168 ± 15.7 vs. 168 ± 14.6; p = 0.920), hip-knee-ankle angle correction (181° in both groups; p = 0.687), or clinical union time (10.2 ± 1.77 vs. 10.7 ± 1.35 weeks; p = 0.133).ConclusionAutologous iliac crest bone grafting significantly improved the radiological healing in open-wedge high tibial osteotomy without increasing the incidence of complications.