High Tibial Osteotomy following Biologic Replacement of the Knee

Abstract

Biologic unicondylar replacement with fresh osteoarticular allografts of the femoral condyle and tibial plateau plus a meniscus transplant provides an option for young or active patients with severe articular cartilage loss. The timing of osteotomy procedures to correct malalignment either before, concurrent, or after allograft implantation has become an area of research interest. Concurrent osteotomies and allograft transplantation have become increasingly popular due to the decreased patient morbidity from multiple surgeries that require a period of toe-touch weight bearing (TTWB) postoperatively. We discuss here our techniques for correcting malalignment, which concurrently repair major bipolar knee lesions while transplanting the meniscus. We prefer to perform a simultaneous biologic unicondylar replacement with an osteotomy, if needed. Weight bearing alignment radiographs should be obtained 6 weeks following surgery to confirm the intraoperative findings that were obtained using fluoroscopy and the alignment rod. If malalignment persists and the biologic grafts are overloaded, a staged osteotomy should be performed as soon as possible.

Patient-Reported Outcomes for Large Bipolar Osteochondral Allograft Transplantation in Combination with Realignment Osteotomies for the Knee

“…Cortical and/or cancellous allograft bone soaked in autogenous bone marrow aspirate concentrate was packed into the defect site. 31 Patient outcomes were retrospectively collected from an IRB-approved patient database with documented informed consent. Patients were categorized by osteotomy type (HTO or DFO) and surgery type (concurrent or staged OCA transplantation and osteotomy).…”