Cancellous Autograft Transfer From Screw-Hole to the Proximal Tibial Osteotomy Opening Gap for Early Bone Consolidation Without Donor-Site Morbidity.

Abstract

Autologous bone grafting can enhance gap healing after medial open-wedge high tibial osteotomy and open-wedge distal tibial tuberosity osteotomy, but iliac-crest harvest adds donor-site morbidity and is therefore not routinely performed. We describe a bone autografting technique, termed cancellous autograft transfer from screw-hole, which leverages routinely drilled locking plate screw pilot holes as a local donor source to obtain cancellous autograft without a separate donor-site or additional incision. During plate fixation, cancellous bone is cored from the proximal screw pilot holes using a coring device (4.9 mm outer diameter, 4.5 mm inner lumen), and each harvested hole is then secured with a 5.5 mm locking screw. The cylindrical cores are transferred into the hinge-side portion of the opening gap. In the initial 8 cases, mean cumulative core length is approximately 80 mm (range, 60-130 mm), and computed tomography at 1 month shows early consolidation with bony bridging despite a lateral hinge fracture. The cancellous autograft transfer from screw-hole technique is a simple adjunct to plate fixation that provides local cancellous autograft while fully avoiding donor-site morbidity.