Editorial Commentary: Autologous and Synthetic Bone Fillers for Medial Open-Wedge High Tibial Osteotomy Have No Effect on Clinical Outcomes But Autologous Graft Promotes Complete Bony Union.

In contrast to closed-wedge high tibial osteotomy, medial based open-wedge high tibial osteotomy produces gaps of various sizes. Synthetic bone void fillers are an attractive option to close these gaps, potentially increase bone union, decrease time to union, and improve clinical outcomes. Autologous bone grafts are the accepted standard and result in reliable and reproducible outcomes. However, harvesting of autologous bone requires an additional procedure and is associated with potential complications. The use of synthetic bone void fillers could theoretically avoid these issues and reduce operating times. The current evidence suggests that autologous bone grafting has higher union rates but is not associated with better clinical and functional outcomes. Unfortunately, the certainty of evidence to support the use of bone void fillers is low, and the question of whether bone grafting of the gap should be performed in medial based open-wedge high tibial osteotomies cannot be answered with confidence.