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A synthetic bone insert may protect the lateral cortex and fixation plate following a high tibial osteotomy by reducing the tensile strains



To determine the effectiveness of a synthetic bone insert on improving medial opening wedge high tibial osteotomy integrity in response to post-surgical cyclical loading.

Materials and methods

A medial opening wedge high tibial osteotomy, secured with a compression fixation plate, was performed on 12 cadaveric knee specimens that were randomised to either: (1) a synthetic insert condition (n = 6), in which a 9 mm bio-absorbable wedge was inserted into the gap space; or (2) a plate-only condition (n = 6). Uniaxial strain gauges, placed on the lateral cortex and fixation plate, measured the strain response as the specimens were subjected to a staircase cyclical loading protocol; a sinusoidal waveform between 100 and 800 N was applied and increased by increments of 200 N every 5000 cycles until failure. Peak strains at failure were compared between conditions using a one-tailed independent samples t test.


The strains from the fixation plate were significantly different between the insert and plate only conditions (p = 0.02), transitioning from a compressive strain with the wedge (mean [SD] = − 8.6 [− 3.6] µε) to a tensile strain without the wedge (mean [SD] = 12.9 [23] µε). The strains measured at the lateral cortex were also significantly affected by the inclusion of a synthetic bone insert (p = 0.016), increasing from − 55.6 (− 54.3) µε when the insert was utilised to 23.7 (55.7) µε when only the plate was used.


The addition of a synthetic insert limited the tensile strains at the plate and lateral cortex, suggesting that this may protect these regions from fracture during prolonged loading.

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The authors would like to thank SBM Inc. (Winchester, MA) for providing both funding and materials (synthetic inserts, fixation plates, and related tools) for this study.


This work was partially funded by SBM, Smith and Nephew Orthopaedics Grant number A17-ASDUS-GR-598, Western University Bone and Joint Institute Grant number R5467A01.

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Correspondence to Timothy A. Burkhart.

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SBM Orthopaedics provided in-kind support for this study and Dr. Getgood has received consulting fees from SBM Inc. However, SBM had no involvement in the design of the experiment or the interpretation of the results. None of the other authors have any other relevant disclosures. Dr. Burkhart receives salary support from Smith and Nephew.

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The study protocol was reviewed and approved in adherence with the tissue use and ethical guidelines of de-identified cadaveric tissue (approval 11757).

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MacDonald, R., Huebner, K., Farr, J. et al. A synthetic bone insert may protect the lateral cortex and fixation plate following a high tibial osteotomy by reducing the tensile strains. Knee Surg Sports Traumatol Arthrosc 28, 1814–1820 (2020).

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