Patient-specific cutting guides allow 1° precision in asymmetric anterior closing-wedge osteotomy

Purpose: Asymmetric anterior closing-wedge high tibial osteotomy (ACWHTO) allows correction of both excessive posterior tibial slope (PTS) and varus deformity. However, the complexity of this surgery requires a high degree of accuracy, which is less likely to be achieved with standard instrumentations. This study aimed to determine the accuracy of 3D patient-specific cutting guides (PSCGs) to provide the accurate planned correction in the frontal and sagittal planes.

Methods: Eight sawbones tibiae were identically printed from the same patient data. An ACWHTO with a PSCG was performed on each sawbone. Postoperative measurements of PTS, mechanical medial proximal tibial angle (mMPTA), hinge area and hinge-posterior cruciate ligament (hinge-PCL) distance were compared with the preoperative planned measurements. The precision was defined as the absolute difference (∆) between the target planned values and postoperative values.

Results: The mean accuracy was 0.6° ± 0.74° for PTS, 0.8° ± 0.71° for mMPTA, 0.3 ± 0.2 cm² for hinge area and 0.1 ± 0.06 mm for hinge-PCL distance.

Conclusion: In the setting of sawbones, the use of PSCGs was a reliable and accurate method of achieving simultaneous correction in the frontal and sagittal planes during asymmetric ACWHTO.

Level of evidence: Level V, basic science biomechanical laboratory study.