Patient-Specific Instrumentation for Medial Opening Wedge High Tibial Osteotomy With Concomitant Medial Meniscal Root Repair
Robert E. Bilodeau, Romed P. Vieider, Jacob Hartline, Karina Dias, Joseph Euringer, Jonathan D. HughesBackground:
Osteotomies to correct knee alignment are powerful tools to unload the joint in unilateral osteoarthritis (OA) or to augment meniscal and ligamentous procedures. Patient-specific implants (PSI) are accurate tools that enable greater precision in preoperative planning and technical ease of use.
Indications:
One indication for medial opening wedge high tibial osteotomy (HTO) is isolated, symptomatic medial compartment OA in a relatively young patient with varus malalignment. In this joint preservation procedure, addressing concomitant pathology—including meniscus root tears—optimizes compartment biomechanics and may lead to improved outcomes. PSI simplifies this technique by avoiding tunnel compromise and enabling greater intraoperative precision than manual techniques.
Technique Description:
PSI is preoperatively planned and manufactured via computed tomography imaging. After dissection, the PSI guide is then placed on the tibia and pinned into place. Once positioned appropriately, guide holes are drilled, and pegs are placed. A saw is then placed through the cut guide, and biplanar cuts are made in the anterior third of the tibia just behind the tubercle. Using anteromedial and anterolateral portals, diagnostic arthroscopy is performed, and the tear is lightly debrided. Meniscal quality was deemed suitable for repair. A luggage tag construct is used for adequate meniscal fixation, and the PSI guide is drilled for meniscal root fixation. A plate is provisionally held proximally with pegs, and a spreader is introduced to open the osteotomy to planned correction. Precontoured allograft bone graft is then placed into the osteotomy site, and an anchor is placed just medial to the plate and is used to fix the root repair.
Results:
PSI has been frequently reported to be more precise than manual techniques, with complication profiles similar to those of manual HTOs. While the PSI has built-in safeguards that protect against hinge fractures, these can still occur, and caution must be exercised to avoid this complication.
Discussion/Conclusion:
PSIs enhance HTO accuracy and allow for optimization of concomitant procedures, such as meniscal root repair, to avoid tunnel compromise from osteotomy fixation.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.