Elsevier

Arthroscopy Techniques

Volume 10, Issue 2, February 2021, Pages e431-e435
Arthroscopy Techniques

Technical Note
Minimally Invasive High Tibial Osteotomy Using a Patient-Specific Cutting Guide

https://doi.org/10.1016/j.eats.2020.10.029Get rights and content
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open access

Abstract

Medial opening wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. This article presents a technique of performing a minimally invasive OW-HTO using a patient-specific cutting guide (PSCG). Preoperative 3-dimensional planning with computed tomography imaging is essential. The correction parameters, the final plate position, as well as the 3-dimensional position of the hinge as well as wedge are verified preoperatively before the PSCG is produced. After exposure with an oblique incision over the posteromedial tibia, the hamstring tendons are released for later re-attachment and the medial collateral ligament is released slightly. The PSCG is then used to perform the OW-HTO with protection of the posterior neurovascular structures by a retractor placed posterior to the medial collateral ligament. The final fixation of the osteotomy is achieved with a low-profile locking plate and a femoral head allograft wedge.

Technique Video

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Video 1. This surgical technique video displays the following (with time markers). A 5-cm slightly oblique incision is made along the posteromedial surface of the tibia, starting 1 cm below the joint line and extending inferior to the distal aspect of the tibial tuberosity (00:08). The 2 parts of the patient-specific cutting guides (PSCG) are clipped together and applied onto the medial surface of the tibia (00:30). A posterior retractor is placed posterior to the medial collateral ligament (MCL), scratching the posterior surface of the tibia, anterior to the popliteus (00:52). Two 2.2-mm pins are inserted through the PSCG to ensure cut orientation and to protect the hinge (01:05). The MCL is protected by a second and more anterior retractor (01:40). A fluoroscopic comparison is made with the virtual plan to confirm the good positioning of the PSCG (01:50). A 4.0-mm drill bit is used through the 6 pin holes of the PSCG to achieve the guide fixation (01:54). The saw blade is inserted on the PSCG window for the initial saw cut (02:24). To finalize the cut, the proximal pins and the upper part of the PSCG are removed (02:34). Free-hand technique is used to perform the ascending biplane cut (02:54). The cutting K-wire and the PSCG are removed leaving the hinge K-wire within the osteotomy site (03:14). The posterior cortex is checked to be cut and the osteotomy is gradually opened using osteotomes (03:40). A laminar spreader is positioned posterior to the MCL to maintain the osteotomy opening (04:00). The locking plate is then applied to the proximal tibia using the previously drilled holes (04:13).

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The authors report the following potential conflicts of interest or sources of funding: A.J.W., K.K., S.P., and M.O. are paid consultants for Newclip Technics, outside the submitted work. S.P. is a consultant for Zimmer Biomet, outside the submitted work. M.O. is a consultant for Stryker and Arthrex, outside the submitted work. K.K. is a consultant for Stryker, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.