Stacy H Jeong1, Linsen T Samuel1, Alexander J Acuña1, Atul F Kamath2. 1. Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. 2. Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. kamatha@ccf.org.
Abstract
PURPOSE: We report our experience with a 3D patient-specific instrument (PSI) in an opening-wedge tibial osteotomy for the correction of varus malalignment in a patient with prior anterior cruciate ligament reconstruction. Previous studies have not reported the use of 3D PSI in patients with prior knee surgeries. METHODS: A pre-operative CT was used to create a 3D model of the lower extremity using Bodycad Imager. The pre-operative medial proximal tibial angle (MPTA), lateral distal femoral ankle, hip-knee-ankle (HKA), and tibial slope were calculated. The Bodycad Osteotomy software package was used to create a simulated osteotomy and correction. The resulting 3D patient-specific surgical guide and plate were used to conduct the high tibial osteotomy. Radiographic measurements and range of motion were evaluated at 6-week follow-up. RESULTS: The arthroscopy and open portions of the procedure were performed in 65 min, with only three fluoroscopy shots taken intraoperatively. At 6-week follow-up, the patient had 125° of flexion and minimal pain. The angular correction of the bone was achieved within 1.9° (planned MPTA 91.9° vs. actual 90°); the HKA angle was achieved with an error of 0.7° (planned 2.4° vs. actual 1.7°); and there was no change in the posterior tibial slope (planned 13.5° vs 13.8° actual). CONCLUSION: Three-dimensional PSI can be successfully used for the accurate and efficient correction of varus malalignment while accommodating pre-existing hardware, with good short-term clinical outcomes.
PURPOSE: We report our experience with a 3D patient-specific instrument (PSI) in an opening-wedge tibial osteotomy for the correction of varus malalignment in a patient with prior anterior cruciate ligament reconstruction. Previous studies have not reported the use of 3D PSI in patients with prior knee surgeries. METHODS: A pre-operative CT was used to create a 3D model of the lower extremity using Bodycad Imager. The pre-operative medial proximal tibial angle (MPTA), lateral distal femoral ankle, hip-knee-ankle (HKA), and tibial slope were calculated. The Bodycad Osteotomy software package was used to create a simulated osteotomy and correction. The resulting 3D patient-specific surgical guide and plate were used to conduct the high tibial osteotomy. Radiographic measurements and range of motion were evaluated at 6-week follow-up. RESULTS: The arthroscopy and open portions of the procedure were performed in 65 min, with only three fluoroscopy shots taken intraoperatively. At 6-week follow-up, the patient had 125° of flexion and minimal pain. The angular correction of the bone was achieved within 1.9° (planned MPTA 91.9° vs. actual 90°); the HKA angle was achieved with an error of 0.7° (planned 2.4° vs. actual 1.7°); and there was no change in the posterior tibial slope (planned 13.5° vs 13.8° actual). CONCLUSION: Three-dimensional PSI can be successfully used for the accurate and efficient correction of varus malalignment while accommodating pre-existing hardware, with good short-term clinical outcomes.
Authors: Stefano Zaffagnini; Giacomo Dal Fabbro; Claudio Belvedere; Alberto Leardini; Silvio Caravelli; Gian Andrea Lucidi; Piero Agostinone; Massimiliano Mosca; Maria Pia Neri; Alberto Grassi Journal: J Clin Med Date: 2022-09-27 Impact factor: 4.964