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Accuracy of Patient-Specific Instruments for Supramalleolar Osteotomies.

Cédric Bonte1,2, Jules Rasschaert3, Juliette L'Herroux4

  • 1BioCAT Lab, Ghent University Hospital, Ghent, Oost-Vlaanderen, Belgium.

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|April 30, 2026
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Summary

Patient-specific instruments (PSIs) accurately correct distal tibia deformities during supramalleolar osteotomy (SMO). Achieved corrections closely matched pre-operative plans, demonstrating PSI precision in deformity correction.

Keywords:
3D measurementpatient-specific instrumentsupramalleolar osteotomyweightbearing CT

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Area of Science:

  • Orthopaedic Surgery
  • Biomedical Engineering
  • Radiology

Background:

  • Supramalleolar osteotomy (SMO) is a technically demanding procedure for correcting distal tibia deformities.
  • Patient-specific instruments (PSIs) offer potential to improve SMO accuracy, but their efficacy requires investigation.
  • This study evaluates the accuracy of PSIs in correcting supramalleolar ankle deformities.

Purpose of the Study:

  • To assess the accuracy of patient-specific instruments (PSIs) in supramalleolar osteotomy (SMO).
  • To compare pre-operative deformity correction plans with post-operative outcomes using PSIs.
  • To evaluate the clinical and radiographic improvements following PSI-assisted SMO.

Main Methods:

  • A prospective pre-post comparative study involving 18 patients undergoing closing wedge SMO with PSIs.
  • Weight-bearing CT scans were used to generate 3D bone models and measure the lateral distal tibia angle (LDTA).
  • Clinical outcomes were assessed using AOFAS, EFAS, and VAS scores.

Main Results:

  • Significant improvement in tibial alignment (LDTA) for both varus and valgus deformities post-surgery (P < .05).
  • Significant improvements observed in AOFAS, EFAS, and VAS scores post-operatively (P < .05).
  • The mean achieved correction post-operatively differed by less than 1° from the pre-operative simulated correction.

Conclusions:

  • Supramalleolar osteotomy using PSIs accurately corrects distal tibia deformities.
  • PSIs enable precise execution of pre-operative surgical plans for SMO.
  • Further research is needed to compare PSI-assisted SMO with free-hand techniques for clinical and radiographic outcomes.