Modular guided tibial plateau-leveling osteotomy improves osteotomy centering accuracy compared to a freehand...

To compare the accuracy of a tibial plateau-leveling osteotomy (TPLO) using a modular guide (OssAbility) compared to the traditional freehand method. We hypothesized that guide use would improve TPLO centering and accuracy in the sagittal and frontal planes compared to freehand. Additionally, we hypothesized that surgeon experience would improve freehand unguided osteotomy accuracy but would not influence guided osteotomy accuracy.

A randomized controlled experimental study was conducted with 8 voluntarily recruited surgical trainees from 1 institution. Each performed 18 total modular guided or freehand osteotomies in randomized order in a single session on bone models of 3 different tibial morphologies with 3 TPLO blade sizes. Bone models were photographed and osteotomies compared to a target optimal osteotomy. Correlation was determined with participants' clinical experience.

Centering of guided osteotomies was significantly closer to the ideal planned location (95% CI, -0.85 to -0.15; P = .005). The difference in osteotomy angulation in the frontal plane compared to the ideal angle of 90° was lower for guided osteotomies (95% CI, -2.0 to -0.03; P = .042). The number of TPLOs performed clinically and osteotomy accuracy in the transverse plane approached significance; however, ultimately no statistically significant association was found between experience and freehand or guided osteotomy accuracy (r = 0.23; P = .055).

The use of a modular guidance system improved centering of the osteotomy but did not improve accuracy in the sagittal or frontal planes.

Modular surgical guides may improve curvilinear osteotomy centering accuracy for surgeons of various levels of active training.