Combined Management of Meniscus Root Tear and High Tibial Osteotomy: A Surgical Strategy Using 3-Dimensional Printing

Combining high tibial osteotomy with meniscal posterior root repair is technically challenging because of the limited metaphyseal bone stock, the proximity of the transtibial tunnel to the osteotomy site, and the risk of implant conflict or tibial fracture. To address these challenges, we describe a surgical technique that integrates computed tomography-based 3-dimensional (3D) preoperative planning with patient-specific 3D-printed surgical guides. 3D simulation of the osteotomy plane, fixation plate position, screw trajectories, and transtibial tunnel enables preoperative assessment of the spatial relation among these structures, allowing optimization of tunnel orientation, implant placement, and preservation of adequate bone stock before surgery. Patient-specific 3D-printed guides accurately reproduce the virtual plan intraoperatively, facilitating precise execution of both the osteotomy and transtibial tunnel creation.