{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T06:46:21Z","timestamp":1776235581491,"version":"3.50.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100031478","name":"NextGenerationEU","doi-asserted-by":"publisher","award":["PNRR-MAD-2022-12375978"],"award-info":[{"award-number":["PNRR-MAD-2022-12375978"]}],"id":[{"id":"10.13039\/100031478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction and aim<\/jats:title>\n                    <jats:p>Medial closing wedge distal femoral osteotomy (MCW-DFO) is a surgical technique used to treat symptomatic valgus knee deformity. This retrospective study aims to evaluate the reliability of Patient-Specific Instrumentation (PSI) in reproducing preoperative planning and to assess preliminary clinical and radiographic outcomes in patients treated with MCW-DFO using the PSI technique compared to conventional instrumentation. This research was conducted within the framework of the Italian National Recovery and Resilience Plan (PNRR), Mission 6\u2014Health, as part of the PNRR-MAD-2022-12375978\u2014PEARL Project, supporting the development of precision-based surgical strategies to prevent early osteoarthritis progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Between 2012 and 2023, 34 patients underwent MCW-DFO, of whom 16 were treated with NewClip Technics PSI and met the study's inclusion and exclusion criteria. Preoperative planning was performed using TraumaCad\u00ae software, identifying preoperative and planned mechanical femorotibial angle (mFTA) and mechanical lateral distal femoral angle (mLDFA) values. Postoperative measurements were obtained to determine the difference between planned and achieved alignment as an index of surgical reproducibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The difference between planned and postoperative values for mFTA and mLDFA angles differed significantly between the two groups. In the PSI group, mean postoperative values differed from planned values by 0.46\u00b0 for mFTA and 0.66\u00b0 for mLDFA. In contrast, in the conventional instrumentation group, the difference exceeded 2\u00b0 for both angles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The PSI technique proved to be significantly more reliable than traditional instrumentation in adhering to preoperative planning in MCW-DFO. The integration of patient-specific technologies represents a precision-surgery approach consistent with PNRR objectives, potentially improving alignment accuracy and contributing to joint preservation strategies in patients at risk of early osteoarthritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1738442","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:44:48Z","timestamp":1776231888000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Medial closing wedge distal femoral osteotomy with patient-specific instrumentation: surgical technique, accuracy, and preliminary outcomes"],"prefix":"10.3389","volume":"13","author":[{"given":"Leonardo","family":"Puddu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, ASUIT Rovereto","place":["Rovereto, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Lugani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, ASUIT Rovereto","place":["Rovereto, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Perusi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, ASUIT Rovereto","place":["Rovereto, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hansheng","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari","place":["Sassari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianfeng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari","place":["Sassari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Pisanu","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Azienda Ospedaliero-Universitaria di Sassari","place":["Sassari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Fantinato","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari","place":["Sassari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Pescia","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca","place":["Monza, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Fabio","family":"Manunta","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Azienda Ospedaliero-Universitaria di Sassari","place":["Sassari, Italy"]},{"name":"Department of Orthopedics and Traumatology, Mater Olbia Hospital","place":["Olbia, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Doria","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari","place":["Sassari, Italy"]},{"name":"Orthopedic and Traumatology Unit, Azienda Ospedaliero-Universitaria di Sassari","place":["Sassari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Cortese","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, ASUIT Rovereto","place":["Rovereto, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianfilippo","family":"Caggiari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari","place":["Sassari, Italy"]},{"name":"Orthopedic and Traumatology Unit, Azienda Ospedaliero-Universitaria di Sassari","place":["Sassari, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1002\/art.37726","article-title":"Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the multicenter osteoarthritis study and the osteoarthritis initiative","volume":"65","author":"Felson","year":"2013","journal-title":"Arthritis Rheum"},{"key":"B2","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/ggi.13879","article-title":"Knee osteoarthritis and its association with mental health and health-related quality of life: a nationwide cross-sectional study","volume":"20","author":"Park","year":"2020","journal-title":"Geriatr Gerontol Int"},{"key":"B3","first-page":"428","article-title":"Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review","volume":"51","author":"Santaguida","year":"2008","journal-title":"Can J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1177\/0363546510377445","article-title":"Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee","volume":"39","author":"Hui","year":"2011","journal-title":"Am J Sports Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1002\/ksa.70009","article-title":"Successful return to sport following distal femoral osteotomy and lateral unicompartmental knee arthroplasty for isolated lateral knee osteoarthritis: a systematic review and meta-analysis","volume":"34","author":"Ten Noever de Brauw","year":"2026","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s10195-021-00600-z","article-title":"Medial closure supracondylar femoral osteotomy: an effective solution for long-term treatment of arthritic valgus knee?","volume":"22","author":"Uboldi","year":"2021","journal-title":"J Orthop Traumatol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3686","DOI":"10.1002\/ksa.12795","article-title":"Preoperative CPAK phenotype does not affect clinical and radiological outcomes after medial closing-wedge distal femoral osteotomy in valgus knees at 8-year follow-up","volume":"33","author":"Maione","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.arth.2007.01.026","article-title":"Long-term follow-up of distal femoral varus osteotomy of the knee","volume":"22","author":"Backstein","year":"2007","journal-title":"J Arthroplasty"},{"key":"B9","first-page":"499","article-title":"Surgical options for the middle-aged patient with osteoarthritis of the knee joint","volume":"50","author":"Hanssen","year":"2001","journal-title":"Instr Course Lect"},{"key":"B10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.2106\/00004623-198870010-00017","article-title":"Distal femoral varus osteotomy for valgus deformity of the knee","volume":"70","author":"McDermott","year":"1988","journal-title":"J Bone Joint Surg Am"},{"key":"B11","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1002\/ksa.12404","article-title":"Ten-year minimal follow-up of lateral opening wedge distal femoral osteotomy for lateral femorotibial osteoarthritis: good survivorship and high patient satisfaction","volume":"33","author":"Cance","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.csm.2019.02.005","article-title":"Medial closing wedge distal femoral osteotomy","volume":"38","author":"Duethman","year":"2019","journal-title":"Clin Sports Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3","DOI":"10.5792\/ksrr.16.064","article-title":"Distal femoral varus osteotomy for valgus arthritis of the knees: systematic review of open versus closed wedge osteotomy","volume":"30","author":"Kim","year":"2018","journal-title":"Knee Surg Relat Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e2085","DOI":"10.1016\/j.eats.2017.08.012","article-title":"Medial closing-wedge distal femoral osteotomy with medial patellofemoral ligament imbrication for genu valgum with lateral patellar instability","volume":"6","author":"Sabbag","year":"2017","journal-title":"Arthrosc Tech"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1357","DOI":"10.1016\/j.eats.2016.08.009","article-title":"Medial closing-wedge distal femoral osteotomy for genu valgum with lateral compartment disease","volume":"5","author":"Wylie","year":"2016","journal-title":"Arthrosc Tech"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2194","DOI":"10.1002\/ksa.12273","article-title":"Surgical strategy and complication management of osteotomy around the painful degenerative varus knee: ESSKA formal consensus part II","volume":"32","author":"Ollivier","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B17","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.joca.2009.10.005","article-title":"A comparison of five approaches to measurement of anatomic knee alignment from radiographs","volume":"18","author":"McDaniel","year":"2010","journal-title":"Osteoarthritis Cartilage"},{"key":"B18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13018-017-0571-6","article-title":"Do small changes in rotation affect measurements of lower extremity limb alignment?","volume":"12","author":"Jamali","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1302\/2058-5241.6.210015","article-title":"Radiological assessment of lower limb alignment","volume":"6","author":"Marques Lu\u00eds","year":"2021","journal-title":"EFORT Open Rev"},{"key":"B20","doi-asserted-by":"publisher","first-page":"S208","DOI":"10.1002\/acr.20632","article-title":"Measures of knee function: international knee documentation committee (IKDC) subjective knee evaluation form, knee injury and osteoarthritis outcome score (KOOS), knee injury and osteoarthritis outcome score physical function short form (KOOS-PS), knee outcome survey activities of daily living scale (KOS-ADL), lysholm knee scoring scale, Oxford knee score (OKS), western Ontario and McMaster universities osteoarthritis Index (WOMAC), activity rating scale (ARS), and tegner activity score (TAS)","volume":"63","author":"Collins","year":"2011","journal-title":"Arthritis Care Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s12178-025-09987-2","article-title":"Indications, technique, and outcomes of patient specific instrumentation for osteotomy about the knee","volume":"18","author":"Khela","year":"2025","journal-title":"Curr Rev Musculoskelet Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2141","DOI":"10.1016\/j.arthro.2016.04.010","article-title":"Distal femoral osteotomy for the valgus knee: medial closing wedge versus lateral opening wedge: a systematic review","volume":"32","author":"Wylie","year":"2016","journal-title":"Arthroscopy"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e25.00121","DOI":"10.5435\/JAAOSGlobal-D-25-00121","article-title":"Distal femoral varus osteotomy in valgus knee with lateral compartment osteoarthritis: a systematic review","volume":"9","author":"Yazdi","year":"2025","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"B24","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.csm.2025.03.006","article-title":"Closing wedge medial distal femoral osteotomy-technique, pearls, and pitfalls","volume":"45","author":"Rounds","year":"2026","journal-title":"Clin Sports Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1186\/s12893-022-01629-5","article-title":"Influence of lower-limb mechanical axis on the curative effect of medial high tibial osteotomy for knee osteoarthritis","volume":"22","author":"Yuan","year":"2022","journal-title":"BMC Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"3992","DOI":"10.1007\/s00167-023-07449-1","article-title":"In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided","volume":"31","author":"Schr\u00f6ter","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B27","doi-asserted-by":"publisher","first-page":"3151","DOI":"10.1007\/s00167-022-07303-w","article-title":"Favorable rates of return to activity and work following lateral closing wedge distal femoral osteotomy for femoral-based symptomatic varus malalignment: an analysis at a mean 6-year follow-up","volume":"31","author":"Rupp","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B28","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3390\/jpm15070289","article-title":"Accuracy of lower extremity alignment correction using patient-specific cutting guides and anatomically contoured plates","volume":"15","author":"Matthias","year":"2025","journal-title":"J Pers Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1001\/jama.286.2.188","article-title":"The role of knee alignment in disease progression and functional decline in knee osteoarthritis","volume":"286","author":"Sharma","year":"2001","journal-title":"J Am Med Assoc"},{"key":"B30","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1097\/01.bor.0000240365.16842.4e","article-title":"The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis","volume":"18","author":"Andriacchi","year":"2006","journal-title":"Curr Opin Rheumatol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"104643","DOI":"10.1016\/j.otsr.2026.104643","article-title":"Intra-articular alignment after distal femoral osteotomy: a multicenter analysis of intra-articular changes","volume":"13","author":"Onorato","year":"2026","journal-title":"Orthop Traumatol Surg Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/j.rdc.2009.08.004","article-title":"The meniscus in knee osteoarthritis","volume":"35","author":"Englund","year":"2009","journal-title":"Rheum Dis Clin North Am"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1002\/art.22515","article-title":"Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee","volume":"56","author":"Brouwer","year":"2007","journal-title":"Arthritis Rheum"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1738442\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:44:49Z","timestamp":1776231889000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1738442\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":33,"alternative-id":["10.3389\/fsurg.2026.1738442"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1738442","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"article-number":"1738442"}}