Nihat Demirhan DEMİRKIRAN, Süleyman Kaan ÖNER, Ali İhsan KILIÇ, Umur BATAK
Archives of Current Medical Research - 2026;7(3):519-527
Background: Medial open-wedge high tibial osteotomy (HTO) is an established treatment for medial compartment osteoarthritis in patients with varus alignment. Accurate K-wire placement is essential for a safe and reproducible osteotomy, yet it often requires repeated fluoroscopic checks, increasing radiation exposure. To evaluate whether an anterior cruciate ligament (ACL) tibial drill guide improves the accuracy of K-wire placement and reduces radiation exposure and surgical time compared with the freehand technique. Methods: This retrospective study included 40 patients who underwent medial open-wedge HTO. Patients were divided into a Freehand Group (n=20) and a Guided Group (n=20), in which an ACL tibial drill guide was used for K-wire placement. Primary outcomes were the number of fluoroscopic images, radiation dose, surgical time, and K-wire repositioning rate. Results: The Guided Group required significantly fewer fluoroscopic images (11.7 +/- 2.8 vs. 27.2 +/- 5.2; p < 0.001) and had a substantially lower radiation dose (9.36 +/- 2.24 vs. 23.76 +/- 4.16 mGy; p < 0.001). Surgical time was shorter (60.9 +/- 8.7 vs. 78.2 +/- 12.4 minutes; p < 0.001), and K-wire repositioning was less frequent (8.8% vs. 38.8%; p=0.001). Conclusion: The ACL tibial drill guide may serve as a useful adjunct in medial open-wedge HTO, enabling more precise K-wire placement while reducing radiation exposure and operative time. Further prospective studies are needed to validate these findings.
