Use of an ACL Tibial Drill Guide to Reduce Radiation Exposure During High Tibial Osteotomy: A Comparative Analysis

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