Riveros Paula Andrea Sarmiento, Quiceno Alejandro Jaramillo, Arias Pérez Rubén Darío
Knee surgeon, Clinica del Campestre, Medellín, Colombia.
Knee surgeon, Salud Sura, Medellín, Colombia.
3D Print Med. 2025 May 6;11(1):20. doi: 10.1186/s41205-025-00267-w.
Meniscal allograft transplantation (MAT) restores knee function by replacing a damaged or absent meniscus with a healthy allograft, helping to preserve joint stability, distribute the load, and reduce cartilage degeneration. However, traditional 2D imaging techniques fail to fully capture the knee's complex three-dimensional anatomy, making accurate surgical planning challenging. Computed Tomography (CT)-based 3D printing offers a patient-specific solution by generating anatomically precise tibial models, allowing for enhanced preoperative planning. This is particularly valuable in complex cases involving tibial osteotomy and anterior cruciate ligament (ACL) reconstruction, where precise tunnel positioning is critical to avoid tunnel convergence and ensure optimal graft integration.
We present a case study and methodology demonstrating the generation and application of 3D-printed tibial models to assist in MAT, ACL reconstruction, and tibial osteotomy. High-resolution CT scans (slice thickness < 1 mm) were processed using D2P software to create a full-scale 3D model, which was printed using Hyper PLA filament. The 3D-printed model was provided to the tissue bank to optimize meniscal allograft selection and was integrated into preoperative planning to precisely determine tibial tunnel locations and angles, preventing overlap between MAT, ACL tunnels, and the osteotomy site. Intraoperatively, the model served as an accurate physical guide, facilitating osteophyte removal, guided tunnel drilling, and precise meniscal graft placement. Its use improved graft sizing accuracy minimized tunnel convergence, and allowed real-time intraoperative adjustments, which can improve surgical precision and decision-making.
The integration of patient-specific 3D-printed models into surgical planning and execution may improve accuracy and efficiency in complex MAT procedures that also involve tibial osteotomy and ACL reconstruction. These models offer detailed anatomical reference points that facilitate more precise graft selection, tunnel placement, and intraoperative decision-making. However, further studies are needed to validate their dimensional accuracy, evaluate clinical outcomes in larger cohorts, and determine their feasibility for routine use in orthopedic practice.
半月板同种异体移植（MAT）通过用健康的同种异体移植物替代受损或缺失的半月板来恢复膝关节功能，有助于保持关节稳定性、分散负荷并减少软骨退变。然而，传统的二维成像技术无法完全捕捉膝关节复杂的三维解剖结构，使得准确的手术规划具有挑战性。基于计算机断层扫描（CT）的三维打印通过生成解剖学精确的胫骨模型提供了一种针对患者的解决方案，有助于加强术前规划。这在涉及胫骨截骨术和前交叉韧带（ACL）重建的复杂病例中尤为重要，其中精确的隧道定位对于避免隧道汇聚和确保移植物的最佳整合至关重要。
我们展示了一个病例研究及方法，阐述了三维打印胫骨模型在辅助MAT、ACL重建和胫骨截骨术中的生成与应用。使用D2P软件处理高分辨率CT扫描（层厚<1毫米）以创建全尺寸三维模型，该模型使用Hyper PLA细丝打印。将三维打印模型提供给组织库以优化半月板同种异体移植物的选择，并整合到术前规划中以精确确定胫骨隧道的位置和角度，防止MAT、ACL隧道与截骨部位之间发生重叠。术中，该模型作为精确的实体导向，便于去除骨赘、引导隧道钻孔以及精确放置半月板移植物。其使用提高了移植物尺寸的准确性，使隧道汇聚最小化，并允许术中进行实时调整，这可以提高手术精度和决策能力。
将针对患者的三维打印模型整合到手术规划和执行中，可能会提高复杂MAT手术（同时涉及胫骨截骨术和ACL重建）的准确性和效率。这些模型提供了详细的解剖参考点，有助于更精确地选择移植物、放置隧道以及术中决策。然而，需要进一步研究来验证其尺寸准确性，评估更大队列中的临床结果，并确定其在骨科实践中常规使用的可行性。
