Distal Femoral Osteotomy Planning: Reversed Miniaci’s Method is More Accurate Than Dugdale and Paley Methods

Why precision in femoral osteotomy planning matters

In correcting femoral-based coronal malalignment (varus or valgus) via distal femoral osteotomy (DFO), the accuracy of pre-operative planning directly influences mechanical axis restoration, joint line obliquity (JLO), and long-term knee function. Keywords: distal femoral osteotomy (DFO) planning, Reversed Miniaci method, Dugdale method, Paley method, alignment correction accuracy, weight-bearing line (WBL) target.

Study design: comparing three planning methods in DFO

This retrospective study covered 59 DFOs performed from January 2019 to October 2021. After applying eligibility criteria, 24 patients were analysed with detailed radiographic metrics. Planning was carried out using PeekMed v2.3.7.6® software. Measured parameters included hip­–knee–ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), joint line obliquity (JLO), the width of the proximal tibia and the weight-bearing line (WBL). The three planning strategies compared were: Reversed Miniaci, Dugdale, and Paley. The primary outcome was the mean deviation between the target WBL (planned) and the achieved post-correction WBL, normalised for the size of correction.

Results: Reversed Miniaci delivers superior alignment precision

• Inter- and intra-observer reliability (ICC) exceeded 0.8 across all methods.
  
• After normalising for correction magnitude, the average deviation for the Reversed Miniaci method was ~3%, compared with ~9% for Dugdale and ~8.6% for Paley (p < 0.001 for both comparisons).
  
• These findings suggest that the choice of planning method materially affects how well the surgical objective (WBL target) is met.

Clinical take-aways: which planning method should you use?

• For DFOs where precision of mechanical axis and joint line are critical (e.g., younger, active patients, joint-preserving surgeries), the Reversed Miniaci method appears clearly preferable.
  
• Keywords: digital osteotomy planning software, WBL target achievement, joint line obliquity avoidance, surgical planning methodology in osteotomy.
  
• Others (Dugdale, Paley) still perform reliably, but may carry higher deviation risk—important when aiming for tight tolerances in alignment correction.

Summary conclusions

• The Reversed Miniaci method is validated as an effective and reliable tool for planning distal femoral osteotomies, outperforming the Dugdale and Paley methods in achieving target WBL alignment in this cohort.
  
• Surgeons should review their planning workflows and consider adopting the Reversed Miniaci method (or similar high-precision digital planning tools) especially when correct alignment is vital to clinical outcomes.
  

Link to full paper: Distal Femoral Osteotomy Planning: Reversed Miniaci’s Method is More Accurate Than Dugdale and Paley Methods

Sources used in report overview:

1. https://www.researchgate.net/publication/374347343_Distal_femoral_osteotomy_planning_reversed_Miniaci%27s_method_is_more_accurate_than_Dugdale_and_Paley_methods?_tp=eyJjb250ZXh0Ijp7InBhZ2UiOiJzY2llbnRpZmljQ29udHJpYnV0aW9ucyIsInByZXZpb3VzUGFnZSI6bnVsbH19
2. https://pubmed.ncbi.nlm.nih.gov/37783427/
3. https://www.sciencedirect.com/science/article/pii/S1877056823002074