Correct planning of a distal femoral osteotomy (DFO) is critical to restoring coronal alignment in knees with femoral-based deformities. This study compares three planning methods— the reversed Carlos H. Miniaci method, the Mark J. Dugdale method and the Dror Paley method — examining which technique leads to the most accurate alignment correction. Keywords for SEO: distal femoral osteotomy (DFO) planning, Miniaci inverse method, alignment correction precision, coronal plane deformity planning, osteotomy pre-operative planning software.
Study design & methodology overview
- The study included 59 DFOs between January 2019 and October 2021; after applying inclusion and exclusion criteria, a subset of 24 patients (18 varus, 6 valgus) underwent detailed radiographic analysis.
- Pre-operative measurements: HKA (hip-knee-ankle), mLDFA (mechanical lateral distal femoral angle), MPTA (medial proximal tibial angle), JLCA (joint-line convergence angle), JLO (joint-line obliquity), width of proximal tibia, weight-bearing line (WBL).
- Planning methods compared using software (PeekMed v2.3.7.6®):
- Reversed Miniaci method
- Dugdale method
- Paley method
- The primary outcome: deviation of the achieved WBL from the planned target, normalised to expected correction to allow fair comparison across corrections of different size.
Key findings: the reversed Miniaci method delivered superior planning accuracy
- Inter- and intra-observer reliability were excellent (ICC > 0.8) for all methods.
- The reversed Miniaci method had a mean deviation from target of ~3%, significantly better than Dugdale (~9%) and Paley (~8.6%) (p < 0.001) when normalised for correction magnitude.
- These results indicate that planning methods matter significantly in the accuracy of DFO outcomes — not just the surgical execution but how the plan is formulated.
Clinical implications & take-home messages for orthopaedic surgeons
- For femoral-based coronal deformities requiring DFO, consider using the reversed Miniaci method for pre-operative planning to enhance alignment precision.
- Keywords: pre-operative digital planning software, WBL target accuracy, joint-line obliquity correction, femoral osteotomy planning methodology.
- Accurate planning helps reduce the risk of under- or over-correction, joint-line obliquity issues, and may contribute to improved long-term joint loading and outcomes in joint-preserving knee surgery.
- Surgeons should ensure that planning software, observer training, and method standardisation are in place — since even small deviations from the plan correlate with poorer alignment restoration.
Link to full paper: Planification de l’ostéotomie fémorale distale : la méthode de Miniaci inversée est plus précise que les méthodes de Dugdale et de Paley
Sources used in report overview:
- https://www.researchgate.net/publication/378203060_Planification_de_l%27osteotomie_femorale_distale_la_methode_de_Miniaci_inversee_est_plus_precise_que_les_methodes_de_Dugdale_et_de_Paley
- https://pubmed.ncbi.nlm.nih.gov/37783427/
- https://em-consulte.com/article/1648473/planification-de-l-osteotomie-femorale-distale-la-methode-de-Miniaci-inversee-est-plus-precise-que-les-methodes-de-…
