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Purpose: Current surgical methods for multi-ligament knee reconstruction involve the creation of several reconstruction tunnels in the distal femur. However, the limited bone mass in the knee increases the risk of tunnel convergence. Increasing the accuracy of tunnel direction can minimize tunnel collision during anatomical reconstruction. 3D-printed patient-specific instrumentation (PSI) has gained prominence in orthopaedic surgery due to its precision. This study aims to compare the accuracy of PSI with that of the 'freehand' approach by an experienced surgeon for drilling the medial and lateral femoral tunnels while adhering to the recommended angulations for multi-ligament knee injuries., Methods: Ten cadaveric knees underwent computerized tomography (CT) scans to identify anatomical femoral attachments of the lateral collateral ligament (LCL), popliteal tendon (PT), medial collateral ligament (MCL) and posterior oblique ligament (POL). Using Materialise Mimics Medical v25.0 software, virtual planning of a bone tunnel for each ligament was performed, and a total of four tunnels per knee were obtained. Ten PSIs were designed for five knees: five for the medial side and five for the lateral side. The first five knees were operated on via PSI, and the other five knees were operated on by an experienced surgeon using freehand drilling based on preoperative plans. The angular deviation and entry point were assessed by overlaying post-operative CT images onto preoperative CT images., Results: In the freehand group, the median angular deviation was 22.3°, with an interquartile range (IQR) of 17.6-25.2°. The PSI group presented a significantly greater accuracy in angular deviation for femoral tunnels of 5.7°, with an IQR of 4-8.2° ( p  < 0.001). Compared with that in the preoperative planning group, the median entry point distance in the freehand group was 5.5 mm, with an IQR of 2.6-8.8 mm. The PSI group had a median entry point distance of 4.2 mm, with an IQR of 3.6-5.7 mm ( p  = n.s)., Conclusions: Compared with the freehand technique performed by an experienced surgeon, PSI demonstrated significantly greater accuracy in terms of the mean angular deviation., Level of Evidence: Level V., Competing Interests: Ferran Fillat‐Gomà holds stocks of Tailor Surgery SL. Ferran Fillat‐Gomà has another affiliation organization not related to this study but related to orthopaedic surgery, Department of Orthopedic and Trauma Surgery, Hospital Clinic Barcelona, University of Barcelona. The remaining authors declare no conflicts of interest., (© 2025 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Tibial valgus osteotomy has shown to be a successful and cost-effective procedure. The advent of image processing and three-dimensional (3D) printing is an interesting tool for achieving more accurate and reproducible results. The aim of our study was to compare the accuracy of the conventional technique and the use of customized guides in the correction of tibial deformities in tibial varus patients, the surgical and clinical benefits, and the impact of treatment in the outpatient setting., Methods: A prospective cohort of 30 patients who underwent tibial valgus osteotomy were selected and randomized into two groups (3D-printed guidewires and conventional techniques). All patients underwent a complete radiological study to plan the surgical procedure. During the surgical procedure, the surgical time and X-ray exposure were analysed. The following results were evaluated: surgical time and X-ray exposure, the correlation between the planned correction and the correction obtained at 3 post-operative months, pre- and post-operative knee injury and osteoarthritis outcome score (KOOS) value at 3 and 12 months, and differences between the two groups in terms of the correction obtained., Results: Radiation exposure in the '3D-guide' group was significantly different (8 [±4.51], p  < 0.05), whereas surgical time was not significantly different between the control and guide 3D groups (60.69 [±8.89] and 53.43 [±11.69], respectively). At the 3-month follow-up, the post-operative hip-knee-ankle and post-operative mechanical-proximal-tibial angle were not significantly different ( p  > 0.05). At 3- and 12-month post-surgery, the Knee Injury and Osteoarthritis Outcome Score (KOOS) did not significantly differ between the conventional technique and the 3D-guide technique ( p  > 0.05). The KOOS at 3 months were 87.86 (±5.64) for the control group and 88.46 (±3.53) for the 3D-guide group, while at 12 months they were 91.5 (±5.72) for the control group and 88.57 (±8.81) for the 3D-guide group., Conclusion: Customized 3D-printed guides do not permit better correction or functional results than the conventional technique; rather, they reduce surgical time and intraoperative radiation exposure., Level of Evidence: II., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)